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Here are some informational tools to help make you both successful...

Team Building The Power of One:True Story Success Stories Employment opportunities ripe for physician assistants  More family doctors find PAs to be practice assets Want to improve quality? Increase income? Decrease stress? Team with a PA Physician Help Thyself Arterial health is only a scan away Doctor Shortage for the U.S. PA the answer! Hiring A Physician Assistant Multiplying efforts: Expanding the health care team Avoid Legal Pitfalls EDITORIAL: Calling all PAs, NPs Physician Assistants: Monster.com Links

CHARACTER and VALUE: Physician Assistants are by character compassionate advanced medical providers and team builders through individual professional excellence in collaboration and partnership with physicians, consultants, fellows / residents, nursing and other medical staff, achieving high quality outpatient and inpatient care, through problem solving, working interdependently and assuming responsibility for their patients. PAs are cost effective medical providers for insurance companies, businesses, and patients, contributing to a solid financial foundation of the whole health care system. 

MISSION and SERVICE: The Physician Assistant’s mission serves in all medical and surgical specialties, operating as established medical colleagues and associates through collaborative care agreements with doctors, hospitals, practices, and clinics. PAs are extended Hospital credentials and privileges.

MEDICAL COMPETENCY: First and foremost PAs are trained in the same medical model as are physicians. This training exposes them to all areas of medicine in a condensed time frame-training is roughly two-thirds the length of medical school with 108 weeks of general primary care education. PAs then in practice, enhance their chosen specialty in a structured residency program and/or hand in hand with their  physician colleagues. PAs must also pass national certification boards and recertify every six years. In many cases PAs who are in practice for years bring their patients a level of experience and care that often exceeds that of medical residents and less experienced physicians.

PHYSICIAN ASSISTANTs: Are rigorously medically trained and are licensed medical professionals as advanced medical providers who establish and build a medical practice diagnosing and treating their own patient roster, serving in a variety of clinical settings, such as specialists in Cardiac care, Orthopaedics and Sports medicine, Pediatrics, Internal Medicine, Emergency Medicine, Occupational Health, Pulmonary Care, Neurology, Gastroentology, Neonatology, Family Medicine, Urology, Obstetrics and Gynecology, in primary care practices, geriatric long-term care facilities, hospitals, correctional institutions, Federal and community-based clinics. In short, PAs are trained and certified advanced medical practitioners giving complete and outstanding patient care. 

DEGREES OF AUTONOMY: Physician Assistants are generally excellent team builders respecting the limits of their consulting  Physician's medical professional relationships and state laws. It's vitally important that the PA and MD are similar in their team approach! This successful continuum includes Physician Assistants practicing significant autonomy in their medical practice, exclusive of a physician's presence, while other PAs want a much closer professional relationship with a consulting MD who is more, often than not, physically present for practical direction and oversight. 

SCOPE OF PRACTICE includes:

1. Comprehensive physical assessment; evaluating, diagnosing, and treating new and existing patient's medical and surgical conditions. 
2. Initiating and interpreting labs and x-ray studies including CTs & MRIs.
3. Performing medical and surgical procedures.
4. Prescribing and referring patients for specialized consultation. 
5. Assisting Physicians in medical and surgical procedures.
6. Using prescriptive authority to write prescription medicines for patients. 
7. Write/Dictate progress notes on patients' charts indicating patient status and treatment procedures performed.
8. Conducting follow-up patient care.
9. Providing health education to patients and families. 
10. Supervising and/or coordinating the activities of patient care and support staff within the clinic. 
11. Training and supervising medical residents engaged in specific clinical activities. 
12. Teaching and training illness prevention.
13. Actively participate in community health education. 
14. Performing emergency life saving procedures in cases such as cardiac arrest, respiratory arrest, massive hemorrhage, or similar emergencies.
15. Are among front line medical providers in emergency disaster services.

 

• Excellent interpersonal and communication skills.
• Giving the patient quality compassionate and empathetic caring.
• Giving the patient more time through Active listening.
• Giving the patient more easily understood feedback and instructions,
• Promoting greater patient health and wellness.

resulting in patients often preferring medical treatment by physician assistants-associates...

"Consumers seek a broader array of health services than physicians have time, inclination, or expertise to address. Interdisciplinary care is a more efficient and effective strategy for providing care of high quality since all providers contribute what they do best." Linda H. Aiken, PhD, RN Jan. 14, 2002 http://www.medscape.com/viewarticle/447839

For patients with chronic illness, treatment by a multidisciplinary team represents the state of the art, with nonphysicians providing most of the routine care and ancillary services while physicians and PAs manage more acute and complex problems.

1. Ability to perform medical examinations using standard medical procedures. 
2. Knowledge of drugs and their indications, contraindications, dosing, side effects, and proper administration. 
3. Knowledge of clinical operations and procedures. 
4. Knowledge of primary care principles and practices. 
5. Knowledge of patient care charts and patient histories. 
6. Knowledge of OR, pre-op and/or post-op procedures. 
7. Knowledge of CPR and emergency medical procedures. 
8. Knowledge of current and emerging trends in technologies, techniques, issues, and approaches in area of expertise. 
9. Ability to clearly communicate medical information to professional practitioners and/or the general public. 
10. Ability to maintain quality, safety, and/or infection control standards. 
11. Ability to observe, assess, and record symptoms, reactions, and progress. 
12. Ability to make administrative and procedural decisions.
13. Knowledge of related accreditation and certification requirements. 
14. Ability to react calmly and effectively in emergency situations. 
15. Ability to supervise and train staff, including organizing, prioritizing, and scheduling work assignments. 
16. Skill in preparing and maintaining patient records. 
17. Ability to educate patients and/or families as to the nature of disease and to provide instruction on proper care and treatment.

