Physician assistant


Physician assistant
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A physician assistant/associate (PA) is a healthcare professional trained and licensed to practice medicine with limited supervision by a physician.[1]

Contents

General description

A physician associate/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 or medical practitioner.[citation needed] Physician associates/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.[2]

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.[citation needed] They are educated in the medical model designed to complement physician training, rather than in the nursing model as nurse practitioners are.[citation needed] 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.[citation needed]

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.[3]

PAs in the United States

History of the profession

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."[4] 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.[5] 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.[6]

It was not until 1970 that the AMA passed a resolution to develop educational guidelines and certification procedures for PAs.[6] 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.[7]

Education and certification

As of June 2011, there were 154 accredited PA programs in the United States.[8] 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.[citation needed] Professional licensure is regulated by the medical boards of the individual states. Many PAs go on to pursue doctorate degrees in healthcare related fields.[citation needed] For example, the ((Doctor of Philosophy)) (PhD) and the ((Doctor of Health Science)) (DHSc) degree are both popular choices for PAs interested in continuing their education beyond the Masters level.[citation needed] However, PAs are not required to possess the doctorate to hold license and practice. Doctorate level PAs are also discouraged from being called "doctor" in clinical settings, to avoid misrepresentation and scope of practice of the profession.[citation needed]

Physician assistant education is based on the medical model[9] 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.[citation needed] Many PA schools do not differentiate between the first year PA students and first year medical students, and their classes are taken together.[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. Despite this, there are "residency" programs in certain specialties for PAs who choose to continue formal education in such a format.[10]

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".[citation needed] 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.[11] 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>[12]

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 or second-assist in surgery. Physician assistants' scope of practice is spelled out 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.[citation needed]

Physician assistants have their own medical licenses and do not work under a physician's license.[13] 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).[14] PAs in Florida, Kentucky, Puerto Rico and the U.S. Virgin Islands, are not allowed to prescribe, order, dispense, or administer any controlled substances.[15] 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.[15]

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.[citation needed]

Employment

The first employer of PAs was the then Veterans Administration, known today as the Department of Veterans Affairs. Today 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.[16] The remainder were employed in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs[17] Fifteen percent of responding PAs work in counties classified as non-metropolitan by Economic Research Service of the United States Department of Agriculture;[18] approximately 17% of the US population resides in these counties.[19]

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..."[20] 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.[21]

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%.[22] 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.[23] Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn $100,000–200,000 per year.[24]

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.[25]

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.[26] 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]

Name change

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, but is not the original title of the profession which was physician assistant.[27] It is argued that the word "assistant" no longer accurately portrays the Physician Assistant profession's responsibilities and causes confusion to patients.[28] Out of the 154 accredited PA training programs,[8] Yale School of Medicine,[29] Duke University Health System,[30] University of Oklahoma--Oklahoma City,[31] and Our Lady of the Lake College (which has a provisionally-accredited PA program)[32] 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[citation needed] of the nation's leading and founding physician assistants, as well as the Association of Family Practice Physician Assistants.[33] 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.

International

Australia

Edith Cowan University in Perth, Western Australia, offers a two-year Master of Medical Science (Physician Assistant); James Cook University in Northern Queensland offer a gradaute-entry Bachelor of Health Science (Physician Assistant) and University of Queensland in Brisbane offer a 2-year Master of Physician Assistant Studies[34][35]

The Master of Physician Assistant Studies program at the University of Queensland is not currently taking further enrolments; however, James Cook University School of Medicine and Edith Cowan University will commence their first cohort in 2012.

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.[36][37] Education programs are now offered at Canadian Forces Base Borden at the Canadian Forces Health Services Training Centre[38], 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.[39] Education programs are now being offered by 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 perceived 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 either the UK's General Medical Council or the Health Professions Council expected to become the registering body. Programs are 24 months in length and award a Post-Graduate Diploma with some programmes offering the option of "topping up" to a Master's degree either by full or part-time study.[40] Training is in the areas of General Medicine (including Emergency/Medical Assessment Units), Emergency Medicine (A&E) and General Practice.

Germany

In Germany, the B.Sc Physician Assistant program is currently offered at the Steinbeis-Hochschule in Berlin, The Mathias Hochschule in Rheine (University of Applied Sciences) and at the Duale Hochschule Baden-Württemberg in Karlsruhe. The standard B.Sc takes 3 years to complete. Most PA students start their medical education with a background of health care experience. They are educated in the medical model designed to complement physician medical training, rather than in the nursing model. Physician assistants are not to be confused with medical assistants "arztassistents" or "arzthelfer", who perform administrative and simple clinical tasks with limited postsecondary education, under the direct supervision of doctors and other health professionals.

