Physician assistant

Not to be confused with medical assistant.
Physician assistant
Occupation
Names
  • physician associate (UK)
  • physician assistant (USA/Canada)
Occupation type
 Professional
Activity sectors
 Medicine, Healthcare
Description
Competencies The ethics, art and science of medicine, analytical skills, critical thinking, communication
Education required

Any of the following:

  • Master of Science in Medicine (MMSc or MMS
  • Master of Science Physician Assistant (MSPA)
  • Master of Physician Assistant Studies (MPAS)
  • Master of Health Science (MHS)
  • Master of Medical Science (MMSc)
  • Master of Clinical Medical Science (MCMSc)
  • Master of Clinical Health Services (MCHS)
  • Postgraduate Diploma in Physician Associate studies (PgDip)
  • Master of Science in Physician Associate studies (MSc)
  • Bachelor of Science in Physician Assistant Studies (BS)

A physician assistant (US) or physician associate (UK) is a healthcare professional who practices medicine as a part of a healthcare team with collaborating physicians and other providers. In the United States, PAs are nationally certified and state licensed to practice medicine. A certified PA may use "C" at the end of his/her credentials. PAs are trained using the medical model and complete these qualifications in less time than a traditional medical degree. The PA education model is based on the fast-track training of doctors during World War II.

PAs are concerned with preventing and treating human illness and injury by providing a broad range of health care services with a collaborating physician.[1] Their scope of practice can vary according to jurisdiction and healthcare setting. Accordingly, their work may include conducting physical exams, ordering and interpreting tests, diagnosing illnesses, developing treatment plans, care coordination, performing procedures, prescribing medications, clinical research, advising on preventive health care, and doing first assist in surgery.[2]

The occupational title originated in the United States in the 1960s; similar occupations outside the US include clinical officers in parts of Africa and feldshers in countries of the former Soviet Union.[3]

Overview

Physician assistants or physician associates (PAs) may undertake tasks such as: obtain medical histories, perform examinations and procedures, order treatments, diagnose diseases, prescribe medication, order and interpret diagnostic tests, care coordination, clinical research, refer patients to specialists as needed, and first assist in surgery. They train to work in settings such as hospitals, clinics and other types of health facilities, or in academic administration, and exercise autonomy in medical decision making. PAs practice primary care or medical specialties, including emergency medicine, surgery, cardiology, etc. according to a legal scope of practice that may vary across jurisdictions. A period of extensive clinical training precedes obtaining a license to practice as a physician assistant, and similar to physician training but shorter in duration, includes all systems of the human body. Renewal of licensure is necessary every few years, varying by jurisdiction. PAs may also complete residency training, similar to physicians' residencies but significantly shorter, in fields such as: OB/GYN, emergency medicine, critical care, orthopaedics, neurology, surgery, and other medical disciplines.

History

The PA profession was first proposed in the United States when Charles Hudson recommended to the American Medical Association (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 four former U.S. Navy Hospital Corpsmen.[5][6] He based the curriculum of the PA program on his first-hand knowledge of the fast-track training of medical doctors during World War II.[7] Two other physicians, Richard Smith at the University of Washington in Seattle, and Hu Myers at Alderson-Broaddus College in Philippi, West Virginia, also launched their own programs in the mid and late 1960s. And Dr. J. Willis Hurst started the Emory University Physician Assistant Program in 1967.

Beginning in January 1971,[8] the U.S. Army produced eight classes of physician assistants, at 30 students per class, through the Academy of Health Sciences, Brooke Medical Center, Fort Sam Houston, Texas. (Academically accredited by Baylor University, Texas)[4]

Although the PA profession has historically consisted mostly of men, by 2003 women constituted nearly 60% of physician assistants in the United States.[9]:45

The PA profession has expanded globally. It can now be found in Afghanistan, Australia, Canada, Germany, Ghana, India, Israel, Liberia, Netherlands, New Zealand, Saudi Arabia, and the United Kingdom. Many countries do not have PAs, but do have people that are employed to do similar types of work, such as: clinical officers in Africa; clinical associates in South Africa;[10] assistant medical officers in Malaysia; assistant doctors in China;[11] Health extension officers in Papua New Guinea[12] and feldsher in countries of the former Soviet Union.[3]

Canada

As of October 2015, there are approximately 400 PAs working in healthcare settings in Canada.[13] The first formally trained PAs graduated in 1984 from the Canadian Forces Medical Services School at Borden, Ontario.[14] The Canadian Medical Association (CMA) recognized the PA as a health professional in 2003.[14]

The first civilian PA education programs were launched in 2008 at the University of Manitoba and McMaster University.[14] In 2010, a third civilian program was launched by the Consortium of PA Education (University of Toronto, Northern Ontario School of Medicine, and The Michener Institute).

