What is a physician assistant? What can a physician assistant do?
A physician assistant (PA) is a licensed health professional educated to practice medicine with the supervision of a physician. A physician assistant provides health care services that were traditionally performed only by a doctor.
In 49 states (excluding Mississippi), physicians may delegate to PAs those medical duties that are within the physician's scope of practice, within the PA's training and experience, and are allowed by law. Such duties include performing physical examinations, diagnosing and treating illnesses, ordering and interpreting lab tests, suturing lacerations, assisting in surgery, providing patient education and counseling, and making rounds in nursing homes and hospitals.
In 44 states plus the District of Columbia and Guam, physicians may delegate prescriptive privileges to the PAs they supervise. The scope of the PA's practice corresponds to the supervising physician's practice. For example, the PA working with a surgeon would be skilled in surgical techniques in the operating room, perform pre- and post-operative care, and be able to perform special tests and procedures.
In general, PAs can perform a substantial portion of the functions provided by primary care physicians. And PAs are widely accepted by patients.
How did the profession begin?
Dr. Charles Hudson at the Cleveland Clinic recommended the creation of a professional trained and supervised by physicians to assist in the examination, testing, and care of patients. Almost a decade passed, however, before Dr. Eugene Stead, then chairman of the Department of Medicine at 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 in 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.
What areas of medicine do you/can you work in?
Physician assistants can be found in all areas of medicine and surgery. The PA concept was designed to increase patient access to quality medical care and to provide health care to individuals in medically underserved areas, such as rural and inner-city communities. Today, over 50% of all physician assistants practice what is known as "primary care medicine" -- that is family medicine, internal medicine, pediatrics, and obstetrics and gynecology. About 19% are in surgery or the surgical subspecialties. Physician assistants receive a broad-based medical education as generalists and after graduation they may work with specialists.
You say PAs can perform a substantial portion the functions provided by primary care physicians. What can't a PA do?
What a physician assistant does and does not do depends on the PA's training, education, state law, and the relationship he or she has with the supervising physician. The cases handled by physicians are generally the more complicated medical cases or those cases that require care that is not a routine part of the PA's scope of work.
Where do PAs "draw the line" as far as what they can treat and what a physician can treat?
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. Referral to the physician, or close consulting between the patient-PA-physician, is done for unusual or hard to manage cases and to ensure continuity of care by both the PA and the physician. Physician assistants are taught to "know our limits" and refer to physicians appropriately. It is an important part of PA training.
Can PAs prescribe medication?
46 states plus the District of Columbia and Guam allow PAs to write and sign prescriptions upon delegation of this authority by a supervising physician. In these states, a pharmacist will fill a PA's script.
What does "PA-C" stand for? What does the "C" mean?
Physician assistant-certified. The "C" is an indication that the PA is nationally certified. In many states the title of physician assistant (PA) is one that is protected by law. Just as the title of physician, attorney, registered nurse, or certified public accountant would be. It means that the person who holds the title has met the defined course of study and maintains professional standards.
How many PAs are there?
There are more than 34,000 PAs in clinical practice in the United States and uniformed services.
Are there female PAs?
Yes. In 1998, just over 50 percent of all physician assistants were women.
How much education does a PA need? What training did you receive?
Most physician assistant programs require applicants to have previous health care experience and some college. The typical applicant in 1997 already had a bachelor's degree and approximately four years of health care experience. Commonly, nurses, EMTs, lab technicians, and paramedics apply to PA programs.
PA programs look for students who have a desire to study, work hard, and "to be of service." On average, the accredited physician assistant programs last 24 months -- or stated another way, run about 111 weeks compared to 155 weeks for medical school.
PA programs are all accredited by one independent organization -- the Commission on Accreditation of Allied Health Educational Programs (or its predecessor) sponsored in part by the American Medical Association, the American College of Physicians, the American Academy of Family Physicians, and the American College of Surgeons. All PA programs must meet the same accreditation standards.
In the first year, PA students take classes in anatomy and physiology, psychology, microbiology, internal medicine, pediatrics, emergency medicine, obstetrics and gynecology, geriatrics, surgery and the like. These classes were taught as both course work and lab sessions.
In the second year of study, PA students are on clinical rotations, like medical students. During this period they treat patients in each of the major disciplines of medicine and perform additional course work on campus.
A PA's education doesn't stop after graduation, though. PAs are required to take on-going continuing medical education classes and be re-tested on their clinical skills on a regular basis in order to maintain national certification.
What qualifies a PA graduate to practice?
Physician assistant education is competency-based. The focus is not on the type of degree earned but on the proven competency of a PA graduate to provide quality medical care.
In the 49 states with laws covering PA services, PAs are required to pass a national certifying examination developed by the National Board of Medical Examiners and administered by the National Commission on Certification of Physician Assistants (NCCPA). Only graduates of accredited PA programs are eligible to sit for the national certification exam. In addition to passing the exam, PAs are licensed or registered by the state in which they practice.
The NCCPA is an independent organization and is made up of representatives from medical and the physician assistant organizations. It is not a part of the PA professional organization, the American Academy of Physician Assistants (AAPA).
To maintain national certification, a physician assistant must log 100 hours of continuing medical education every two years and take the recertification exam every six years.
Where can I find out more about physician assistant programs? Are there PA educational programs this state?