PAs are to be employed within various hospital settings according to their chosen specialities. Though not yet a registered profession PAs are already allowed to practice under delegation rules from a medical doctor ("Approbierter Arzt"). Currently legislation in the advanced thinking southern province of Germany, Baden-Württemberg, are allowing for a registered Physician Assistant (Staatlich annerkanter). The registering body is the "Deutsche Gesellschaft für Physician Assistants e.V." DGPA (German Association of Physician Assistants) under Chairmanship from Chairman Mr Klaus Waibel, who is currently responsible for the registration of National and International Physician Assistants. Currently the "Master of Science" (MSc), the "Doctor of Science Physician Assistant" (DScPA) or "PhD" degree is not available in Germany, in contrast to the USA. Also, Germany is quickly realizing the growing need for Physician Assistants to fill the large deficit of medical doctors in the city hospitals. Included is the growing deficit of the traditional "Family Physician" (Hausarzt), a position which in the future could be successfully filled by a PA. 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 and assist in surgery. Currently there is no official website for the "Deutsche Gesellschaft für Physician Assistants" DGPA. The official website for the DGPA is currently under construction. More information can be obtained direct from Chairman Mr Klaus Waibel.

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.[41]

Scotland

Pilot projects in Scotland are underway, but no official educational programs have been implemented as of 2008.[42]

South Africa

Programs for the training of clinical associates are offered in South Africa at the Walter Sisulu University and University of the Witwatersrand.

See also

References

  1. ^ About Physician Assistants. American Academy of Physician Assistants (AAPA), Accessed 26 June 2009.
  2. ^ The PA Profession. Yale School of Medicine, 26 March 2009. Accessed 26 June 2009.
  3. ^ International Standard Classification of Occupations, 2008 revision: Unit Group 2240-‘Paramedical pracititioners’. International Labour Organization, Geneva, 2011.
  4. ^ 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.
  5. ^ Eugene A. Stead, Jr., MD Biography - PA History Center
  6. ^ 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.
  7. ^ Physician Assistant History Center
  8. ^ a b "PA Programs Directory," Accessed 3 June 2011
  9. ^ "Issue Brief - Physician Assistant Education: Preparation for Excellence" - AAPA
  10. ^ The Association of Postgraduate PA Programs (APPAP)
  11. ^ "Physician Assistant National Certifying Exam (PANCE)" - National Commission on Certification of Physician Assistants (NCCPA)
  12. ^ "Pathway II" - NCCPA
  13. ^ "Becoming a Physician Assistant" - AAPA
  14. ^ 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.
  15. ^ 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.
  16. ^ 2008 AAPA Physician Assistant Census Report. page 2.
  17. ^ 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
  18. ^ 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
  19. ^ "Measuring Rurality: Rural-Urban Continuum Codes" - USDA Economic Research Service
  20. ^ "Physician Assistants" - U.S. Department of Labor Bureau of Labor Statistics
  21. ^ "Malpractice Consult: Liability insurance for a physician assistant" - Modern Medicine
  22. ^ "50 Best Jobs in America" (May 1, 2006) - CNN/Money.com
  23. ^ "Facts At A Glance" (March 24, 2008) - AAPA
  24. ^ 2008 AAPA Physician Assistant Census Report - Specialty Reports
  25. ^ U.S. Department of State
  26. ^ U.S. Army PA Information
  27. ^ http://ajph.aphapublications.org/cgi/reprint/63/12/1024.pdf
  28. ^ "Physician Associate: A Change Whose Time Has Come" (April 10, 2010)
  29. ^ "Yale School of Medicine Physician Associate Program". http://paprogram.yale.edu/dean.aspx. Retrieved 2011-06-03. 
  30. ^ "Duke University Health System Physician Assistant Program: After Graduation". http://paprogram.mc.duke.edu/Student-Life/After-Graduation/. Retrieved 2011-06-03. 
  31. ^ "University of Oklahoma Physician Associate Program: Post Graduation". http://www.oumedicine.com/body.cfm?id=1303. Retrieved 2011-06-03. 
  32. ^ "Our Lady of the Lake College Graduate Programs". http://www.ololcollege-edu.org/content/academic-programs-graduate-programs. Retrieved 2011-06-03. 
  33. ^ AFPPA Membership Supports PA Name Change from “Assistant” to “Associate”
  34. ^ "Graduate Certificate in Physician Assistant Studies". University of Queensland. http://www.uq.edu.au/study/program.html?acad_prog=5472. Retrieved 14 August 2010. 
  35. ^ "Master of Physician Assistant Studies". University of Queensland. http://www.uq.edu.au/study/program.html?acad_prog=5474. Retrieved 14 August 2010. 
  36. ^ The Manitoba Pharmaceutical Association Newsletter
  37. ^ Canadian Association of Physician Assistants (CAPA)
  38. ^ [1]
  39. ^ "Evaluation of US-trained Physician Assistants Working in the NHS in England" - University of Birmingham
  40. ^ Physician Assistant Studies Medical Practice - University of Hertfordshire
  41. ^ "The Global Applicability of Physician Assistants" - AAPA
  42. ^ "NHS Scotland Pilot: Physician Assistants Terms and Conditions of Service" - Scottish Executive Health Department

External links


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