The role of the Physician Assistant

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The role of the Physician Assistant

• Towson University
• Allied Health Program

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What is a Physician Assistant?

• Physician assistants are health care
  professionals licensed, or in the case of those
  employed by the federal government they are
  credentialed, to practice medicine with physician
  supervision.
• 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
  write prescriptions.

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The Physician Assistant

• 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.

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The history of the profession

• In the 1960s there were several social factors
  that led to the development of PAs. These
  included
• Loss of the general practitioner
• Shortage of Physicians
• The Influence of Eugene Stead (the founder of the
  PA profession) at Duke University
• International Experiences with different health
  care providers
• Better Division of Labor in Medicine

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Other social factors

• The Vietnam War.
• The culture of the1960s.
• Medicines Acceptance of New Realities Team
  practice, other types of health care
  professionals, needing to meet the needs of the
  population.

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First PA Program at Duke University

• Duke University felt that this new physician
  assistant concept could help alleviate the
  increasing shortage of primary care physicians in
  rural areas.
• The nursing profession, who had no interest in
  developing this idea, turned them down.
• They decided then that an even better candidate
  would be corpsmen or medics who were being used
  in the Viet Nam war.
• Duke proved that they were able to successfully
  train these individuals using the WW II fast
  track model and the PA profession was born.

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http//www.paworld.net/whatisapa.htm
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The scope of practice

• Comprehensive physical assessment evaluating,
  diagnosing, and treating new and existing
  patient's medical and surgical conditions.
• Initiating and interpreting labs and x-ray
  studies including CTs MRIs..
• Prescribing and referring patients for
  specialized consultation.
• Performs high quality sophisticated medical and
  surgical procedures.

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More scope of practice

• Using prescriptive authority to write
  prescription medicines for patients.
• Write/dictate progress notes on patients' charts
  indicating patient status and treatment
  procedures performed.
• Conducting follow-up patient care.
• Providing health education to patients and
  families.

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More scope of practice

• Supervising and/or coordinating the activities of
  patient care and support staff within the clinic.
  
• Training and supervising medical residents
  engaged in specific clinical activities.
• Teaching and training illness prevention.

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More scope of practice

• Actively participate in community health
  education.
• Performing emergency life saving procedures in
  cases such as cardiac arrest, respiratory arrest,
  massive hemorrhage, or similar emergencies.
• Are among front line medical providers in
  emergency disaster services.

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The current status of the profession

• 79,706 people are currently eligible to practice
  as PAs and 68,124 people are currently in
  clinical practice.
• Eighty-five percent of all individuals eligible
  to practice as PAs were in clinical practice at
  the beginning of 2008
• All 50 states, the District of Columbia and Guam
  and the Commonwealth of the Northern Mariana
  Islands have enacted laws that authorize PA
  prescribing.

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The current status of the profession

• The United States Bureau of Labor Statistics
  (BLS) projects that the number of PA jobs will
  increase by 27 percent between 2006 and 2016.
• The PA profession was ranked the fourth fastest
  growing profession in the country by CNN.com and
  Forbes.com in 2007..

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Where PAs work

• The most prevalent primary work setting for a
  PA is a hospital.
• The hospital departments cited most frequently as
  primary settings are hospital inpatient units.
• Other hospital departments include emergency
  rooms, hospital outpatient units and hospital
  operating rooms.

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Where PAs work

• Physician group practices are the primary work
  setting for close to a third of PAs.
• PAs report working in a single-specialty group
  practice and in multi-specialty group practices).
  

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Where PAs work

• Other settings reported as the primary work
  setting by large numbers of PAs include
• solo-practice physician offices
• Federally Qualified Health Centers
• Community health facilities

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How does one become a PA?

• Physician assistants spend an average of 25
  months studying an intensive core curriculum.
• This resembles a shortened form (about 80) of
  traditional medical education, and emphasizes a
  primary care, generalist approach.
• Most students have had four years of medical
  experience in a variety of fields before they
  start their training to become a PA.

