Intro to the Physician Assistant Profession
The "____________________" doctrine simply states - Physician is considered liable for the negligent acts of other employees
Captain of the ship
_____________________________________ are eligible to sit for the national certifying "entry level" ________examination each year
~8000 - 10,000 new graduates of physician assistant programs are eligible to sit for the national certifying "entry level" PANCE examination each year
_______Year the _____ establish registration category for "midlevel practitioners" to prescribe controlled substances
1993: Year the DEA establish registration category for "midlevel practitioners" to prescribe controlled substances
____________from __________________________ is considered a challenge to the growth and sustainability of the physician assistant role in the U.S. particularly in the areas of ___________________________
Competition from nurse practitioners is considered a challenge to the growth and sustainability of the physician assistant role in the U.S. particularly in the areas of primary care
Organization solely responsible for creation, administration, scoring and reporting of physician assistant national certification examinations (PANCE and PANRE)
NCCPA
_________________ - Organization solely responsible for the creation, administration, scoring and reporting of the physician assistant national certification examinations (PANCE and PANRE)
NCCPA
______________________- Designed by Dr. Henry Sliver for PA training in pediatrics; First PA program (1975) to offer a Masters degree
University of Colorado (Denver) PA Program
The ______________________________of urban PAs tends to be less than rural PAs. The more rural the PA practice, the wider range of activities.
range of clinical activities
Most recently, most physician assistant graduates choose _______________________ over primary care
surgical specialties
Neurology is NOT included in the new NCCPA specialty certification testing for physician assistants. *CAQ* (Certificate of Added Qualification) testing is available in the following
• Cardiovascular and Thoracic Surgery • Emergency Medicine • Hospital Medicine • Nephrology • Orthopaedic Surgery • Pediatrics • Psychiatry
____________________________s are responsible for ensuring ________________________________
State medical boards are responsible for ensuring public & patient safety
Student section of the AAPA (SAAAPA) says about ___________________________ - It is much more important to cooperate and help each other succeed
competition & grades
Single _________________ of physician assistants in the United States is the U.S. federal government including the military, U.S. Public Health Service and other federal agencies
largest employer
In 2004, the Accreditation Commission on Graduate Medical Education (ACGME) for physicians set ______________________________________. This enhanced the number physician assistants hired by hospitals 2005-2015
limitations on physician resident work hours.
0-10% of graduate physician assistants have gone on to _________________ (either MD or DO)
medical school
Trained _______________teams (combat medics, Navy corpsmen, etc.) returning from war in SE Asia (Vietnam, Cambodia, Laos) contributed to the emergence of the physician assistant profession in the 1960's
military medical
A predominance of ________________________work in urban areas. Less likely to find occupational medicine in rural areas of the U.S.
occupational medicine physician assistants
PA Profession Timeline: Currently (2017) in a period of _____________________
"Global Expansion"
PA Profession Timeline: Period following 1990 = ___________________________
"Maturation and Establishment"
PA Profession Timeline: 1981 - 1990 = ___________________
"Recognition and incorporation"
76-90% of patients are willing to be seen by a PA if the primary doctor isn't available and would be willing to see the PA again if necessary
76-90% of patients are willing to be seen by a PA if the primary doctor isn't available and would be willing to see the PA again if necessary
A physician assistant who works with a physician, ______________________ being provided by that physician, is practicing in the mode of _______________________
A physician assistant who works with a physician, enhancing services being provided by that physician, is practicing in the mode of "complementary
Purpose of the ________________________________to establish the standards for U.S. PA education
Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)
Purpose of the _________________________________________- To establish the standards for U.S. PA education>
Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) -
___________________established the first accreditation mechanism for Physician Assistant programs in 1969. Now operated by a separate organization, the _____________
American Medical Association (AMA) established the first accreditation mechanism for Physician Assistant programs in 1969. Now operated by a separate organization, the ARC-PA (Accreditation Review Commission on Education for the Physician Assistant)
Assisted by the basic organization of these organizations, "_____________________" systems like _____________, are ideal settings for examining the cost benefits of Physician Assistants
Assisted by the basic organization of these organizations, "vertically integrated" systems like HMOs (Health Maintenance Organizations), are ideal settings for examining the cost benefits of Physician Assistants
___________________- formed in 1988 to further specialty education of PAs and assist in the development of postgraduate educational programs and curriculum
Association of Postgraduate Physician Assistant Programs (APPAP)
At the __________Census of practicing physician assistants, the largest represented group (40%) had a __________ degree. Transition to the masters degree had occurred over the past 9-10 years.