PAs are currently practicing across Canada in the Canadian Armed Forces and are working in the public health care system in the provinces of Manitoba, Ontario, New Brunswick and Alberta. PAs are regulated in Manitoba and New Brunswick by the respective provincial college of physicians and surgeons. In both Ontario and Alberta, the profession is not regulated. However, the Ontario Minister of Health has recommended that a mandatory registry be established which would be governed by the College of Physicians and Surgeons of Ontario. In Alberta, a voluntary registry has been established for PAs under the College of Physicians and Surgeons of Alberta. PAs are permitted to practice, by way of delegation, under the provincial Medical Act. PAs are represented by the Canadian Association of Physician Assistants, which had formed in October 1999 as the "Canadian Academy of Physician Assistants".[14]

United Kingdom

Overview

The position of physician associate (PA) has been established in the United Kingdom since 2005. The position evolved from the position of physician assistant, developed in the USA in the 1960s. In 2012, the profession voted to change the name of physician associate to distinguish the position from another one with the same name within the NHS.

Hillingdon Hospitals NHS Foundation Trust was asked to manage the recruitment of 200 physician associates who are expected to come from the USA for 40 NHS trusts in September 2015.[15]

Faculty of Physician Associates at the Royal College of Physicians of London

The Faculty of Physician Associates (FPA) is the professional body for Physician Associates working in the United Kingdom. A joint venture between the Royal College of Physicians of London and the previous professional body, the United Kingdom Associate of Physician Associates (UKAPA), the Faculty officially launched in July 2015, taking over all professional body rights from then on. The Faculty oversee the managed voluntary register, to which all practising PAs are encouraged to become a member of, as well as setting and running the National Assessment Examination and National Recertification Examination.

Scope of practice

PAs are trained under the medical model, similarly to doctors, to deliver high-quality medical care in both primary and secondary care settings. The role of PAs has developed to provide medical services similar to those provided by house officers or senior house officers. They are trained to perform a variety of tasks including diagnosis and taking medical histories.[16]

They work under the direct supervision of a doctor. Due to the infancy of the profession, there is currently limited progression to senior posts, but there has been an emphasis on employers to develop dedicated study leave and training times to help develop their skills, this is often paired with junior doctor training. The current avenues which PAs can develop their skills are through research, teaching, training to become first assistants in surgery and running outpatient clinics and post-surgical follow ups. Tasks they perform include medical history taking, interpreting ECG and venipuncture/blood draws, among others.[17]

Voluntary register

The title of physician associate is not a protected medical profession. Hence, even if a PA has been trained in pharmacology and IRMER[18] (ability to request radiology imaging – X-rays), they are not able to prescribe or request imaging.[19] At present, there is no regulatory body for PAs, such as the General Medical Council (GMC) for doctors. Since June 2010, physician associates have been able to obtain membership of the Managed Voluntary Register (MVR) for Physician Associates.[20] This database, run by PAs for PAs, aims to identify all qualified PAs who are able to practise in the United Kingdom. It is intended to maintain high standards in the UK.[21] To remain on the register, Physician associates in the United Kingdom are required to re-certify every 5–6 years[22] and maintain up-to-date practice through attendance of training accumulating CPD hours (Continuous professional development), which need to be completed on an annual basis.

Training

PA training in the UK is through a 2-year MSc or Postgraduate Diploma in Physician Associate Studies. As of 2016 there are at least 19 universities offering these programmes.

Aberdeen requires a science-based degree with a minimum 2:1 grade achieved and St George's requires a science-based degree with a minimum 2:2 grade achieved. This includes Sport Science, Biology, Geology, Psychology and Biomedical degrees. Applicants should preferably have experience in the healthcare industry, such as a HCA or auxiliary nursing. Applications from other professionals such as nurses, radiographers and paramedics will also be considered.