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Training programs

• The United States has 130 training programs for
  PAs in universities, medical schools, teaching
  hospitals, colleges, and the armed forces.
• In 2001, about 4500 physician assistants
  graduated.
• Competition for training is intense---in 2001
  there were five applications for every place.

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PA Education

• Upon graduation from accredited training program
  PAs must pass the national certifying examination
  of the National Commission on Certification of
  Physician Assistants, an independent accrediting
  agency.
• After the exam they must complete 100 hours of
  continuing medical education every two years and
  pass a recertification examination every six
  years.

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How does one become a PA

• The typical PA program is 24-32 months long and
  requires at least four years of college and some
  health care experience prior to admission.
• The majority of students have a BA/BS degree and
  at least a year of prior health care experience
  before admission to a PA program.
• Science GPA is the strongest factor in
  determining qualified applicants for PA programs.
•    

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PA programs

• While all programs recognize the professional
  component of PA education with a document of
  completion for the professional credential (PA),
  80 percent of the programs also award a masters
  degree.
• 113 programs award masters degrees, 21 award
  bachelors degree, 3 award associate degrees, and
  5 award certificates.

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Incoming PA students

• All applicants should have a bachelors degree, a
  strong science GPA (3.5 or above) and at least a
  year of patient contact hours to be competitive.
• Programs differ in their approach to applicants
  and pre-requisites and most programs use a
  national screening application process called
  CASPA for applications http//www.aapa.org/pgmlis
  t.php3

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What do PAs need to practice

• Medical knowledge
• Interpersonal skills
• Ability to provide patient care
• Professionalism
• Practice based learning and improvement
• Systems based practice

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Medical Knowledge

• Medical knowledge includes an understanding of
  pathophysiology, patient presentation,
  differential diagnosis, patient management,
  surgical principles, health promotion and disease
  prevention.
• Physician assistants must demonstrate core
  knowledge about established and evolving
  biomedical and clinical sciences and the
  application of this knowledge to patient care in
  their area of practice.
• In addition, physician assistants are expected
  to demonstrate an investigatory and analytic
  thinking approach to clinical situations.

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INTERPERSONAL COMMUNICATION SKILLS

• Interpersonal and communication skills encompass
  verbal, nonverbal and written exchange of
  information.
• Physician assistants must demonstrate
  interpersonal and communication skills that
  result in effective information exchange with
  patients, their patients families, physicians,
  professional associates, and the health care
  system.

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PATIENT CARE

• Patient care includes age-appropriate assessment,
  evaluation and management.
• Physician assistants must demonstrate care that
  is effective, patient-centered, timely, efficient
  and equitable for the treatment of health
  problems and the promotion of wellness.

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PROFESSIONALISM

• Professionalism is the expression of positive
  values and ideals as care is delivered.
• Foremost, it involves prioritizing the interests
  of those being served above ones own.
• Physician assistants must know their professional
  and personal limitations.
• Professionalism also requires that PAs practice
  without impairment from substance abuse,
  cognitive deficiency or mental illness.
• Physician assistants must demonstrate a high
  level of responsibility, ethical practice,
  sensitivity to a diverse patient population and
  adherence to legal and regulatory requirements.

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PRACTICE-BASED LEARNING AND IMPROVEMENT

• Practice-based learning and improvement includes
  the processes through which clinicians engage in
  critical analysis of their own practice
  experience, medical literature and other
  information resources for the purpose of
  self-improvement.
• Physician assistants must be able to assess,
  evaluate and improve their patient care practices.

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SYSTEMS-BASED PRACTICE

• Systems-based practice encompasses the societal,
  organizational and economic environments in which
  health care is delivered.
• Physician assistants must demonstrate an
  awareness of and responsiveness to the larger
  system of health care to provide patient care
  that is of optimal value.
• PAs should work to improve the larger health
  care system of which their practices are a part.

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Helpful websites for potential PAs

• www.aapa.org
• http//www.paworld.net/whatisapa.htm
• http//www.caspaonline.org/
• http//www.aapa.org/pgmlist.php3