BY JORDAN LITE
New York Daily News

NEW YORK - (KRT) - When former President Bill Clinton undergoes surgery this week, his doctors will stop his heart for up to three hours to allow them to carry out the bypass.

While it sounds dramatic, Dr. Joseph DeRose, chief of minimally invasive heart surgery at St. Luke's-Roosevelt Hospital in Manhattan, who regularly performs bypass operations, said the operation is now routine, and when Clinton's heart is restarted it is likely to work better than it did before.

Here he explains who will perform the operation and provides a step-by-step guide about what Clinton will face in the theater.

THE TEAM: There will be a large team for the operation, led by a head heart surgeon, who will perform the bypass, assisted by a second heart surgeon. An anesthesiologist will tend to Clinton while he is asleep, while a physician assistant harvests veins from the president's leg that will be used to create some of the bypass of the blockages around his heart. A scrub nurse will help the surgeons, while two or three "perfusionists" will run the bypass machine that maintains blood flow while the heart is stopped.

THE OPERATION: When Clinton is anesthetized, a special probe will be inserted through the mouth to monitor the heart throughout the operation. The surgeon will open the chest with a saw, dividing the breast bone, to remove the mammary artery, which will also be used for bypassing the blockage.

At the same time, special instruments will remove a vein from his leg through a tiny incision by the knee.

After they remove the 1- to 2-mm artery and veins - at this point about an hour and a half into the operation - doctors will stop Clinton's heart. To do that, the surgeon will place a large IV into the heart and another into the aorta, the major artery in the body. The IVs take the blood out of the patient and into the bypass machine, which will pump blood around his body to keep him alive.

The heart stops, and the surgeons will start sewing the new vessels onto the areas of the heart where the blood needs to go around the blockages. After the bypass grafts are completed, the blood flow to Clinton's heart will be restored.

Many times, once the heart senses blood, it will restart right away, but there may be the need for a little shock to get it back into a regular rhythm. Next, everything will be closed and Clinton will return to the intensive care unit.

RECOVERY: The patient will be on a breathing machine for three to six hours, but once Clinton wakes up from anesthesia, the breathing tube will be removed.

He is likely to remain on some medications to help the heart pump better, but will be weaned off those within 24 hours.

Clinton would be expected to leave the intensive care unit the first or second day after surgery to go to a regular room, and at this point will be able to get out of bed, eat regular food and perhaps walk a short distance.

By the third or fourth day, he will be on ordinary painkillers, walking without assistance up and down the hall, and by the fifth day will probably go home.

REHABILITATION: Four or five weeks later, Clinton will start cardiac rehabilitation, which focuses on increasing the heart rate - working out the heart to help it get used to its new circulation.

Clinton will have to do aerobic exercise - walking or biking or treadmill - to increase the heart rate and the blood pressure. With the newly forceful blood flow, the heart is able to get stronger and stronger.   Back to Top

Matthew McQuillan said the calls come frequently from doctors who want to hire physician assistants. "The doctors are saying, 'Where's my PA?'" recalled McQuillan, who teaches physician assistants at the UMDNJ School of Health Related Professions. 

His experience reflects new data by the U.S. Bureau of Labor Statistics indicating the profession of physician assistant will be the third fastest-growing occupation in the country between 2002-2012 (after medical assistants and network systems and data communications analysts). 

The government predicts the number of physician assistant jobs will grow by 49 percent. The bureau estimates there were 63,000 PA jobs in 2002, but the number of jobs to be filled in 2012 will be 94,000. 

The trend is holding true in New Jersey. 

"New Jersey is starting to catch on that PAs are extremely valuable as a PA-physician team, in hospitals and in the office," said Whitney Gaydos, president of the New Jersey Society of Physician Assistants. 

"They can handle run-of-the-mill cases, enabling the doctor to spend more time with complex cases," she said. 

Last year, job prospects for PAs got even better in the state because of new rules requiring hospitals to reduce the number of hours that residents work. Hospitals are hiring physician assistants to fill in the gaps. More PAs now work in emergency departments, on medical floors and in operating rooms. 

Physician assistants work under the supervision of doctors. They can prescribe medications, evaluate patients, diagnose and treat illnesses, order and interpret tests and counsel patients on their health. 

The UMDNJ physician assistant program requires students to complete three years of post-graduate study. "If the family doctor needs to make rounds, the PA can see patients," McQuillan said. "Physicians have learned they can open up hours to see more patients by hiring PAs." 

The PA tradition in New Jersey is relatively young. Although UMDNJ has trained PAs since the 1970s, the graduates had to leave the state to get jobs. State law did not allow them to work in New Jersey until 1992. New Jersey was the last state to recognize PAs. 

The number of practicing PAs in the state went from zero before the law to 751 in January of this year, according to the American Academy of Physician Assistants. 

In contrast, more than 3,000 PAs work in Texas; 4,800 in California. 