University of Bradford requires a 2:1 (or above) undergraduate degree in a Life Science, Biomedical Science, or Healthcare subject. Under exceptional circumstances, extensive experience in healthcare practice may contribute and compensate if the above requirements have not been fully met.[24]

United States

Regulation

In the United States, the profession is represented by the American Academy of Physician Assistants, and all PAs must graduate from a nationally accredited ARC-PA program as well as passing the national certification exam.[34] It was not until 1970 that the AMA passed a resolution to develop educational guidelines and certification procedures for PAs.[4] The Duke University Medical Center Archives had established the Physician Assistant History Center, dedicated to the study, preservation, and presentation of the history of the PA profession. The PA History Center became its own institution in 2011, was renamed the PA History Society, and is now located in Johns Creek, Georgia.[35]

Education and certification

As of October 2016, there were 218 accredited PA programs in the United States, and dozens more in development, represented by the Physician Assistant Education Association (PAEA).[36] Most educational programs 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. The majority of PA programs in the United States utilize the CASPA application for selecting students.[36] Professional licensure is regulated by the medical boards of the individual states. Physician Assistant students train at medical schools and academic medical centers across the country.

Physician assistant education is based on medical education[37] although unlike medical school which lasts four years plus a specialty-specific residency, PA training is usually 2 to 3 years of full-time study, completed during their post-graduate studies, for a total of 6–7 years of science-based postsecondary education.[38] The didactic training of PA education consists of classroom and laboratory instruction in medical and behavioral sciences, such as anatomy, microbiology, immunology, pharmacology, pathophysiology, hematology, pathology, genetics, 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. 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 after they complete their schooling. Despite this, there are residency programs in certain specialties for PAs who choose to continue formal education in such a format.[39]

PA clinical postgraduate programs are clinical training programs which differ from training on the job in their inclusion of didactic education and supervised clinical experience to meet learning objectives which are clearly defined.[40] The Montefiore Medical Center Postgraduate Surgical Physician Assistant Program was established in 1971 as the first clinical postgraduate PA program to be recognized.[40] Currently, there are known to be 49 programs in various specialties such as Neurology, Trauma/Critical Care and Oncology.[41] The Association of Postgraduate Physician Assistant Programs was formed in 1988 as an instrument in the establishment of educational standards for postgraduate PA programs[40] and currently includes 50 member programs.[41]

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. APA stands for aeromedical physician assistant and indicates that a physician assistant successfully completed the U.S. Army Flight Surgeon Primary Course.[42] 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 and who have passed the PANCE.

In the United States, 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.[43] The content of the exam is covered in the PANCE BLUEPRINT. In addition, a PA must log 100 Continuing Medical Education (CME) hours and reregister his or her certificate with the NCCPA every two years. Every ten years (formerly six years), a PA must also recertify by successfully completing the Physician Assistant National Recertifying Exam (PANRE)[44][45]

"National Physician Assistant Week" is celebrated annually in the US from October 6 through October 12. This week was chosen to commemorate the anniversary of the first graduating physician assistant class at Duke University on October 6, 1967.[46]

Scope of practice

Physician assistants have their own licenses with distinct scope of practice.[47] Each of the 50 states has different laws regarding the prescription of medications by mid-level practitioners (which include PAs) and the licensing authority granted to each category within that particular State through the Drug Enforcement Administration (DEA).[48] PAs in Kentucky, Puerto Rico and the U.S. Virgin Islands are not allowed to prescribe any controlled substances.[49] 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.[49]

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 supervisor 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).

Employment

The first employer of PAs was the then-Veterans Administration (VA), known today as the Department of Veterans Affairs. Today, the VA is the largest single employer of PAs, employing nearly 2000 PAs.

