Physician assistant

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Physician Assistant
Rod of Asclepius2.svg
Occupation
Names
  • Physician Assistant
Activity sectors Medicine
Description
Education required
  • Master of Science in Medicine (MMSc)
  • Master of Physician Assistant Studies (MPAS)
  • Master of Health Science (MHS)
  • Master of Medical Science (MMSc)
  • Master of Clinical Medical Science (MCMSc)

A physician assistant (PA), is a healthcare professional who is trained to practice medicine as part of a team with physicians. Specifically, under the direction and supervision of attending physicians. [1]

Physician assistants are concerned with preventing and treating human illness and injury by providing a broad range of health care services under the direction of a physician or surgeon.[2] Physician assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, prescribe medications, counsel on preventive health care and may assist in surgery.[3]

Contents

Environment [edit]

Physician assistants work in hospitals, clinics, and all other types of health facilities, and exercise autonomy in medical decision making. Physician Assistants practice medicine as a team and exercise a scope of practice and knowledge content similar to their supervising physician. A period of extensive clinical training precedes obtaining a license to practice as a physician assistant, and similar to physician training, includes all systems of the human body. Renewal of licensure is necessary every few years, varying by state as well as re-certification every six years, however this is changing to a 10 year cycle[citation needed]. Physician assistants may also complete residency training, similar to physicians' residencies, in fields such as OB/GYN, emergency medicine, critical care, orthopedics, neurology, surgery, and other medical disciplines.

Regulation [edit]

In the United States, the profession is represented by the American Academy of Physician Assistants, and all Physician Assistants must graduate from a nationally accredited ARC - PA program as well as passing the national certification exam. [4]. In Canada, it is represented by the Canadian Association of Physician Assistants. Similar providers have different titles in other countries such as clinical officers in Africa, Clinical associates in South Africa, assistant medical officers in Malaysia, Physician Associate (formally known as Physician Assistant) in the UK[citation needed], Assistant Doctors in China, and Feldsher in countries of the former Soviet Union.[5]

History [edit]

The PA profession was first proposed when Charles Hudson recommended to the AMA in 1961 the "creation of two new groups of assistants to doctors from nonmedical and nonnursing personnel."[6] Dr. Eugene A. Stead, Jr. of the Duke University Medical Center in North Carolina assembled the first class of physician assistants in 1965, composed of former U.S. Navy hospital corpsmen.[7] He based the curriculum of the PA program in part on his first-hand knowledge of the fast-track training of medical doctors during World War II.[citation needed] Two other physicians, Dr. Richard Smith at the University of Washington, and Dr. Hu Myers at Alderson-Broaddus College, also launched their own programs in the mid and late 1960s.[8]

It was not until 1970 that the AMA passed a resolution to develop educational guidelines and certification procedures for PAs.[8] The Duke University Medical Center Archives has established the Physician Assistant History Center, dedicated to the study, preservation, and presentation of the history of the PA profession.[9]

In the United States, "National Physician Assistant Week" is celebrated annually from October 6 through October 12. This week was chosen to commemorate the anniversary of the first graduating physician assistant class at Duke University on October 6, 1967.[10]

Education and certification [edit]

As of October 2011, there were 156 accredited PA programs in the United States.[11] All educational programs are graduate programs leading to the award of master's degrees or higher in either Physician Assistant Studies (MPAS), Health Science (MHS), or Medical Science (MMSc), and require a bachelor's degree and GRE or MCAT scores for entry. Professional licensure is regulated by the medical boards of the individual states. Physician Assistant students train at medical schools and academic medical centers across the United States.