Physician assistants are sought after in areas where there is a need for doctors, such as in urban and rural communities, experts said. "Reports are showing we are approaching a period where there will be a shortage of physicians," said Stephen Crane, executive vice president and chief executive officer of the American Academy of Physician Assistants. "It's a lower-cost way for physicians to expand their services." 

Nationwide, recent graduates earn about $65,000. The average salary for all PAs is $76,000. PAs in New Jersey, particularly those with specialties in such areas as surgery or cardiology, will earn more, experts said. 

-- Carol Ann Campbell 
source:http://www.nj.com/business/ledger/index.ssf?/base/business-6/1079421037175220.xml

Here's just one of the Success Stories

Bill,
I am employed with Chesapeake Emergency Physicians and we practice emergency medicine at Chesapeake General Hospital (CGH) in Chesapeake, Virginia.  My group has been the only ED group practicing at this hospital since it's beginning 20+ years ago.  When I joined the group in 1989 I was the only PA to practice with any group at CGH.  Now we have PA's in practice with Internal Medicine Groups, Urology, Surgery and Family Medicine.  We also have another emergency medicine group in town called Emergency Physicians of Tidewater (EPT) and they began utilizing PA's in their practice after seeing the success of our practice in the early 90's.  EPT covers about 8 hospital ED's in the Tidewater area.

I would be happy to assist you in getting our name out to the ED communities looking to employ PA's.  You may give my name, e-mail address or work number out as you see fit.

Thanks again,

Jack Witzenfeld
jwitzenfeld@cox.net
757-312-6200   Back to Top

Business: Physician Assistant Services, 301 Hibiscus Blvd., Melbourne Florida

Business description: “We provide surgical-physician assistants, who have each been certified by the National Commission on Certification of Physician Assistants, 24 hours a day, seven days a week, on a per-operation basis, in most specialties.  Our only focus is assisting in surgery.” 
Business motivation: “To provide a core of professionals to the community and surgeons and the satisfaction that comes from doing this for the love of the patient and medicine.” 
Professional background: Surgical experience for more than 31 years with 22 years as a NCCPA certified surgical P.A. in all specialties. 
Lessons learned:  “Take full responsibility for all successes and setbacks.  Learn and understand your shortcomings and improve upon them.  Spoil your surgeon and patient with the best possible service and care.” 
Business goals:  “To expand and cover all hospitals in Brevard County on a round-the-clock basis.” 

Hamilton Boone, PA-C, Founder 
301 Hibiscus Blvd., 
Melbourne, Florida 
Call (321) 409-8941 
Boone@PAservices.net

"dramatic improvement of my efficiency in the operating room..."
Dr. Jonathan Paine
Email: lalan@bellsouth.net

“I an a neurosurgeon in private practice in Melbourne, Florida, and I have been in solo practice over the course of the last 14 years.  I have been fortunate to become involved with Physician Assistant Services since 2000, and I have experienced a dramatic improvement of my efficiency in the operating room.  Physician Assistant Services provides pre and intraoperative support during my busy elective and emergency case load.  My productivity and quality of life have vastly improved since becoming associated with this fine group!”

Dr. Jonathan Paine
Back to Top

Mr. Stern added that the 1,700 specialists who finish residencies in emergency medicine are not sufficient to staff the nation's 4,500 emergency rooms.  "I think it's very serious," said Mr. Stern of the growing need for emergency department physicians. "The number of patients going to emergency rooms keeps escalating, but the supply of emergency medicine graduates remains stable. So something has to give."

Mr. Stern said that over the past few years, patient visits to emergency departments nationwide have grown by about 20 percent.

Of the 106 million annual visits to the emergency department in 2001, nearly 62 million cases were for treatment of patients who could have been seen in other less-acute care settings, according to Solucient, an Illinois-based firm that estimates health care demand.

In Pennsylvania [for example], 41 percent of these fast-track programs employ actual physicians, while 35 percent use physician assistants and 33 percent have nurse practitioners. Using other personnel in these programs helps to lessen the demand for physicians.

The Stern survey -- now in its 16th year -- consists of responses from more than 800 physicians in 49 states and Washington, D.C. Complete survey results can be found at www.danielstern.com.

Source:http://www.bizjournals.com/pittsburgh/stories/2003/07/07/story8.html   Back to Top

  [Note: The time and money spent establishing the PA's professionalism will result in an easier transition and more productive team.  Encourage, encourage, encourage and talk, talk, talk.  I learned that after spending seven years in my Internal Medicine practice I had spent more time with my supervising physician than his wife had.  It is a lot like a marriage.  If you don't continue to have an open, honest communication, it will breakdown.  If you put the time and effort into building the relationship, it will blossum!]
    please check all that apply:

