(Lec 06) The Role of a Physician Assistant in Health Care

How many PAs in California?

~10,000

PA Programs

2-3 years (27 months, on average); USC = 33 months First half is didactic, 2nd half is clinical Graduate level courses MPAP (physician assistant practice) MPAS (physician assistant studies) MHS (health science) MMSc (medical science) 229 PA Programs nationwide, 270 by 2021

PA professional associations (state)

CAPA (CA Academy of Physician Assistants) CA Medical boards

PA v. Doctor

MD/DO: - 4 yrs med school + 3-5 yrs specialty-specific residency + 1-5 yrs optional fellowships - tests to switch specialties - recurrent board exams - complete autonomy PAs: - 2-3 yrs school (+ optional 1 yr fellowship_ - can change specialties without testing - one board exam, re-cert every 1- years - must work with supervising physician (5% of charts must be signed off w/in 30 days)

History

Started in 1965 at Duke with 4 Navy Corpsmen Based on fast-track training of doctors during WWII

PA v. NP (nurse practitioner)

*Both are "midlevel providers" who work with physicians NPs: - follow nursing model - were RNs before, usually focused in 1 field of practice - can work independently - "furnish" drug orders - usually 2 yr programs, can earn doctorate - re-cert every 5 years, no CME PAs: - trained in medical model - trained as generalists, can specialize - practice with a supervising physician - write drug orders (aka prescribe) - 2-3 yr programs, no doctorate... yet - re-cert every 10 years + 100 CME hours

Delegation of Services Agreement

- Between PA and supervising physician - Further defines exactly what tasks/procedures a physician is delegating - Must match with the supervising physician's specialty or usual and customary practice and with the patient's health and condition

Demographics

- Median age: 38 - in 1980, 36% of PAs were female - in 2015, 67.2% of all certified PAs were female - 22.6% can speak another language in addition to English (81.5% speak Spanish)

"Supervision"

- Physician cannot supervise more than 4 PAs at any moment in time - Physician not required to be on site but must be available in person or by phone/electronic communication at all times when PA is caring for patients - Usually have PA and supervising physician work at same clinical site (rarely off-site)

What can't a PA do?

- limited by scope of his/her supervising physician & must follow state-specific scope-of-practice laws - Delegation of Services Agreement - not used in dentistry and ophthalmology

Looking forward

- part of the fastest growing profession in the country (37% expected job growth) - approximately 80,019 certified PAs by end of 2010 - ranked by Forbes as #1 of 10 most promising jobs in 2015

Challenges

- wide variability in implementation of PAs state to state (outdated regulatory language) - newer profession, less familiarity (must constantly educate patients and MD/DO regarding your role) - continually must prove self/profession, explain what a PA is

Top 5 states with highest concentration of PAs

1. Alaska 2. South Dakota 3. Pennsylvania 4. Maine 5. New York

States with the most PAs

1. New York 2. California 3. Texas 4. Pennsylvania 5. Florida

PA professional associations (national)

AAPA (American Academy of Physician Assistants) - advocacy, legislation PAEA (Physician Assistant Education Association) - curriculum ARC-PA (Accreditation Review Commission) - certification NCCPA (National Commission for Certification of Physician Assistants) - certification

Where can a PA work?

Clinics Hospitals Urgent Care Emergency Departments Universities Congress (majority in private practice and hospital settings)

PA perks and requirements

Needs 5% of charts signed by doc every month Can specialize (ortho, etc.) Cannot own majority shares of a practice (up to 49% of a clinic) Docs only need to be available via phone call or video (so pretty autonomous)

Benefits of a PA Team Member

Non-economic values: - higher patient satisfaction - more team communication and access to information - more physician time for critical/complex cases - better quality of life for physicians - increased access to healthcare for patients Economic values: - higher billing and reimbursement - increased patient load - more accurate coding - lower overall salary costs (instead of hiring 5 physicians, a group can hire 1 physician and 4 PAs)

How Physicians Supervise

Options: 1. see patients the same day they are treated by PA 2. reviews, signs, and dates medical record of every patient treated by PA within 30 days of tx 3. adopts written protocols specifically guiding actions of PA. physician must select, review, sign and date at least 5% of medical records of patients treated by PA w/in 30 days, as well. 4. supervision through another mechanism approved in advance by the board

What is a PA?

Physician Assistant Nationally certified & state-licensed medical professional Practice medicine and work with supervising physicians Can practice and write drug orders (prescribe medication) in all 50 states

PA Education

Pre-PA: - complete a bachelor's degree - pre-requisites - GRE or MCAT - at least 500-2500 clinical hours - community service PA: - complete 2,000 clinical hours - graduate from accredited ARC-PA program - pass the Physician Assistant National Certification Exam (PANCE) = PA-C (no C = no certification)

PA Core Clinical Rotations (at USC)

Primary Care: - family medicine - pediatrics - ob/gyn - internal medicine (inpatient) - 8th can be family med, peds, OB/GYN, IM (outpatient or inpatient) Specialties: - surgery - emergency medicine - orthopedics - senior rotation

What can a PA do?

Take patients' medical histories Conduct physical exams Diagnose & treat illnesses Order & interpret tests Perform procedures, assist in surgery Patient education/counseling Develop treatment plans Write drug orders (aka prescriptions) Do clinical research Advocate for patients & communities

Can a PA work internationally?

Yes Canada, the UK, Netherlands, India, Ghana, South Africa Pending: Afghanistan, Australia, Germany, Israel, Liberia, New Zealand, Saudi Arabia, Taiwan