The Association of Physician Assistant Programs (APAP) publishes a directory of all PA programs in the United States. You can learn more by calling their office at 703/548-5538 or by writing to them at 950 North Washington Street, Alexandria, Virginia, 22314. For more information about the PA profession, contact the American Academy of Physician Assistants (AAPA) at the same address or call them at 703/836-2272 to request their free publication on the profession. They also maintain a web site at www.aapa.org.
What's the difference between a physician assistant and a physician?
Physician assistants are trained in medicine; classroom courses are taught by physicians, the educators who teach physicians, and physician assistants.
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 school. PA instruction averages 111 weeks, and a typical medical school runs 155 weeks. Physicians also 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 doctor has complete responsibility for the care of the patient. PAs share that responsibility with the doctors.
Doctors are independent practitioners. PAs practice medicine with the supervision of a physician. By supervision, I do not mean over-the-shoulder examination of all the patients seen by the PA. The physician is generally not required to be on site when the physician assistant is treating a patient. What it does mean is an interdependent relationship has been established -- with the physician depending on the PA to treat the patient in the same manner as if the physician were providing the care, and the PA depending on the physician to provide consultation and supervision to ensure all patients receive appropriate care.
What's the difference between a physician assistant and a nurse?
Registered nurses study nursing and PAs study medicine. While some areas of education overlap, nurses focus on nursing assessment and patient care issues. A PA is taught to diagnose and treat illnesses using the medical model. A registered nurse, according to the U.S. Department of Labor, works to promote health, prevent disease, and help patients cope with illness.
What's the difference between a physician assistant and a nurse practitioner?
Nurse practitioners (NPs) are registered nurses with advanced training in nursing. They specialize during their training, such as a pediatric NP, geriatric NP, family health NP, or women's health NP. Physician assistants are educated in the broad spectrum of medical and surgical care, allowing them to practice in the variety of specialties rather than one specific area of study.
The education for a NP is degree based -- that is, nursing students are required to obtain a specific degree in an advanced nursing specialty as a requirement to practice as a NP. Physician assistant education is competency based -- that is, they must master certain clinical skills taught by an accredited PA program.
Another difference between NPs and PAs is their relationship to physicians. PAs work with physicians in a team model, with the physician providing appropriate supervision to ensure the patient is receiving quality medical care. This is because PAs and physicians both practice medicine.
NPs, in most states, work in a collaborative model with physicians, that is having a physician to whom the NP can refer patients requiring specific medical care. This is because NPs practice nursing under the state nursing regulations rather than providing medical care under the state medical practice act.
Is a PA between a nurse and doctor?
No. Physicians, nurses, and PAs are all part of the team approach to health care delivery. These professionals provide quality services to their patients, but they have different educational backgrounds and patient responsibilities.
Is a PA a doctor in training?
No. Being a PA is not a first step to becoming a physician. In fact, a study by the Congressional Office of Technology Assessment concluded that, within the limit of their expertise, physician assistants provide care that is equivalent in quality to the care provided by physicians.
Even though a PA has finished his/her formal education, they continue to learn more each day from patients and their supervising physician. In order to maintain national certification, they are also required to log 100 hours of continuing medical education every two years and take the national recertification exam every six years.
Why don't PAs become physicians?
PA training is demanding in its own right. PAs must meet the same standards of care for the patients they treat as their supervising physician. Both -- as a team -- are responsible for the health and well-being of the men, women, and children seen in their practice.
Please understand: PAs are not people who didn't get into or who flunked out of medical school. Most PAs enjoy what they are doing. They get great satisfaction from providing quality, affordable, and accessible patient care.
What do doctors think about physician assistants?
Most physicians who have worked with physician assistants want PAs on their staff. PAs can help make physician practices more productive, more cost effective, and more accessible to the patients.
There are some physicians who have expressed concern about PAs and their ability to practice safe and comprehensive care. However, studies conducted by the Federal Government have shown that PAs 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."
Where do PAs practice?
The vast majority of all practicing PAs are employed by physicians, group practices, HMOs, and outpatient clinics. Many hospitals employ PAs to help meet their clinical inpatient and outpatient needs. PAs are working in virtually every type of medical and surgical specialty.
What about reimbursement for services provided by PAs?
Employers receive reimbursement for physician services provided by PAs under Medicare and Tri-Care (formerly known as CHAMPUS). In addition, most private insurance companies and state Medicaid programs also reimburse employers for services provided by PAs.
What is the American Academy of Physician Assistants?
The American Academy of Physician Assistants (AAPA) is the only national professional organization to represent physician assistants from all medical and surgical specialties. Approximately 30,000 PAs and PA students belonged to the Academy. The AAPA is headquartered in Alexandria, VA.
What are the most pressing issues faced by the PA profession?
Just as patients are facing numerous changes in the deliver of health care in this country, PAs are experiencing rapid change, as well. For example, managed care is becoming more prominent. HMOs have embraced physician assistants as quality providers of health care. However, many PAs are still learning the "ins and outs" of this new health care delivery system.
More insurance companies and government plans are willing to pay for physician services provided by PAs. It means more patients will have greater access to care provided by this growing class of quality providers. But there are still a number of providers who are not willing to cover this choice of providers for patients.
The PA profession has grown steadily since its inception in 1965. The US Bureau of Labor Statistics projects the number of PA jobs will increase 47% from 1996 to the year 2006.