______1. Staff is educated on the professional training and role of the Physician Assistant. 
______2. Staff understands the PA is medically qualified similar to a MD - NOT a medical assistant. 
______3. Staff know how to introduce a PA to patients (e.g. "Doctor Johnson would like you to see Physician Assistant
                Kevin. PA Kevin will keep Dr. Johnson informed about what is going on with you and if necessary, 
                PA K will have Dr. Johnson come and see you.")
______4. Staff treat new PAs as they do new physicians.
______5. PAs are promptly given business cards they can hand out to patients in the hospital, office.
______6. PA's name is promptly placed on the office door and in the entranceway 
                (where patients look for PA's name on the board to find out where to go)
______7. PAs are given lab coats to wear that are consistent with the MD medical staff
______8. PAs have a medical assistant or nurse to work with presenting the PA more professionally and allowing the 
                PA to be more productive, thus providing more revenue for the practice.
______9. PAs are introduced to the hospital medical staff in the form of an announcement.
_____10. PAs are introduced to the community in the form of a open house,  newspaper add or article.
_____11. Patients are educated about having a PA by informing the patient ahead of time that if they are offered an 
                appointment with a PA, please know that Dr. Abc hires the best of the best.  Kevin is completely qualified to
                handle your care and consults with Dr. Abc as needed.
_____12. PAs know that it's preferred, to have them pull their SP out of a room when they have a question about a
                patients care. The more available the SP is the more likely the PA won't reach beyond their comfort zone.
_____13. The SPs initiate spending time teaching PAs, pulling them out for new and interesting radiographs, cases, etc. 
_____14. PAs are encouraged that if there is ANY problem with patients, staff, hospital, etc that they need to let their 
                SP know rather then let it blow up or turn into a big mess.  There isn't any point in hiring a new PA and then
                having them leave over a misunderstanding with your staff, patient, etc. Especially difficult to hire and train a
                new one versus paying a little more each year in bonus, raise, etc.
_____15. SPs demonstrate effective leadership in asserting PA's professionalism in resolving patients, staff, or 
                hospital, issues.
_____16. PAs are encouraged and reimbursed to attend CME lectures and to go to a national, general medicine 
                conference. The more PAs know, the better off the practice is in the long run. 
_____17. There are weekly/frequent discussions about new journal articles. 
_____18. PAs are given the same allowances of time and expenses, as the Physicians are, to attend medical conferences.
_____19. The practice pays for the PA's license, CME, and memberships keeping them up to date on new medicine 
                and laws.

Balanced Budget Act of 1997 allows for 85% reimbursement of physician services provided by physician assistants in most situations. 

Some practices have been dissappointed with performance and revenue generation of physician assistants. 
Problems encountered: individual failures, newness of contcept for practice. 

Issues and solutions to utilization: 

A significant reason for under-utilization was that the physician, the practice, and many times the mid-level themselves were not aware of how to utilize this unique employee. The physicians were often ignorant of the training provided as well as the laws that governed their usage. Putting it succinctly, the physicians did not know how much confidence to place in this new provider. The degree of utilization has been shown to be directly related to the confidence level of the physician supervisor. Solution:  educate all  parties concerned. The physician, the practice and the mid-level must take the time to learn about the concept. One of the first tasks would be to orient the mid-level to the practice. Unfortunately, most receive virtually no instruction beyond, "park you car here." The physicians themselves are also at fault. Many know more about the specifications of their car than they do about the laws that regulate this valuable employee. 

If you are going to hire a mid-level and expect to get the most out of him or her, you are going to have to take the time to correct both your knowledge deficits. This is best done using an objective organized orientation which includes a skills and knowledge assessment program. If you need a pair of trained hands in the operating room and want to use them to do more than hold a retractor, then you are going to have to train them. Once mid-levels have had the opportunity for additional training and experience they have been shown to be interchangeable with residents acting as house staff. The key words here are "additional training" and "experience." The practice can let the practitioner gain this experience in a haphazard manner or it can utilize an organized program. It is plain to see which would be more efficient in terms of time, effort and final result. 

RECOMMENDATIONS to help build a strong foundation: 

Evaluate the financial health of your practice. If money is tight and you’re not busy, don’t hire a mid-level at this time. There will be too much pressure on both parties. 

Write a detailed job description for the position. You have to be able to communicate your needs to your new employee. If you cannot do this neither you or your employee will ever be satisfied. 

Contact the various representative professional groups and obtain information packets on the various mid-level types to help make your decision, but remember they are lobbying organizations. To inject a component of objectivity I usually recommend that the practice check the local regulations and review actual course descriptions from some representative colleges catalogs. These practitioners may be grouped together but their basic educational requirements may vary from state to state and profession to profession. 

Check with your state medical board to see which practitioner has the most flexibility under state law, for example, prescription writing. 

Take the time to read the state regulations that govern mid-levels. They are usually succinct and easy to understand. If you have a question, contact your attorney or the state medical board for clarification. 

Design or have a consultant design an orientation program that is specific to your practice situation. This will become your objective yardstick to assess the knowledge and experience of your employee. Even experienced mid-levels can benefit from this practice, especially if they are moving into a different specialty. 

Educate your office staff and billers on the laws and specifications of this employee and establish a clear chain of command. 

View the mid-level like a newly graduated medical student and not a finished product. The orientation checklists are much like the residency patient lists you were exposed to while in training. Your practice will be their "residency". 

Take the time to introduce the mid-levels to your patients as a colleague. Emphasize that you will always honor a patient request to see only the doctor. 

Build a solid foundation by instituting a detailed orientation and integration program. If this is too difficult or time consuming, you can have a consultant construct one for you. You must have a sound foundation before you can attempt any expanded or innovative practice techniques. Remember, there must be no communication filters between you and the mid-level. 

All of these techniques are useless if the individual chosen is inadequate. Take your time and find the person you want, not just who is available. The physician must take an active role in the interviewing process. It is clear that no employee can be a greater source of revenue or expose the practice to increased liability if not properly supervised. Open lines of communications are a must. As their employer, you are ultimately responsible for their actions despite the fact that they are required to carry their own malpractice insurance. 

