Physician assistant

From Wikipedia, the free encyclopedia

In the United States, Physician Assistants (PAs) are non-physician clinicians licensed to practice medicine with a physician's supervision. Physician Assistants generally have a masters degree in medicine from an accredited university. They have the option depending on the state in which they practice of being board certified or not. The physician supervision, in most cases, need not be direct or on site and many PAs practice in remote or underserved areas in satellite clinics. All states, as well as the District of Columbia (D.C.), Guam, the United States Virgin Islands, and the Commonwealth of the Northern Mariana Islands have laws and/or regulations authorizing physician assistants to practice medicine. PAs can prescribe medications in 49 of the 50 states (excluding Indiana as of 2007) as well as D.C. and Guam. In most states, they carry a DEA number that gives them authority to prescribe controlled medications like narcotics. PAs in surgical practices also serve as first assistants in surgery. PAs provide medical services that are reimbursed under Medicare and third party insurances. Their scope of practice and autonomy are only limited by their precepting physicians' scope of practice, comfort level and the PA's clinical experience, allowing PAs to work in any area of medicine, surgery or research. Where there is a physician, there can be a PA.

Worldwide, the PA concept is being explored in Canada^[1], where military PAs are gaining legislative changes allowing them to work in the civilian world after retirement; in England, where several U.S.-trained PAs are working in a pilot project [1]; Scotland, where a similar pilot project is in planning [2]; and in South Africa and the Netherlands, where a physician assistant training program is underway [3].

1 Employment
2 Education and certification
3 PA scope of practice
4 History of PAs
5 External links

[edit] Employment

Physician assistants held about 65,000 jobs in 2005. The number of jobs is greater than the number of practicing PAs because some hold two or more jobs. For example, some PAs work with a supervising physician, but also work in another practice, clinic, or hospital. According to the American Academy of Physician Assistants, there were about 63,609 certified PAs in clinical practice as of January 2007. Even though a few legacy programs confer an associates degree or just a certificate of completion, most programs now confer a masters degree, requiring a bachelors degree on entry; many more are seeking accreditation at the master's level.

According to the 2005 PA census from the American Academy of Physician Assistants, just over 56 percent of PAs worked in the offices and clinics of physicians, either allopathic or osteopathic. About 40 percent were employed by hospitals. The rest were mostly in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs. According to the American Academy of Physician Assistants, about 17 percent of all PAs provide health care to rural communities and those with fewer than 20,000 residents, in which physicians may be in limited supply.

The U.S. Department of Labor Bureau of Labor Statistics (BLS) [4] reports that employment of physician assistants is expected to grow "much faster than average for all occupations through the year 2014, ranking among the fastest growing occupations," 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 residency workhours. According to the BLS, the physician assistant profession is the fourth fastest growing occupation in America, based on anticipated growth between 2004 and 2014 [5]. Money Magazine, in conjunction with Salary.com, lists physician assistant as the "fifth best job in America" based on salary and job prospects, with an anticipated 10-year job growth of 49.65% for the profession [6]. CNNMoney.com reports that the physician assistant profession is the fastest growing profession in the United States [7]. According to the American Academy of Physician Assistants, in 2006 the mean total income for physician assistants working at least 32 hours per week is $84,396 [8]. Physician assistants in surgical subspecialties can earn above $100,000, with the mean total income for PAs working at least 32 hours per week in cardiovascular/cardiothoracic surgery listed as $104,681 for the year 2006 [9].

[edit] Education and certification

In 2006, there are more than -- 130 accredited PA programs in existence in the United States. They are all accredited by one body -- the Accreditation Review Commission on Education for the Physician Assistant(ARC-PA). A majority of them are master's degree programs (MS, MPAS, MHS, MMS, MCMSc) (requiring GRE or MCAT for entry), but some are available as an undergraduate major as a bachelor's or associate's degree [10]. A number of these undergraduate programs are making a transition to graduate level training.

A Physician Assistant may use the post-nominal initials PA, RPA, PA-C or RPA-C, where the R indicates Registered and the C indicates "Certified." The "R" designation is unique to only a couple of states; most Physician Assistants use the PA-C. The use of the "PA-C" is limited only to those physician assistants certified and currently in compliance with the regulations of one certifying body, the National Commission on Certification of Physician Assistants (NCCPA).'Every two years, a PA must earn and log 100 CME hours and reregister her/his certificate with the NCCPA (second and fourth years), and by the end of the sixth year, recertify by successfully completing the Physician Assistant National Recertifying Examination (PANRE).' [11]

[edit] PA scope of practice

Physician assistants are lisenced to practice medicine under the supervision of a physician.[12] They obtain medical histories and perform examinations, order treatments, diagnose illnesses, prescribe medication, interpret diagnostic tests, refer patients to specialists when appropriate and first assist in surgery. The education of a physician assistant is a generalist approach, but is based on the medical school model [13]. PAs may practice in general medicine or any medical or surgical specialty. PA's can change specialties and have the ability to work throughout their career in different medical/surgical specialties. According to the AAPA, PAs must always work under the supervision of a physician.[14] That supervision can be in person, telecommunication systems or other means deemed reliable.[15]

[edit] History of PAs

The Physician Assistant profession has its beginnings in the highly trained Hospital corpsmen of the Vietnam War era. Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of PAs in 1965, to expand the availability of medical care in the face of a shortage of primary care physicians. For his first class, he selected former Navy corpsmen, who had received considerable medical training during their military service and during the war in Vietnam but who had no comparable civilian employment or equivalent. He based the curriculum of the PA program in part on his knowledge of the fast-track training of medical doctors during World War II. In 1968, Alderson-Broaddus College in Philippi, West Virginia established the first four-year (baccalaureate-granting) physician assistant program.^{[citation needed]} 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 Physician Assistant profession.