At the 2008 Census of practicing physician assistants, the largest represented group (40%) had a bachelors degree. Transition to the masters degree had occurred over the past 9-10 years.
Based on studies from director reports,______________________________________or "interns" average ______________________per week and are technically ______________________ under current MD/DO resident hour restrictions
Based on studies from director reports, post graduate physician assistant "residents" or "interns" average 76-100 hours of activity/work per week and are technically not restricted under current MD/DO resident hour restrictions
_____where?_____in early 2000, successfully piloted a project to move former Canadian military Physician Assistants into general and ED practice
Canada
___________________ In 1961 when president of National Board of Medical Examiners (NBME), called for training of "mid-level providers" in Journal of American Medical Association
Charles Hudson
________________________ physician assistants in the U.S. by end 2017 = Well __________________
Clinically active physician assistants in the U.S. by end 2017 = Well over 100,000
Core right tested in legal case ____________________________________in 1966 - Right of a physician or surgeon to use an "extra pair of hands" under conditions not constituting a medical emergency
Core right tested in legal case People v. [neurosurgery physician assistant] Whittaker in 1966 - Right of a physician or surgeon to use an "extra pair of hands" under conditions not constituting a medical emergency
____________________ = validating background and assessing qualifications of healthcare professionals. Hospital "credential" providers and then grant "privileges" to practice.
Credentialing
Current __________of the Florida Academy of Physician Assistants (____) - Susan Salahshor
Current president of the Florida Academy of Physician Assistants (FAPA) - Susan Salahshor
Current ___________________ of the Florida Academy of Physician Assistants(________) - mike nuccio
Current president-elect of the Florida Academy of Physician Assistants (FAPA) - Mike Nuccio
Currently the largest % of practicing physician assistants are of the U.S. federal government designated category "Black, non-Hispanic" minority group
Currently the largest % of practicing physician assistants are of the U.S. federal government designated category "Black, non-Hispanic" minority group
Average salary of certified Physician Assistants was $98,387 with the highest paid to those working in ________________________________________________ OB/Gyn is one of the lowest paid "specialties" and in line with salaries for primary care.
Dermatology, Emergency Medicine, Critical care, Surgery.
First HMO to employ a physician assistant in 1970 -
First HMO to employ a physician assistant in 1970 - Kaiser Permanente
___________ degrees are the next step in the educational development of Physician Assistants. NPs have already begun this route. The_________ now has an ________Medicine __________ program for physician assistants.
Doctorate degrees are the next step in the educational development of Physician Assistants. NPs have already begun this route. The Army now has an Emergency Medicine doctorate program for physician assistants.
_______________________________ of PA _____________________ programs have ____________________ so their benefit to the system is not completely understood.
Economic and social benefits of PA postgraduate programs have not been studied so their benefit to the system is not completely understood.
Factors influencing___________________of physicians toward physician assistants are most likely to be influenced by whether PAs are viewed as _____________________________________________
Factors influencing future attitudes of physicians toward physician assistants are most likely to be influenced by whether PAs are viewed as colleagues or competitors
____________________ of the early and mid 1600's, considered to be a precursor of Physician Assistants in the U.S., originally began in the German military
Feldshers
First ________________of Cohort #1 of the ________ Physician Assistant program class were ex-medical corpsmen from the ________. Three of them graduated the program in 1967.
First 4 students of Cohort #1 of the Duke Physician Assistant program class were ex-medical corpsmen from the Navy. Three of them graduated the program in 1967.
________________________ Prepaid group practices that provide capitated care for groups of patients; Capitated = pays clinician or group a set amount $ for each enrolled person assigned to them, per period of time, whether or not that person seeks care
HMO (Health Maintenance Organization)
Mostly rural _______________________________________have the greatest percentage of physician assistants working in "primary care"
Health Professional Shortage Areas (HPSAs)
________________Physician/PA ________________ [determined by level of delegation and comparative productivity of physicians and PAs for the delegated services] = _______________
Highest Physician/PA substitution ratio [determined by level of delegation and comparative productivity of physicians and PAs for the delegated services] = Military
Textbook - Physician Assistants: Policy and Practice 3rd Edition by
Hooker Cawley and Asprey Roderick S. Hooker PhD, James F. Cawley MPH PA-C, David P. Asprey PhD PA-C.
____________________________has grown in the past 10 years for physician assistants and currently employ ~31-45% of all practicing PAs
Hospital employment
In ____ the physician assistant student characteristic of ______________________ "peaked" and has been dropping off ever since, to the current day. Applicants have less healthcare experience than applicants of the 60's-80's.