SUMMARY 
Structure the practice for success by ensuring that the mid-level, the practice and the physician have taken the time to prepare a solid foundation. 

Know exactly how and where you want to use the mid-level. 

Take an active role in the recruitment and training so that he or she can perform the tasks assigned. 

Remember, the practitioner will only become what you allow him or her to become! 

Finally, the mid-level concept can work extremely well, but only in those practices willing to make the commitment to orient, educate, and integrate mid-levels into the practice. 

If you are not ready to make that commitment, you should be prepared for a lower level of service and/or consider not hiring a mid-level at this time. 

William J. Mazzocco is president and chief consultant for Medical Administrative Support Services in Altoona, Pennsylvania.    Back to Top

Family physician Harvey Frank, MD, supervises physician assistants because he loves teaching and mentoring. He also believes it is a cost-effective way for his patients to receive quality care. 

General practitioner Walter Eidbo, MD, supervises physician assistants because it allows him to extend the geographical reach of his practice deep into underserved areas and increase the number of patients under his supervision. The former Army surgeon also believes teamwork enhances patient care. 

St. Paul, Minn., emergency department physicians Felix Ankel, MD, and Richard Lamon, MD, supervise physician assistants because they believe having another health care professional on hand frees them for more critical cases. 

Physician assistants are part of a growing cadre of allied health professionals who help physicians, hospitals and managed care payers extend care to patients in rural and inner-city areas, provide scheduling options to patients and lower staffing costs, according to a 1999 report by Health and Human Services' Health Resources Services Administration. 

The number of accredited PA programs has more than doubled to 122 from 55 during the last six years. 
"Patients respect them and have confidence in them," Dr. Eidbo said. "They work rural areas where there are few doctors. They see this as a challenge and a calling. In the future, as more doctors accept them, they will become an even greater part of the medical team." 

Under physician supervision, more than 50% of the nation's 41,500 PAs work in primary care settings -- the majority in family practice. Another 10% work in emergency medicine, 20% work in surgical specialties and the remainder work in a variety of other fields, according to the American Academy of Physician Assistants. Most PAs are supervised by allopathic physicians, but 25% are supervised by osteopathic physicians, AAPA said. 

The first PAs were Vietnam War-era medics. During the 1960s, a handful of medical schools led by Duke University School of Medicine in Durham, N.C., began educating PAs in the medical model. During the last six years, the number of accredited PA programs has more than doubled to 122 from 55. The programs graduated 4,500 physician assistants in 2001. 

Supervision arrangements vary
At the Redfield (Iowa) Medical Clinic, Dr. Eidbo supervises Ed Friedmann, a rural PA. 

Like a growing number of PAs and their supervising physicians, Friedmann, a former Green Beret medic in Vietnam, and Dr. Eidbo do not share offices. Each week, Friedmann and two medical assistants see about 125 patients a week in the federally certified rural health clinic. It is located 38 miles west of Des Moines, Iowa, where Dr. Eidbo's multispecialty clinic is located. 

About 25% of PAs work in rural areas, while 12% work in inner cities. These percentages have been increasing as more physicians become comfortable with off-site supervision and PAs gain more delegated prescribing rights. Only three states -- Indiana, Ohio and Louisiana -- do not allow PAs to prescribe; 41 states allow delegated controlled substance prescribing. 

"The key to our relationship is trust," said Dr. Eidbo, who visits the Redfield Clinic at least once a week. "It is not 100% trust; it is 1,000% trust. You cannot work with anybody like that unless you have that level of trust." 

In a typical example of collaborative care, one of Friedmann's regular patients, an 82-year-old man, came in for a visit after the sudden appearance of a black lesion on his ear. "Ed called me in to take a look," Dr. Eidbo said. "It was a malignant melanoma. We did a wide incision and took it off." 

Under state laws and following AMA policy, PAs take care of patients under individual collaborative agreements with supervising physicians. Iowa law requires Dr. Eidbo to review all Friedmann's charts every two weeks, but the two generally go over charts once a week. 

"I do what I am qualified for in education and training," said Friedmann, AAPA president. "Things beyond my capabilities I refer to the doctors. Patients schedule appointments with me for routine exams and problems. They primarily see [Dr. Eidbo] for surgical problems, [but also for] multiple sclerosis and rheumatoid arthritis." 

In another common scenario, patients with multiple sclerosis who live in the Redfield area are treated by specialists, but come into the clinic to see Friedmann for injectable medications. "We administer that per specialist instructions," he said. 

Knowing when to refer
At the Forest Lake (Minn.) Clinic, a multispecialty clinic with 18 doctors and two PAs located about 25 miles north of St. Paul, Dr. Frank supervises PA Beverly Kimball. Some 37% of PAs work in solo or group practice settings, the AAPA said. 

"We collaborate a lot on cases, but she practices under my license, so every patient is my ultimate responsibility," Dr. Frank said. "Bev knows when to treat and when to refer." 

Under Minnesota law, Dr. Frank is required to review a sampling of Kimball's cases every 24 hours. 

"We have our own primary patients, and then we take care of emergencies as they come into the office," said Kimball, who was voted Physician Assistant of the Year in Minnesota for 2001 by the state PA chapter. 

