Physician assistant
A physician assistant or physician associate (PA) is a healthcare professional licensed to practice medicine with supervision of a licensed physician.[1] A physician assistant is concerned with preventing, maintaining, and treating human illness and injury by providing a broad range of health care services that are traditionally performed by a physician. Physician assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and write prescriptions.[2]
Physician assistants exercise autonomy in medical decision making as determined by their supervising physician. They are educated in the medical model designed to complement physician training, rather than in the nursing model as nurse practitioners are. Physician assistants are not to be confused with medical assistants, who perform administrative and simple clinical tasks with limited college-level education in hospitals and clinics under the direct supervision of physicians, physician assistants, registered nurses, or nurse practitioners.
The profession is represented in the United States by the American Academy of Physician Assistants.
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History of the profession
The PA profession came into existence in the mid-1960s due to the shortage and uneven geographic distribution of primary care physicians in the United States. Dr. Eugene A. Stead of the Duke University Medical Center in North Carolina assembled the first class of Physician Associates in 1965, composed of former U.S. Navy hospital corpsmen and U.S. Army combat medics, who had received considerable medical training during their military service and gained valuable experience during the Vietnam War.[3] 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]
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.[4]
Education and certification
As of May 2008, there were 142 accredited PA programs in the United States [5]. 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.
Physician assistant education is based on the medical model [6] although unlike medical school which lasts four years plus a specialty-specific residency, PA training is usually 2 to 3 years in duration. 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, oncology, 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.[7]
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.[8] 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 either the Physician Assistant National Recertifying Exam (PANRE) or Pathway II exam.[9][10]
Scope of practice
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-assist in surgery. Physician assistants' scope of practice is spelled out in their PA-Physician practice agreement, and they can not practice in a manner other than prescribed by their supervising physician. 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.[11] 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 underserved areas in satellite clinics.
All states, as well as the District of Columbia, Guam, the United States Virgin Islands, and the Commonwealth of the Northern Mariana Islands, have laws or regulations authorizing physician assistants to practice medicine. PAs may also prescribe medications in all of these locations; those who prescribe controlled medications in their scope of practice must also have a DEA number.[12]
Employment
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.[13] The remainder were employed in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs.[14] Fifteen percent of responding PAs work in counties classified as non-metropolitan by Economic Research Service of the United States Department of Agriculture;[15] approximately 17% of the US population resides in these counties.[16]
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..."[17] 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.[18]
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%.[19] 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.[20] Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn $100,000–200,000 per year. [21]
International
Australia
Education programs are now offered in Australia at the University of Queensland. [22] [23]
Canada
The PA concept is being explored in Canada, where Canadian military PAs are gaining legislative changes allowing them to work in the civilian world after retirement.[24][25] Education programs are now offered at the University of Manitoba in Winnipeg, McMaster University in Hamilton, Ontario, and the University of Toronto. Programs are 24 months in length.
England
In England, U.S.-trained PAs are working in a pilot project in Sandwell and West Birmingham.[26] Education programs are now being offered by four universities: University of Birmingham, University of Wolverhampton, University of Hertfordshire (operating as Bedfordshire and Hertfordshire Postgraduate Medical School, in conjunction with the University of Bedfordshire), and St George's, University of London. The University of Warwick and University of Coventry have also explored offering these programs, but did not implement them due to a lack of need. However, the NHS trusts in the West Midlands are currently forecasting a large-scale need for PAs.
Also formally referred to as "Medical Care Practitioners", PAs are to be employed by the National Health Service. Though currently not a registered profession, PAs can currently practice under delegation rules and it is expected that the required legislation will be taken before Parliament with the UK's General Medical Council expected to become the registering body. Programs are 24 months in length and are a Post-Graduate Diploma with the option of "topping up" to a Master's degree either by full or part-time study.[27] Training is in the areas of General Medicine (including Emergency/Medical Assessment Units), Emergency Medicine (A&E) and General Practice.