In 1992, the physician assistant student characteristic of healthcare experience "peaked" and has been dropping off ever since, to the current day. Applicants have less healthcare experience than applicants of the 60's-80's.
In an _______ setting, typical physician assistant _____________ is comparable to a physician's productivity seeing _____________/patients per day
In an HMO setting, typical physician assistant productivity is comparable to a physician's productivity seeing 16-25 PPD/patients per day
I___________________________aka foreign medical graduates, FMG's) comprise 0- 30% percentage of all practicing physicians in the U.S. today
International medical graduates or IMGs
Physician Assistant profession expert, George Washington University, one of the three main authors of the text for this course.
James Cawley
______________________(salary, benefits, demand) is the main reason for PA grads from choosing specialties in the past 5 years
Market forces
________________ founded the Frontier Nursing Service and was the predecessor of the Nurse midwife profession. Physician Assistants, midwives, nurse practitioners all began about the same time in medical profession history.
Mary Breckinridge
Greater than 80% of programs award ____________________ degrees currently
Master's
A majority of programs offer the terminal degree for the profession,__________ degree
Masters
Now, the _________________ degree is considered to be the "terminal" degree for the Physician Assistant profession
Masters
Majority of PA programs in United States are based in _____________ without medical schools
Universities
_________________________________- To ______________________________ and support their professional development
Mission of the American Academy of Physician Assistants (AAPA) - To speak on behalf of PAs and support their professional development
The first physician assistant post-graduate program was at _________Hospital, New York in surgery. Post grads at Montifiore acted as interns/residents on surgical services
Montifiore
Characteristic of the physician assistant profession
More than 100,000 practitioners • Mean age ~40 years old • Mostly female • Predominate population of PA's in NE U.S. • Minorities ~14%
Most Physician Assistants practice in "Single/multi-specialty physician group practice" employer settings
Most Physician Assistants practice in "Single/multi-specialty physician group practice" employer settings
_____________ ensures that ___________________________________ and _________necessary for safe and effective clinical practice with the administration of the __________ and _________ exams
NCCPA ensures that PAs meet a standard level of knowledge and have skills necessary for safe and effective clinical practice with the administration of the PANCE and PANRE exams
National data repository of all state board actions or _______________ against licensed health care professionals is called the __________________________
National data repository of all state board actions or malpractice actions against licensed health care professionals is called the National practitioner data bank
___________________________- legal doctrine that occurs when an employer (physician or hospital/clinic in medicine) fails to reasonably monitor and control an employee's actions (a Physician Assistant or NP etc.
Negligent supervision
Referral "to" specialists by physician assistants ->
Not all specialist providers welcome referrals from physician assistants
_____________________________insurance that covers a _______________ event provided there was insurance coverage at the time of the alleged event, regardless if the coverage is in force at the time the claim is filed
Occurrence type - liability insurance that covers a malpractice event provided there was insurance coverage at the time of the alleged event, regardless if the coverage is in force at the time the claim is filed
One of the early predecessors of the Physician Assistant profession was military "loblolly boys" of the _____________________ assisted ships doctors with sick sailors.
One of the early predecessors of the Physician Assistant profession was military "loblolly boys" of the U.S. Navy. Loblolly boys assisted ships doctors with sick sailors.
One of the key "needs" verbalized supporting the development of the Physician Assistant profession was the need to reverse the mis-distribution of clinicians (mostly physicians at the time)
One of the key "needs" verbalized supporting the development of the Physician Assistant profession was the need to reverse the mis-distribution of clinicians (mostly physicians at the time)
_____________________________- A function in hospital setting, that instructs hospital to perform functions on behalf of patient (meds, services, labs, nursing services, etc.)
Order writing
Reasonable conclusion about the PA profession given the perspective of the textbook authors -_______________________________________
PAs will be drivers of improved care and standards of care in the future
______________________ - Administers Centralized Application Service for PA Applicants (_________), creates and administers _____________________ and supports PA programs and faculty.
PAEA (Physician Assistant Education Association) - Administers Centralized Application Service for PA Applicants (CASPA), creates and administers End of Rotations Examinations and supports PA programs and faculty.