In one case, a 70-year-old woman came to the office coughing and short of breath, Dr. Frank said. "Bev had been seeing her for routine exams, but this time she felt there was a more serious problem that I needed to take a look at," he said. "It turned out I had to hospitalize [the patient] for a mild case of congestive heart failure." 

Since 1991, Forest Lake has employed PAs, and, over time, most physicians have become comfortable with them, said Kathy Dill, clinic manager. The clinic is owned by 18-hospital Allina Health System and employs its physicians, PAs and other health professionals. 

"We use PAs as independent practitioners under the supervision of physicians," Dill said. "They share their own panel of patients and pick up the slack when physicians are unavailable. Some doctors aren't comfortable with them. A lot depends on how good they are at mentoring and how busy their practice is." 

Dill said some female patients ask for the PAs because they are women. "There are gender issues," she said. "Having PAs in the mix helps give patients quicker access to our system. We also use them as on-call backup when a physician isn't available." 

Working in parallel
At Regions Hospital in St. Paul, Minn., Steve Wandersee, the lead emergency medicine PA, works alongside physicians, nurses and medical students. Some 26% of PAs work in hospitals. 

"The [eight] PAs work in parallel with our residents," said Dr. Ankel, emergency medicine residency director, during a Wednesday evening shift in June. "As residents rotate through the department, they learn to work with PAs and nurses. It is a good educational experience." 

When Wandersee first started at Regions in 1984, nobody knew what a PA was or what they did. "Now we are accepted members of the health care team," he said. 

Like attending physicians and residents, Wandersee waits for emergency cases to be wheeled in from ambulances or admitted as walk-ins by triage nurses. "If a patient comes in with a chest pain, they get bumped up to the critical care unit," he said. 

Using a computer at the doctor's work station, Wandersee checks the "who's next board" that lists all the patients the nurses have triaged and their symptoms. "I take the next one on the list," he said. 

Next up on the board is a 77-year-old man with a 103-degree temperature and a history of heart failure. Brought into the hospital from a nearby nursing home, the patient had vomited once earlier that day and was in a mild state of confusion. Wandersee ordered chest x-rays, blood tests and an urinalysis. Within 15 minutes, Wandersee and Kathleen Neacy, MD, chief of the critical care unit, were examining the chest x-ray. 

"This doesn't look nice to me," said Dr. Neacy. "There's fluid in there and wedging at his lung bases." The two decided to wait for the lab test results before committing to a course of treatment. After less than 70 minutes, the lab results came back: white blood count above 20,000 and a urinary tract infection. "We will put him on Cipro [ciprofloxacin] and admit him," Wandersee said. 

Five years ago, PAs at Regions performed intubations, Wandersee said. But when Regions added an emergency medicine residency, their workload changed. 

"The residents have to do so many procedures that it takes away some of our responsibilities," Wandersee said. "There still is plenty of work for everybody." 

 ADDITIONAL INFORMATION: 
PA educational requirements
Training. Training of physician assistants follows the medical model. After about three years of what amounts to "pre-med" studies, PAs train in clinical rotations in medical and surgical specialties alongside medical students at hospitals and clinics. 
Coursework. At least two years of college courses in basic science and behavioral science. About one-third of PA schools now require a bachelor's degree for admission and grant master's degrees upon completion. The typical PA student is at least 28 years old, has a bachelor's degree and four years of health care experience. 
Program length. PA programs are 25 to 27 months long, which includes 2,000 hours of supervised clinical practice prior to graduation. During their "internship," PAs rotate through medical and surgical specialties (family medicine, internal medicine, obstetrics and gynecology, pediatrics, general surgery, emergency medicine and psychiatry). 
Certification. Some states and employers require PAs to be certified. To become certified, PAs are required to complete 100 hours of continuing medical education every two years and take a recertification examination every six years. PAs do not have specialty boards. 

Source: American Academy of Physician Assistants   Back to Top
--------------------------------------------------------------------------------

Pertinent PA facts
Physician assistants work an average of 44 hours a week compared with 57 for physicians. 
PAs earn an average of $68,000 a year compared with family physicians, who earn an average of about $141,000. The average age of a PA is 41; 55% are female and 45% are male. 
Medicare covers medical services provided by PAs at 85% of the physician fee schedule. Medicaid programs reimburse PAs for their services at 75% to 100% of physician rates. Private insurers generally cover medical services provided by PAs when they are included as part of the physician's bill or as part of a global fee for surgery. AMA policy calls for "reimbursement for services of a physician assistant be made directly to the employing physician." 
Under physician supervision in medical practices, PAs perform examinations and procedures, order tests, provide follow-up care and help with the coordination of care for patients with complex illnesses. In surgical practices, PAs take preoperative histories and physical examinations, order tests and help surgeons with postoperative care. 

PROFESSIONAL ISSUES Copyright 2003 American Medical Association. All rights reserved. 
Avoid legal pitfalls when hiring physician extenders
By Tanya Albert, AMNews staff. July 14, 2003.
Tanya Albert covers legal issues. (312) 464-5748 (tanya_albert@ama-assn.org) 
--------------------------------------------------------------------------------
excerpted from source: http://www.ama-assn.org/sci-pubs/amnews/pick_03/prca0714.htm

As physicians look for ways to see as many patients as possible, nurse practitioners and physician assistants are finding their ways into physician offices in greater numbers than ever before.
...
American Medical News talked to Raymund C. King, MD, an otorhinolaryngologist who practiced medicine for 10 years before obtaining his law degree. 