The interests of PAs in the UK are currently being looked after by the UK Association of Physician Assistants.[28]
Netherlands
The Netherlands has educational programs at the Academie Gezondheidszorg in Utrecht, University of Arnhem/Nijmegen, the University of Groningen and the University of Leiden. Programs are 30 months in length.[29]
Scotland
Pilot projects in Scotland are underway, but no official educational programs have been implemented as of 2008.[30]
South Africa
One program is now offered in South Africa at the University of Witwatersrand.
United States
In the Federal Government, Uniformed Services, and U.S. Armed Forces
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.[31]
U.S. Army PAs typically serve as Medical Specialist Corps officers within Army combat or combat support battalions located in the continental US, Alaska, Hawaii and overseas.[32] 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.
See also
- Clinical officer, a similar class of healthcare providers in East Africa.
- National Physician Assistant Week
- Nurse practitioner
- Feldsher
References
- ^ About Physician Assistants. American Academy of Physician Assistants (AAPA). Accessed 26 June 2009.
- ^ The PA Profession. Yale School of Medicine, 26 March 2009. Accessed 26 June 2009.
- ^ Eugene A. Stead, Jr., MD Biography - PA History Center
- ^ Physician Assistant History Center
- ^ "Accredited Entry-level Programs" (6/30/2008) - Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)
- ^ "Issue Brief - Physician Assistant Education: Preparation for Excellence" - AAPA
- ^ The Association of Postgraduate PA Programs (APPAP)
- ^ "Physician Assistant National Certifying Exam (PANCE)" - National Commission on Certification of Physician Assistants (NCCPA)
- ^ "Physician Assistant National Recertifying Exam (PANRE)" - NCCPA
- ^ "Pathway II" - NCCPA
- ^ "Becoming a Physician Assistant" - AAPA
- ^ "Where Physician Assistants Are Authorized To Prescribe" - AAPA
- ^ 2008 AAPA Physician Assistant Census Report. page 2.
- ^ 2008 AAPA Physician Assistant Census Report. Table 3.4: Number and Percent Distribution of Clinically Practicing Respondents by Primary Work Setting
- ^ 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
- ^ "Measuring Rurality: Rural-Urban Continuum Codes" - USDA Economic Research Service
- ^ "Physician Assistants" - U.S. Department of Labor Bureau of Labor Statistics
- ^ "Malpractice Consult: Liability insurance for a physician assistant" - Modern Medicine
- ^ "50 Best Jobs in America" (May 1, 2006) - CNN/Money.com
- ^ "Facts At A Glance" (March 24, 2008) - AAPA
- ^ 2008 AAPA Physician Assistant Census Report - Specialty Reports
- ^ "Graduate Certificate in Physician Assistant Studies". University of Queensland. http://www.uq.edu.au/study/program.html?acad_prog=5472. Retrieved 14 August 2010.
- ^ "Master of Physician Assistant Studies". University of Queensland. http://www.uq.edu.au/study/program.html?acad_prog=5474. Retrieved 14 August 2010.
- ^ The Manitoba Pharmaceutical Association Newsletter
- ^ Canadian Association of Physician Assistants (CAPA)
- ^ "Evaluation of US-trained Physician Assistants Working in the NHS in England" - University of Birmingham
- ^ Physician Assistant Studies Medical Practice - University of Hertfordshire
- ^ UK Association of Physician Assistants
- ^ "The Global Applicability of Physician Assistants" - AAPA
- ^ "NHS Scotland Pilot: Physician Assistants Terms and Conditions of Service" - Scottish Executive Health Department
- ^ U.S. Department of State
- ^ U.S. Army PA Information
External links
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Wikimedia Commons has media related to: Physician assistants |
- Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)
- American Academy of Physician Assistants (AAPA)
- National Association of Physician Assistants
- National Commission on Certification of Physician Assistants (NCCPA)
- Journal of the American Academy of Physician Assistants (JAAPA)
- Physician Assistant History Center
- ADVANCE for NPs & PAs journal
- Physician Assistant Education Association
- UK Association of Physician Assistants (UKAPA)
