A Physician Assistant (PA) is a healthcare professional licensed, registered, or certified by the state to practice medicine as part of a team with physicians.[1]
Contents |
A Physician Assistant is concerned with preventing, maintaining, and treating human illness and injury by providing a broad range of health care services that were traditionally performed by a physician.[2] Physician Assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, give medical orders and write prescriptions.[3]
Physician associates/assistants work in hospitals, clinics, and other types of health facilities, and exercise autonomy in medical decision making as determined by their supervising physician, surgeon or medical practitioner. The professional requirements typically include at least two years of post-graduate education. They are educated in the medical model designed to complement physician training, rather than in the nursing model as nurse practitioners are. Physician associates/assistants are not to be confused with medical assistants, who perform administrative and simple clinical tasks with limited postsecondary education under the direct supervision of physicians and other health professionals, or nursing assistants.
In the United States, the profession is represented by the American Academy of Physician Assistants. The equivalent type of provider may also go under different titles in different countries, such as clinical officer, clinical associate, assistant medical officer medical care practitioner or Feldsher.[4]
The PA profession was first proposed when Dr. Charles L. Hudson recommended to the AMA in 1961 the "creation of two new groups of assistants to doctors from nonmedical and nonnursing personnel."[5] 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.[6] 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.. 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.[7]
It was not until 1970 that the AMA passed a resolution to develop educational guidelines and certification procedures for PAs.[7] 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.[8]
As of October 2011, there were 156 accredited PA programs in the United States.[9] The majority are graduate programs leading to the award of master's degrees 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. Some PA programs are starting to offer a clinical doctorate degree (Doctor of Science Physician Assistant or DScPA), while a few still award an undergraduate bachelor's, but many of these are transitioning to graduate-level training. Professional licensure is regulated by the medical boards of the individual states. Many PAs go on to pursue doctorate degrees in healthcare related fields. Doctorate level PAs are also discouraged from being called "doctor" in clinical settings, to avoid misrepresentation and scope of practice of the profession.
Physician assistant education is based on the medical model[10] although unlike medical school which lasts four years plus a specialty-specific residency, PA training is usually 2 to 3 years in duration, completed during undergraduate education or post-graduate studies, for a total of 4–7 years of postsecondary education. 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. Many PA schools do not differentiate between the first year PA students and first year medical students, and their classes are taken together. 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. Despite this, there are "residency" programs in certain specialties for PAs who choose to continue formal education in such a format.[11]
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).
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.[12] 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). NCCPA eliminated the Pathway II as a means of recertifying in 2010."Physician Assistant National Recertifying Exam (PANRE)" - NCCPA</ref>[13]
PAs are medical professionals. They typically obtain medical histories, perform examinations and procedures, order treatments, diagnose illnesses, 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. PAs may practice in any medical or surgical specialty, and have the ability to move within and between different medical and surgical fields during their careers.
Physician assistants have their own medical licenses and do not work under a physician's license.[14] 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).[15] PAs in Florida, Kentucky, Puerto Rico and the U.S. Virgin Islands, are not allowed to prescribe, order, dispense, or administer any controlled substances.[16] 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.[16]
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). The physician supervision, in most cases, need not be direct or on-site, and many PAs practice alone in remote or under-served areas in satellite clinics.
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.
In the 2008 AAPA census, 56 percent of responding PAs worked in physicians' offices or clinics and 24 percent were employed by hospitals.[17] The remainder were employed in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs[18] Fifteen percent of responding PAs work in counties classified as non-metropolitan by Economic Research Service of the United States Department of Agriculture;[19] approximately 17% of the US population resides in these counties.[20]
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..."[21] 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.[22]
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%.[23] According to the American Academy of Physician Assistants (AAPA), in 2008 the mean total income for physician assistants working at least 32 hours per week was $89,987.[24] Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn $100,000–200,000 per year.[25]
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.[26]
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.[27] 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.
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. 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.
There is a movement within the field to change the profession's title to "physician associate." This is similar to the title of physician's associate that was used in the early 1970s. [28] It is argued that the word "assistant" no longer accurately portrays the Physician Assistant profession's responsibilities and causes confusion to patients.[29] Out of the 154 accredited PA training programs,[9] Yale School of Medicine,[30] Duke University Health System,[31] University of Oklahoma--Oklahoma City,[32] and Our Lady of the Lake College (which has a provisionally-accredited PA program)[33] offer "physician associate programs" for students who will go on to become licensed as physician assistants. The name change has been publicly supported by 100 of the nation's leading and founding physician assistants, as well as the Association of Family Practice Physician Assistants.[34] In July 2011, over six thousand of the nations PAs mailed a statement to the AAPA asking for a change to physician associate. The AAPA Board refused to endorse this issue and suggested it go to the 2012 House of Delegates.