Question: To start, what are some of the legal differences between a nurse practitioner and a physician assistant of which physicians should be aware?
...
Physician assistants are licensed to practice medicine under a physician's supervision and can practice only under a physician's license. They can conduct physician exams, diagnose and treat illnesses, order and interpret tests and can write prescriptions in most states.
...
Q: So how should physicians safeguard themselves legally when working with a physician assistant?

A: Get to know the PA's clinical skills and expertise. Watch him or her interact with and evaluate your patients. Review charts. Physicians often get into trouble when they sign off on everything a PA does without reviewing the chart or without examining the patient when they are unaware of the PA's clinical competence or expertise. The bottom line: How much do you, the physician, trust that person's clinical expertise?
...
Q: Any other things to be aware of?

A: Yes. If a physician assistant is registered with the state to work under your license, but not registered to work under your partner's license, don't let the PA see your partner's patients until he or she is registered under your partner's license, too.    -end-

RESPONSES TO ARTICLE:

Robert M. Blumm, MA PAC
Immediate past president AASPA

I appreciate the insights in Dr. King's article on liability for the "mid levels" yet he is not all together accurate on his investigation of the Physician assistant.  PA's are licensed Health care Providers who practice medicine as dependent practitioners. PA's must by their definition, work with a Physician whose presence is not required in the office while the PA cares for the patient.  the error of Dr. King is that PA's do not practice under their Physicians license.  Yes, a physician is responsible for the actions of their PA but in most states they need not identify the physician or physicians with whom they engage in the practice of medicine.  They are licensed or registered by the state and the only legal issue is that their is supervision that is ongoing.  There is no requirement that a PA needs to identify the state agency or malpractice carrier of the individuals with whom they are employed.

Thanks for allowing me the correction.  It still make sense to hire PA's and NP's as they provide the physician with the opportunity to maintain a fairly normal lifestyle which is of great importance in these days.

Sincerely,
Robert M. Blumm, MA PAC
Immediate past president AASPA
 

Jim Gunther, E-Mail: JJG1@riskmanagementseach.com
Principal, Harvard Aimes Group
www.RiskManagementSearch.Com

Anyone who hires an a PA and thinks they can protect themselves' from legal liability, is making a BIG mistake. 

Furthermore, they are running a real chance of a run-in with the IRS. 

Many small businesses try to get around Work Comp, F.I.C.A.,  and F.U.T.A. costs and, invariably, lose out if they are audited. When the principal sets the hours of practice (for the extender) and/or CONTROLS other key parts of the extender's practice (such as "which" patients the extender will see"), he's 'gonna be seen (by the IRS) as the employer. 

From a liability point-of-view, if the Principal has presented "an extender" to his patient THE 
PATIENT IS RELYING ON THE ENDORSEMENT OF THE DOCTOR, there is NO WAY  the principal is going to escape liability for actions taken by the extender during the ordinary course of his/her duties as extender." 

About the only "POSSIBLE BENEFIT" to bringing someone in as an independent contractor is the possibility that one more insurance policy "might" be brought in should there be litigation.  Such a scenario could actually work against the Principal and, practically speaking, only manages to "muck things up" to the benefit of plaintiff's attorney. 

Like all free advice - take the article (and this response) for what it's worth.

Jim Gunther,  Principal
E-Mail: JJG1@riskmanagementseach.com
Harvard Aimes Group
www.RiskManagementSearch.Com
Phone (203)-933-1976
FAX   (203)-933-0281

First of all, and perhaps most important, the fact that a physician assistant goes through numerous checks and balances, as it were, should stand alone as a defense for the position, both individually and as a whole, i.e., as a profession.

As for the issue concerning the capabilities of a physician assistant to carry out his or her duties in the capacity of a physician's office, there is an issue that was overlooked by the author of the article, which is the use of protocols.  Such protocols generally exist, as in the state of Florida, that define the limits of a nurse practitioner, whereas a physician assistant, on the other hand, by design and by training, should be able to perform (within prescribed limits) only those practices that are shared by the physician(s).  I don't think anyone has any problem if a physician logically questions the ability of a physician "extender," as it were; it is merely an intelligent and often necessary means to an end: can the physician assistant perform; and this is the reason for the interview and the training process that ought to exist before the physician feels comfortable with the job description(s).

The issue that is in question is obviously the idea of using a physician assistant as a contracted employee.  These situations occur all the time in different situations, but it is clear that, if a PA is to practice medicine, he or she is to see the patients that are assigned to the physician through which he or she is licensed.  Doing anything less than that is putting the PA as well as the physician in jeopardy.
Mark Abell, BS, PA   Mea305@aol.com

Physician  Help Thyself Take Another Look at Physician Assistants By Larry Rosen, PA-C, Vice President California Academy of Physician Assistants

