What is a PA?
Q. What is a Physician Assistant (PA)?
A. Physician assistants are health care professionals licensed to practice medicine with physician supervision. PAs employed by the federal government are credentialed to practice. As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and in virtually all states can write prescriptions. Within the physician-PA relationship, physician assistants exercise autonomy in medical decision making and provide a broad range of diagnostic and therapeutic services. A PA's practice may also include education, research, and administrative services.
PAs are trained in intensive education programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) .
Because of the close working relationship the PAs have with physicians, PAs are educated in the medical model designed to complement physician training. Upon graduation, physician assistants take a national certification examination developed by the National Commission on Certification of PAs in conjunction with the National Board of Medical Examiners. To maintain their national certification, PAs must log 100 hours of continuing medical education every two years and sit for a recertification every six years. Graduation from an accredited physician assistant program and passage of the national certifying exam are required for state licensure.
Q. How did the Physician Assistant profession begin?
A. In the mid-1960s, physicians and educators recognized there was a shortage and uneven distribution of primary care physicians. To expand the delivery of quality medical care, Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of PAs in 1965. He selected Navy corpsmen who received considerable medical training during their military service and during the war in Vietnam but who had no comparable civilian employment. He based the curriculum of the PA program in part on his knowledge of the fast-track training of doctors during World War II.
Q. What does "PA-C" stand for? What does the "C" mean?
A. Physician assistant-certified. It means that the person who holds the title has met the defined course of study and has undergone testing by the National Commission on Certification of Physician Assistants (NCCPA). The NCCPA is an independent organization, and the commissioners represent a number of different medical professions. It is not a part of the PA professional organization, the American Academy of Physician Assistants (AAPA). To maintain that "C" after "PA", a physician assistant must log 100 hours of continuing medical education every two years and take the recertification exam every six years.
Q. How is a Physician Assistant educated?
A. Physician assistants are educated in intensive medical programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The average PA program curriculum runs approximately 26 months. There are currently more than 130 accredited programs. All PA programs must meet the same ARC-PA standards.
Because of the close working relationship PAs have with physicians, PAs are educated in a medical model designed to complement physician training. PA students are taught, as are medical students, to diagnose and treat medical problems.
Education consists of classroom and laboratory instruction in the basic medical and behavioral sciences (such as anatomy, pharmacology, pathophysiology, clinical medicine, and physical diagnosis), followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine.
A PA's education doesn't stop after graduation, though. PAs are required to take ongoing continuing medical education classes and be retested on their clinical skills on a regular basis. A number of postgraduate PA programs have also been established to provide practicing PAs with advanced education in medical specialties.
Q. What are the prerequisites for applying to a PA program?
A. PA programs look for students who have a desire to study, work hard, and to be of service to their community. Most physician assistant programs require applicants to have previous health care experience and some college education. The typical applicant already has a bachelor's degree and approximately 4 years of health care experience. Commonly nurses, EMTs, and paramedics apply to PA programs. Check with PA educational programs of interest to you for a list of their prerequisites.
Scope of Practice
Q. What areas of medicine can Physician Assistants work in?
A. Physician assistants (PAs) are found in all areas of medicine. They practice in the areas of primary care medicine - that is family medicine, internal medicine, pediatrics, and obstetrics and gynecology -- as well in surgery and the surgical subspecialties.
Physician assistants receive a broad education in medicine. Their education is ongoing after graduation through continuing medical education requirements and continual interaction with physicians and other health care providers.
Q. Where do PAs "draw the line" as far as what they can treat and what a physician can treat?
A. What a physician assistant does varies with training, experience, and state law. In addition, the scope of the PA's practice corresponds to the supervising physician's practice. In general, a physician assistant will see many of the same types of patients as the physician. The cases handled by physicians are generally the more complicated medical cases or those cases which require care that is not a routine part of the PA's scope of work. Referral to the physician, or close consultation between the patient-PA-physician, is done for unusual or hard to manage cases. Physician assistants are taught to "know our limits" and refer to physicians appropriately. It is an important part of PA training.
Q. Can PAs prescribe medications?
A. Forty-eight states, the District of Columbia, and Guam have enacted laws that authorize PA prescribing. In California, PA prescriptions are referred to as written prescription transmittal orders.
Physicians and PAs
Q. What do physicians think about Physician Assistants?
A. Most physicians who have worked with physician assistants like having PAs on staff. The American Medical Association, the American College of Surgeons, the American Academy of Family Physicians, the American College of Physicians, and other national medical organizations support the physician assistant profession by actively supporting the PA certifying commission and the PA program accrediting agency.
Studies done by the Federal Government have shown that PAs, working with the supervision of physicians, provide care that is comparable to physician care. The Eighth Report to the President and Congress on the Status of Health Personnel in the United States (released in 1992) states, "Physician assistants have demonstrated their clinical effectiveness both in terms of quality of care and patient acceptance."
Q. What is the working relationship between a physician and a physician assistant?
A. The relationship between a PA and the supervising physician is one of mutual trust and respect. The physician assistant is a representative of the physician, treating the patient in the style and manner developed and directed by the supervising physician. The physician and PA practice as members of a medical team. In 1995, the American Medical Association developed suggested guidelines for how physicians and PAs should work as a team in the delivery of medical care.
Q. What's the difference between a PA and a physician?
A. Physician assistants are educated in the "medical model"; in some schools they attend many of the same classes as medical students.