_________________________specialty more likely to be team-based, alert to the idiosyncrasies of _____________________, and aware of variations from normal (as in growth and development) in terms of testing and responses
Pediatrics = primary care specialty more likely to be team-based, alert to the idiosyncrasies of dysmorphology, and aware of variations from normal (as in growth and development) in terms of testing and responses
Physician Assistant __________________ is mostly (according to case records) due to ___________________(alcohol, illegal drugs, prescription medications) ______________________
Physician Assistant Impairment is mostly (according to case records) due to chemical (alcohol, illegal drugs, prescription medications) dependence
Expansion of the _____________________________________ is a factor that signifies the growth of the physician assistant profession and its professional relationships according to our text authors
Physician Assistant based literature
Physician Assistant ________________are mostly non-existent in the U.S. Majority of PAs are not in unions
Physician Assistant unions are mostly non-existent in the U.S. Majority of PAs are not in unions
Physician Assistants in alternative, non-clinical roles - Employment opportunities have led many PAs into different, more complex roles in the past several years
Physician Assistants in alternative, non-clinical roles - Employment opportunities have led many PAs into different, more complex roles in the past several years
______________________ is considered to be a barrier to physician assistant practice
Physician dependence [dependence on physicians by rules, regulations and laws] is considered to be a barrier to physician assistant practice
______________________ begun in 1971, and now number ~__ programs with ~ _____possible spots for post graduate PAs (far fewer than the number PA program graduates each year)
Post graduate PA programs begun in 1971, and now number ~75 programs with ~ 300 possible spots for post graduate PAs (far fewer than the number PA program graduates each year)
Post graduate PA training that is a practically oriented, _________ curriculum combined with intensive ________ rotations and educational experience in a _______setting is called the __________________
Post graduate PA training that is a practically oriented, didactic curriculum combined with intensive clinical rotations and educational experience in a hospital setting is called the "Internship Model
_________________________ = (def.) The provision of integrated, accessible health care services by clinicians who are accountable for meeting most personal health care needs, developing sustained partnerships with patients, and practicing in the context of family and community
Primary Care
Family medicine, Pediatrics, General (adult) Internal Medicine, OB/Gyn (Women's Health)
Primary care
_______________ Physician Assistant pilot project in early 2000's concluded that PAs are _________ as substitutes for ______ or _________
Scotland's Physician Assistant pilot project in early 2000's concluded that PAs are highly regarded as substitutes for nurses or doctors
__________________________________ Some PAs in rural counties serve as coroner and may sign death certificates. New York has pioneered much of this effort.
Signing death certificates
The ___________________________ began training physician assistants in _______ and now has approximately 250 practicing PAs (and growing)
The United Kingdom began training physician assistants in 2004 and now has approximately 250 practicing PAs (and growing)
The federal definition of _______ for a county located in the U.S. = ____________________
The federal definition of "rural" for a county located in the U.S. = Less than 100,000 people
The greatest ______ in employment in the last 10 years has been in the _________________
The greatest growth in employment in the last 10 years has been in the surgical specialties
The growth of physician assistants was assisted in_____ when PA providers became covered for ___________ of services under _______________
The growth of physician assistants was assisted in 1986 when PA providers became covered for reimbursement of services under Medicare, Part B
The post-___________ program at the __________________ is in the specialty of ________________.
The post-graduate program at the University of Kentucky is in the specialty of Neonatology.
There have recently been many _________changes in the "______" regarding physician assistant practice. "______________________" is the _________________________________________ makes a bill become a state law in Florida.
There have recently been many Florida changes in the "law" regarding physician assistant practice. "Signing by the Governor" is the final step in the legislative process that makes a bill become a state law in Florida.
Ultimately, the _____________________________ and ultimately liable _________________of a physician assistant in the clinical setting
Ultimately, the PA him/herself, is responsible and ultimately liable for the acts of a physician assistant in the clinical setting
________________was a physician assistant "predecessor" and worked for Dr. Alfred Blalock (cardiac surgery, Vanderbilt University) who pioneered the surgical treatment for Tetralogy of Fallot. [Aside: remember the defects in ToF?}
Vivien Thomas
When a patient sues a clinician, they make a "_________" against that provider. _________: Assertion that one is entitled to, or perceived or actual right to receive, money or property
When a patient sues a clinician, they make a "claim" against that provider. Claim: Assertion that one is entitled to, or perceived or actual right to receive, money or property
0-20% of physician assistant graduates are currently engaged in __________________(don't see patients) in administration, entrepreneurial activity, pharma sales/support and others.
non-clinical roles
American Academy of Physician Assistants position on _______________ - "Caps on noneconomic damages appropriate if they are part of a comprehensive medical liability insurance reform"
tort reform
*Drivers of future demand* for health care providers (including Physician Assistants)
•Population growth • Population aging • High public expectations • Increased resources of baby boom generation • Rapid rise of lifestyle risk factors