Physician assistant education is based on medical education[12] although unlike medical school which lasts four years plus a specialty-specific residency, PA training is usually 2 to 3 years of full-time study, completed during their post-graduate studies, for a total of 6–8 years of rigorious science based postsecondary education.[13] Medical school for physician assistants does not permit the student to work and is a serious committment to the study of medicine. However, most PA students start their medical education with a background of health care experience. The didactic training of PA education consists of classroom and laboratory instruction in medical and behavioral sciences, such as anatomy, microbiology, pharmacology, pathophysiology, hematology, pathology, clinical medicine, and physical diagnosis, followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine, as well as elective rotations.[citation needed] Many PA schools do not differentiate between PA students and medical students in the content of their education, and their classes are often taken together, although PA students will take additional coursework in the evenings and summers to complete their programs in an accelerated fashion.[citation needed] Unlike physicians, who must complete a minimum of three years of residency after completion of medical school, PAs are not required to complete such residencies after they complete medical school. Despite this, there are residency programs in certain specialties for PAs who choose to continue formal education in such a format.[14] There are also PA to DO bridge programs for PAs who wish to practice as physicians allowing them to match for traditional medical residencies.

PA clinical postgraduate programs are clinical training programs which differ from training on the job in their inclusion of didactic education and supervised clinical experience to meet learning objectives which are clearly defined.[15] The Montefiore Medical Center Postgraduate Surgical Physician Assistant Program was established in 1971 as the first clinical postgraduate PA program to be recognized.[15] Currently, there are known to be 49 programs in various specialties such as Neurology, Trauma/Critical Care and Oncology.[16] The Association of Postgraduate Physician Assistant Programs was formed in 1988 as an instrument in the establishment of educational standards for postgraduate PA programs[15] and currently includes 50 member programs.[16]

A physician assistant may use the post-nominal initials "PA", "PA-C", "APA-C", "RPA" or "RPA-C", where the "-C" indicates "Certified" and the "R" indicates "Registered". The "R" designation is unique to a few states, mainly in the Northeast; The "A" indicates completion of the Army Flight Surgeon Course. Most PAs use "PA-C" During training, PA students are designated PA-S. The use of "PA-C" is limited only to those PAs currently certified and in compliance with the regulations of the national certifying organization, the National Commission on Certification of Physician Assistants (NCCPA).

In the United States, a graduate from an accredited PA program must pass the NCCPA-administered Physician Assistant National Certifying Exam (PANCE) before becoming a PA-C; this certification is required for licensure in all states.[17] In addition, a PA must earn and log 100 Continuing Medical Education (CME) hours and reregister his or her certificate with the NCCPA every two years. Every six years, a PA must also recertify by successfully completing the Physician Assistant National Recertifying Exam (PANRE)[18][19]

Scope of practice [edit]

PAs are medical professionals. They typically obtain medical histories, perform examinations and procedures, order treatments, diagnose diseases, prescribe medication, order and interpret diagnostic tests, refer patients to specialists as required, and first or second-assist in surgery. Physician assistants' scope of practice is delineated in their PA-Physician practice agreement. PAs are employed in primary care or in specialties in urban or rural regions, as well as in academic administration.

Physician assistants have their own medical licenses and do not work under a physician's license.[20] Each of the 50 states has different laws regarding the prescription of medications by mid-level practitioners (which include PAs) by State and the licensing authority granted to each category within that particular State through the Drug Enforcement Administration (DEA).[21] PAs in Florida, Kentucky, Puerto Rico and the U.S. Virgin Islands are not allowed to prescribe any controlled substances.[22] Several other states place a limit on the type of controlled substance or the quantity that can be prescribed, dispensed, or administered by a PA.[22]

Depending upon the specific laws of any given state board of medicine, the PA must have a formal relationship on file with a collaborative physician supervisor. The physician collaborator must also be licensed in the state in which the PA is working, although he or she may physically be located elsewhere. Physician supervision can be in person, by telecommunication systems or by other reliable means (for example, availability for consultation).

Employment [edit]

The first employer of PAs was the then Veterans Administration, known today as the Department of Veterans Affairs. Today, the VA is the largest single employer of PAs, employing nearly 2000 PAs. One of the first three graduates of the Duke program in 1967 was Mr. Vic Germino who was employed after graduation by the Durham, NC VA Medical Center, where he remained for over 25 years. In July 2010, Mr. Germino was honored by the Veteran Affairs Physician Assistant Association (VAPAA) with an honorary membership and assigning him the special membership number 0001 in honor of Mr. Germino being the first PA employed by the VA.