According to the AAPA, there are more than 108,500 certified PAs in the United States as of 2016.[50]

In the 2008 AAPA census, 56 percent of responding PAs worked in physicians' offices or clinics and 24 percent were employed by hospitals.[51] The remainder were employed in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs[52] Fifteen percent of responding PAs work in counties classified as non-metropolitan by Economic Research Service of the United States Department of Agriculture;[53] approximately 17% of the US population resides in these counties.[54]

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..."[55] 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.[56]

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%.[57] In 2010, CNN Money rated the Physician Assistant Career as the number two Best Job In America.[58] In 2012, Forbes rated the Physician Assistant Degree as the number one master's degree for jobs.[59] In 2015, Glassdoor rated Physician Assistant as the Number One Best Job In America.[60] According to the 2014 National Salary Survey of PAs, the mean total income for physician assistants working full-time was $112,344.[61] Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn $100,000 to $200,000 per year.[62]

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 U.S. government employees and their families in American embassies and consulates around the world. An important part of their jobs is to get to know what resources are available locally that they can count on in an emergency. FSHPs have some other important roles, such as advising their ambassadors on the health situation in the country and provide health education to the diplomatic community. 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.[63]

Military PAs serve in the White House Medical Unit, where they provide care to the president and vice president and their families as well as White House staff.

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.[64] 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.

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. 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.

The Marine Physician Assistant (MPA) is a U.S. Merchant Mariner Staff Officer. A Certificate of Registry is granted through The United States Coast Guard National Maritime Center (NMC) located in Martinsburg, West Virginia.[65] Formal training programs for Marine Physician Assistants began in September, 1966 at the Public Service Health Hospital located in Staten Island, N.Y.[66]