One of the main differences between PA education and physician education is not the core content of the curriculum, but the amount of time spent in formal education. In addition to time in school, physicians are required to do an internship, and the majority also complete a residency in a specialty following that. PAs do not have to undertake an internship or residency.
A physician has complete responsibility for the care of the patient. PAs share that responsibility with the supervising physicians.
Suggested Guidelines for Physician-Physician Assistant Practice
Adopted by the AMA House of Delegates, June 1995
Reflecting the comments from the American Academy of Physician Assistants, separate model guidelines for Physician/Physician Assistants practice have been developed. These are based on the unique relationship of Physician Assistants who recognize themselves as agents of physicians with respect to delegated medical acts, and legal responsibilities. They are consistent with the existing AMA policies concerning Physician Assistants cited in this report. In all settings, Physician Assistants recognize physician supervision in the delivery of patient care. The suggested guidelines reflect those as follows:
1. Health care services delivered by physicians and Physician Assistants must be within the scope of each practitioners authorized practice as defined by state law.
2. The physician is ultimately responsible for coordinating and managing the care of patients and, with the appropriate input of the Physician Assistant, ensuring the quality of health care provided to patients.
3. The physician is responsible for the supervision of the Physician Assistant in all settings.
4. The role of the Physician Assistant(s) in the delivery of care should be defined through mutually agreed upon guidelines that are developed by the physician and the Physician Assistant and based on the physician's delegatory style.
5. The physician must be available for consultation with the Physician Assistant at all times either in person or through telecommunication systems or other means.
6. The extent of the involvement by the Physician Assistant in the assessment and implementation of treatment will depend on the complexity and acuity of the patient's condition and the training and experience and preparation of the Physician Assistant as adjudged by the physician.
7. Patients should be made clearly aware at all times whether they are being cared for by a physician or a Physician Assistant.
8. The physician and Physician Assistant together should review all delegated patient services on a regular basis, as well as the mutually agreed upon guidelines for practice.
9. The physician is responsible for clarifying and familiarizing the Physician Assistant with his supervising methods and style of delegating patient care.
* GRADUATES — AAPA estimates there are 83,466 individuals eligible to practice as PAs at the beginning of 2011.
* MEMBERS of TAPA— 2,536 - Members of the American Academy of Physician Assistants - 44,629 (as of October 27, 2010). The number varies throughout the year as a result of renewals, reinstatements, and as new members join.
* ACCREDITED PA PROGRAMS — There are 7 accredited PA programs in Texas. There are 137 accredited programs in the US. Programs are accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA, Web site, www.arc-pa.org). The ARC-PA is recognized by the Council for Higher Education Accreditation (CHEA).
The typical PA program is 24-27 months long and requires at least two years of college and some health care experience prior to admission. The majority of students have a BA/BS degree and 45 months of health care experience before admission to a PA program. While all programs recognize the completion of the professional component of PA education with a certificate of completion, more than half of the programs award a master’s degree. [91 award master’s degrees or a master’s degree option, 51 award bachelor’s degrees or a bachelor’s degree option, 6 award associate degrees, and 50 award certificates. Some programs offer more than one option.] The Physician Assistant Programs Directory is now available on line through www.apap.org at $35 for one year’s unlimited access.
* STUDENTS — About 10,000 students are enrolled in PA programs in the US. The number of new graduates in 2004 was approximately 4,592.
* PRESCRIBING — Forty-eight states, the District of Columbia, and Guam have enacted laws that authorize PA prescribing. (Indiana and Ohio do not yet authorize prescribing by PAs.)
* INCOME — Results of the 2010 AAPA Physician Assistant Census Survey indicate that the mean total income from primary employer for PAs who are not self-employed and who work at least 32 hours per week for their primary employer is $90,000. The comparable mean for PAs who have been in clinical practice for less than one year is $80,000.
* OUTLOOK ON PROFESSION — According to the findings published in AAPA’s Information Update: Projected Number of People in Clinical Practice as PAs as of January 1, 2005, 98 percent of 2004 PA program graduates were estimated to be in clinical practice as PAs in 2005. The United States Bureau of Labor Statistics (BLS) projects that the number of PA jobs will increase by 49 percent between 2002 and 2012. The BLS predicts the total number of jobs in the country will grow by 15 percent over this 10-year period.
* STATE LAWS — All states plus the District of Columbia and Guam have laws or regulations authorizing PA practice.
* CERTIFICATION AND CME — PAs receive their national certification from the National Commission on Certification of Physician Assistants (NCCPA). Only graduates of an accredited PA program are eligible to take the Physician Assistant National Certifying Examination (PANCE). Once a PA is certified, he/she must complete a continuous six-year cycle to keep her/his certificate current. 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 either the Physician Assistant National Recertifying Examination (PANRE) or Pathway II. All states require passage of the PANCE for state licensure. Forty-five states have provisions for new graduates to practice prior to passage of PANCE.
* SALARY PROFILES, CENSUS REPORTS, AND MAILING LIST SALES - contact the American Academy of Physician Assistants for the following information.
o Individual Salary Profiles: Student and Fellow Members only – $35/profile
o Employer Salary Profiles: Associate and Physician Members – $150/profile
o Census Reports for individual states, regions, or specialties are available to nonmembers for $100, $10 for members.
o Other statistical analyses are individually priced.
o Mailing List Sales: Please refer caller to one of the following:
+ MMS, Inc. at 800/633-5478
+ NDC Health Information Services at 602/808-7076
The above information is from the American Academy of Physician Assistants. www.aapa.org