According to the AAPA, there were an estimated 68,124 PAs in clinical practice as of January 2008.[citation needed]

In the 2008 AAPA census, 56 percent of responding PAs worked in physicians' offices or clinics and 24 percent were employed by hospitals.[23] The remainder were employed in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs[24] Fifteen percent of responding PAs work in counties classified as non-metropolitan by Economic Research Service of the United States Department of Agriculture;[25] approximately 17% of the US population resides in these counties.[26]

The U.S. Department of Labor Bureau of Labor Statistics report on PAs states, "...Employment of physician assistants is expected to grow 27 percent from 2006 to 2016, much faster than the average for all occupations..."[27] This is due to several factors, including an expanding health care industry, an aging baby-boomer population, concerns for cost containment, and newly-implemented restrictions to shorten physician resident work hours.

For PAs in primary care practice, malpractice insurance policies with $100,000–300,000 in coverage can cost less than $600 per year; premiums are higher for PAs in higher-risk specialties.[28]

Money magazine, in conjunction with Salary.com, listed the PA profession as the "fifth best job in America" in May 2006, based both on salary and job prospects, and on an anticipated 10-year job growth of 49.65%.[29] In 2010, CNN Money rated the Physician Assistant Career as the number two Best Job In America.[30] In 2012, Forbes rated the Physician Assistant Degree as the number one Master's Degree for jobs.[31] According to the 2012 National Salary Survey of PAs, the mean total income for physician assistants working full-time was $102,165.[32] Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn $100,000 to $200,000 per year.[33]

Federal Government, Uniformed Services, and U.S. Armed Forces [edit]

PAs are employed by the United States Department of State as Foreign Service Health Practitioners (FSHP). PAs working in this capacity may be deployed anywhere in the world where there is a State Department facility. They provide primary care to authorized members of the state department. In order to be considered for the position of FSHP these PAs must be licensed and have at least two years of recent experience in primary care.[34]

U.S. Army PAs typically serve as Medical Specialist Corps officers within Army combat or combat support battalions located in the continental United States, Alaska, Hawaii and overseas.[35] These include infantry, armor, cavalry, airborne, artillery and (if the PA qualifies) Special Forces units. They serve as the "front line" of Army medicine and along with combat medics are responsible for the total health care of soldiers assigned to their unit, as well as of their family members.[citation needed]

PAs also serve in the Air Force and Navy as clinical practitioners and aviation medicine specialists, as well as in the Coast Guard and Public Health Service. The skills required for these PAs are similar to that of their civilian colleagues, but additional training is provided in advanced casualty care, medical management of chemical injuries, aviation medicine and military medicine.[citation needed] In addition, military PAs are also required to meet the officer commissioning requirements and maintain the professional and physical readiness standards of their respective services.[citation needed]

The Marine Physician Assistant (MPA) is a U.S. Merchant Mariner Staff Officer. A Certificate of Registry is granted through The United States Coast Guard National Maritime Center (NMC) located in Martinsburg, West Virginia.[36] Formal training programs for Marine Physician Assistants began in September, 1966 at the Public Service Health Hospital located in Staten Island, N.Y.[37]

See also [edit]

References [edit]