See also

References

  1. ↑ "Physician Assistants". Occupational Outlook Handbook, 2014-15 Edition. United States Bureau of Labor Statistics. Retrieved 23 December 2014.
  2. ↑ "Physician Associate Program: The PA Profession". Yale School of Medicine. 4 January 2013. Retrieved 23 December 2014.
  3. 1 2 International Standard Classification of Occupations, 2008 revision: Unit Group 2240-‘Paramedical pracititioners’. International Labour Organization, Geneva, 2011.
  4. 1 2 3 Carter, R. (Spring 2001). "Physician Assistant History" (PDF). Perspective on Physician Assistant Education. 12 (2): 130−132.
  5. ↑ Braun, J A; Howard, D R; Pondy, L R (December 1973). "The physician's associate-a task analysis". American Journal of Public Health. 63 (12): 1024−1028. doi:10.2105/AJPH.63.12.1024.
  6. ↑ "Eugene A. Stead, Jr., MD". PA History Society. Retrieved 19 June 2016.
  7. ↑ "History of the PA Profession". American Academy of Physician Assistants. Retrieved 26 December 2014.
  8. ↑ Colver, Judith E.; Blessing, J. Dennis; Hinojosa, Jason (2007). "Military Physician Assistants: Their Background And Education". Journal of Physician Assistant Education. 18 (3): 40−45.
  9. ↑ Lindsay, S. (2005). "The feminization of the physician assistant profession". Women & Health. 41 (4): 37–61. doi:10.1300/J013v41n04_03.
  10. ↑ World Health Organization. Classifying health workers. Geneva, WHO, 2010.
  11. ↑
  12. ↑
  13. ↑ "About PAS". Canadian Association of Physician Assistants. Retrieved 8 October 2015.
  14. 1 2 3 4 "About PAs: History". Canadian Association of Physician Assistants. Retrieved 8 October 2015.
  15. ↑ "London trust to recruit 200 physician associates for 40 providers". Health Service Journal. 11 September 2015. Retrieved 23 October 2015. (subscription required (help)).
  16. ↑ http://www.nhscareers.nhs.uk/explore-by-career/doctors/careers-in-medicine/physician-associate/
  17. ↑ Ritsema, Tamara. "Physician Assistant". UKAPA. Retrieved 12/10/13
  18. ↑ http://www.e-lfh.org.uk/projects/ionising-radiation-(medical-exposure)-regulations/
  19. ↑ "FAQs". Faculty of Physician Associates, Royal College of Physicians. Retrieved 19 June 2016.
  20. ↑ "History of the PAMVRegister". Faculty of Physician Associates, Royal College of Physicians. Retrieved 19 June 2016.
  21. ↑ "Physician Associate Managed Voluntary Register (PAMVR)". Faculty of Physician Associates, Royal College of Physicians. Retrieved 19 June 2016.
  22. ↑ "Recertification". Faculty of Physician Associates, Royal College of Physicians. Retrieved 19 June 2016.
  23. ↑ http://www.abdn.ac.uk/smd/physician-associate/
  24. 1 2 http://www.bradford.ac.uk/study/courses/info/physicians-associate-studies-msc
  25. ↑ http://www.bradford.ac.uk/life-sciences/medical-sciences/our-staff/dr-sertip-zangana.php
  26. ↑ http://www.birmingham.ac.uk/postgraduate/courses/taught/med/physician-associate.aspx
  27. ↑ http://www.hyms.ac.uk/postgraduate/taught-programmes/physicianassociate
  28. ↑ http://www1.plymouth.ac.uk/peninsula/postgraduate/Pages/Taught-postgraduate-programmes.aspx
  29. ↑ http://www.reading.ac.uk/pharmacy/pg-cippet/pharm-pg-papgdip.aspx
  30. ↑ http://www.sgul.ac.uk/study/postgraduate/taught-degrees-postgraduate/physician-associate-studies-postgraduate-diploma
  31. ↑ http://www.surrey.ac.uk/postgraduate/physician-associate
  32. ↑ http://courses.wlv.ac.uk/course.asp?code=NH085P01UVD
  33. ↑ http://www.worcester.ac.uk/courses/physician-associate-msc.html
  34. ↑ "PA Information". West Liberty University. Retrieved 2013-05-23.
  35. ↑ "Who we are:The Society for the Preservation Of Physician Assistant History". www.pahx.org. Retrieved 6 April 2016.
  36. 1 2 http://directory.paeaonline.org/programs , Accessed in August 2015
  37. ↑ "Issue Brief - Physician Assistant Education: Preparation for Excellence" - AAPA
  38. ↑ "Physician Assistant". guidetohealthcareschools. Retrieved 18 January 2013.
  39. ↑ The Association of Postgraduate PA Programs (APPAP)
  40. 1 2 3 Polansky, Maura (2007). "A Historical Perspective on Postgraduate Physician Assistant Education and the Association of Postgraduate Physician Assistant Programs.". Journal of Physician Assistant Education. 18 (3): 100–108.
  41. 1 2 Polansky, Maura; Garver GJ; Wilson LN; Pugh M; Hilton G (2012). "Postgraduate clinical education of physician assistants.". J Physician Assist Educ. 23 (1): 39–45.
  42. ↑ "Aeromedical Physician Assistant" Army Regulation 40–501, 6-2.h
  43. ↑ "Physician Assistant National Certifying Exam (PANCE)" - National Commission on Certification of Physician Assistants (NCCPA)
  44. ↑ "Physician Assistant National Recertifying Exam (PANRE)" - NCCPA
  45. ↑ "Pathway II" - NCCPA
  46. ↑ http://www.aapa.org/newsroom/pa-week.html
  47. ↑ "Professional issues: Scope of practice". American Academy of Physician Assistants. 7 November 2013. Retrieved 23 December 2014.
  48. ↑ 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.
  49. 1 2 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.
  50. ↑ https://www.aapa.org/paweek/?utm_source=aapa.org&utm_medium=hero_story&utm_campaign=paweek
  51. ↑ 2008 AAPA Physician Assistant Census Report. page 2.
  52. ↑ 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.l 2008 AAPA Physician Assistant Census Report. Table 3.4: Number and Percent Distribution of Clinically Practicing Respondents by Primary Work Setting
  53. ↑ 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
  54. ↑ "Rural Classifications: Rural-Urban Continuum Codes" - USDA Economic Research Service
  55. ↑ "Physician Assistants" - U.S. Department of Labor Bureau of Labor Statistics
  56. ↑ "Malpractice Consult: Liability insurance for a physician assistant" - Modern Medicine
  57. ↑ "50 Best Jobs in America" (May 1, 2006) - CNN/Money.com
  58. ↑ http://money.cnn.com/magazines/moneymag/bestjobs/2010/snapshots/2.html
  59. ↑ http://www.forbes.com/sites/jacquelynsmith/2012/06/08/the-best-and-worst-masters-degrees-for-jobs-2/
  60. ↑
  61. ↑
  62. ↑ 2008 AAPA Physician Assistant Census Report - Specialty Reports
  63. ↑ U.S. Department of State
  64. ↑ U.S. Army PA Information
  65. ↑ "Code of Federal Regulations".
  66. ↑ "Evaluation of the marine physician assistant program".
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