  1. ^ "The PA Profession". The PA Profession. American Academy of Physician Assistants. Retrieved 12/10/11. 
  2. ^ "Physician Assistants". Occupational Outlook Handbook, 2010-11 Edition. United States Bureau of Labor Statistics. Retrieved 12/10/11. 
  3. ^ The PA Profession. Yale School of Medicine, 26 March 2009. Accessed 26 June 2009.
  4. ^ "PA Information". West Liberty University. Retrieved 5/23/13. 
  5. ^ International Standard Classification of Occupations, 2008 revision: Unit Group 2240-‘Paramedical pracititioners’. International Labour Organization, Geneva, 2011.
  6. ^ Carter, R., Physician Assistant History, Perspective on Physician Assistant Education, Vol. 12, No. 2, Spring 2001, http://www.pahx.org/pdf/Military%20Ranks.pdf Accessed 2011-06-03.
  7. ^ Eugene A. Stead, Jr., MD Biography - PA History Center
  8. ^ a b Carter, R., Physician Assistant History, Perspective on Physician Assistant Education, Vol. 12, No. 2, Spring 2001, http://www.pahx.org/pdf/Military%20Ranks.pdf , Accessed 2011-06-03.
  9. ^ Physician Assistant History Center
  10. ^ http://www.aapa.org/newsroom/pa-week.html
  11. ^ "PA Programs Directory," Accessed 3 June 2011
  12. ^ "Issue Brief - Physician Assistant Education: Preparation for Excellence" - AAPA
  13. ^ "Physician Assistant". guidetohealthcareschools. Retrieved 18 January 2013. 
  14. ^ The Association of Postgraduate PA Programs (APPAP)
  15. ^ a b c Polansky, Maura (2007). "A Historical Perspective on Postgraduate Physician Assistant Education and the Association of Postgraduate Physician Assistant Programs.". Journal of Physician Assistant Education 18 (3): 100–108. 
  16. ^ a b Polansky, Maura; Garver GJ, Wilson LN, Pugh M, Hilton G (2012). "Postgraduate clinical education of physician assistants.". J Physician Assist Educ 23 (1): 39–45. 
  17. ^ "Physician Assistant National Certifying Exam (PANCE)" - National Commission on Certification of Physician Assistants (NCCPA)
  18. ^ "Physician Assistant National Recertifying Exam (PANRE)" - NCCPA
  19. ^ "Pathway II" - NCCPA
  20. ^ "Becoming a Physician Assistant" - AAPA
  21. ^ http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html, U.S. Department of Justice Drug Enforcement Administration, Office of Diversion Control, Mid-Level Practitioners Authorization by State, Accessed 11 June 2011.
  22. ^ a b http://www.deadiversion.usdoj.gov/drugreg/practioners/mlp_by_state.pdf, U.S. Department of Justice Drug Enforcement Administration, Office of Diversion Control, Mid-Level Practitioners Authorization by State Table, Created 10 February 2011, Accessed 11 June 2011.
  23. ^ 2008 AAPA Physician Assistant Census Report. page 2.
  24. ^ which also was the first employer of PAs. Mr. Vic Germino one of the first three graduates was employed by the VA and he remained with the VA for over 25 years.2008 AAPA Physician Assistant Census Report. Table 3.4: Number and Percent Distribution of Clinically Practicing Respondents by Primary Work Setting
  25. ^ 2008 AAPA Physician Assistant Census Report. Table 3.13: Number and Percent Distribution of Clinically Practicing Respondents by Metropolitan Status and Degree of Rurality of County of Primary Work Site
  26. ^ "Measuring Rurality: Rural-Urban Continuum Codes" - USDA Economic Research Service
  27. ^ "Physician Assistants" - U.S. Department of Labor Bureau of Labor Statistics
  28. ^ "Malpractice Consult: Liability insurance for a physician assistant" - Modern Medicine
  29. ^ "50 Best Jobs in America" (May 1, 2006) - CNN/Money.com
  30. ^ http://money.cnn.com/magazines/moneymag/bestjobs/2010/snapshots/2.html
  31. ^ http://www.forbes.com/sites/jacquelynsmith/2012/06/08/the-best-and-worst-masters-degrees-for-jobs-2/
  32. ^ [1]
  33. ^ 2008 AAPA Physician Assistant Census Report - Specialty Reports
  34. ^ U.S. Department of State
  35. ^ U.S. Army PA Information
  36. ^ "Code of Federal Regulations". 
  37. ^ "Evaluation of the marine physician assistant program". 
  38. ^ [2]
  39. ^ [3]
  40. ^ World Health Organization. Classifying health workers. Geneva, WHO, 2010.

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