A physician from La Jolla raised his hand. “ So, I don’t have to be in the office when you see patients? Lowering her voice so as not to disturb the speaker, a neurosurgeon wondered, “He’s saying that PAs work in psychiatry? And oncology?” And “yes” also was the answer to the Santa Monica pediatrician: “If I’m stuck in the clinic, you can round on hospital patients for me?”   he physician assistant profession was conceived by physicians, for physicians, to extend health care beyond the physical reach of the medical doctor. So why has it been such a struggle to get that message across? Today, 46,000 “PAs” practice medicine in the United States, writing 223 million prescriptions. Millions of dollars are generated annually for physician offices by PA-patient encounters in virtually every medical specialty. Despite an impressive record, the physician assistant remains a misunderstood, often unfamiliar commodity in the medical community. And, while the physician assistant profession is committed to the practice of team medicine and harbors no ambition for independent practice, we have failed to deliver that message broadly to physicians. Commonly, we used PAs to deliver the message. Maybe, a different approach was needed. Who better to explain the benefits of the team concept of medical practice than the physicians who embrace it? We tried it. Four years ago, the Los Angeles Mid-Level Providers (LAMP) in association with California Academy of Physician Assistants (CAPA) asked a group of physicians who work with PAs to talk to an audience of physicians who did not. Team practice with PAs was the theme. Tons of questions were asked and answered. Two hours of Category I CME credits were awarded. The results were promising. Orange County was next. More than 60 physicians attended. A few weeks later, one newcomer even bought space at the CAPA Palm Springs conference in October and put up a sign, “Wanting to Hire a Physician Assistant.” He did just that. CAPA hosted three more events in conjunction with county medical societies, one in San Diego with special guest, Jim Hay, M.D. CMA vice speaker, one in Palo Alto with special guest, CMA CEO Jack Lewin, M.D., and another our most recent event in Riverside with CMA President Ronald Bangasser, M.D., in attendance. In all cases, CAPA enjoyed the support and cooperation of each county’s medical society. Evaluations were laudatory. Physicians were grateful for the education about PAs. They welcomed the CME credits and the opportunity to mingle with colleagues and hear first hand the merits of the physician/physician assistant concept of medical practice. The events became more diverse. Along with physicians, CAPA invited a handful of physician assistants to represent the variety of specialties in which we practice; neurology, OB-GYN, emergency medicine, dermatology, internal medicine, surgery, and hospitalist care. Our physician partners were learning that family practice is not our only expertise. In four years, more than 450 California physicians have attended our program: “The Physician-Physician Assistant Team: The Doctor’s Perspective.” Through these dinner events, misconceptions regarding the PA practice are erased. Supervisory regulations are clarified. Reimbursement issues are explained in detail and simplified. Physicians walk away with a much clearer understanding of the physician assistant profession and why PAs have earned a respected place in California’s health care system. Physician to physician encounters have proven to be the most effective method of sharing the experience of working with PAs and we are grateful to our supervising physicians for lending their voices and support to our efforts. Physicians interested in attending “The Physician-Physician Assistant Team: The Doctor’s Perspective” may contact the CAPA office in Santa Ana at 714/427-0321. CAPA will contact you when a dinner event is planned in your area. source:http://www.calphys.org/html/bb376.asp   Back to Top

More family doctors find PAs to be practice assets The number of physician assistants has doubled during the past 10 years, with the largest employment growth in group practices. By Damon Adams, AMNews staff. Nov. 17, 2003. Three years ago, Susan C. Taylor, MD, took a step that made her solo practice more efficient. She hired a physician assistant.  The PA helps the Philadelphia dermatologist plow through paperwork and allows Dr. Taylor to have more time with patients. The PA also handles follow-ups on acne and warts and reviews routine biopsy reports. "Having a physician extender has worked well to accommodate my patients," Dr. Taylor said. "[Without the PA] the wait would be longer, things would not move as smoothly and I would be overworked. They're just a wonderful addition to medicine." Dr. Taylor and other physicians are increasingly employing PAs in solo and group practices while the number of PAs in hospitals has decreased slightly. The number of working PAs more than doubled the past 10 years, rising from 23,300 in 1993 to 50,121 this year, according to the American Academy of Physician Assistants. A 2003 survey of PAs by the academy found that 12.9% of PAs work in a solo physician's office, up from 9.1% in 1998. The percentage of PAs working in group practices climbed from 26.3% in 1998 to 30.4% in 2003. "Increasingly, it's becoming apparent that it really does require a team to deliver quality, affordable and accessible health care. A single physician can't do it alone," said Steve Crane, AAPA executive vice president and CEO. About eight years ago, when a multispecialty group in Salem, Ore., brought in PAs to work with their family physicians, there was some reluctance because PAs were seen as a threat, said David Edmonds, MD. But the doctors soon realized the PAs freed them up for more quality time with patients and filled gaps when doctors went on vacation. "They've been a help to us more than a competition," Dr. Edmonds said. "We've always had a cash flow from their services." Into the office With more PAs working in doctors' offices, fewer are working in hospitals, the AAPA survey said, down from 37.2% in 1998 to 36.4% in 2003. The percentage of PAs at community health centers dropped from 11.1% to 8.3% during the same period. The change reflects the general shift to outpatient care, Crane said. According to a Center for Health System Change study released in May, the number of doctors outside of institutional practice settings who worked with PAs and similar caregivers increased to 48% in 2001 from 40% in 1997. Group practices of three or more doctors showed the biggest increase of nonphysician caregivers, from 53% in 1997 to 66% in 2001. PAs at Harvard Vanguard Medical Associates, a multispecialty group with 14 sites in and around Boston, often take preoperative histories, remove sutures and do postop checks. "We try to approach it as a team concept. This way, the patient feels there's more than one person who actively knows what's going on with them," said Brent Shoji, MD, Harvard Vanguard's chief of surgery. ADDITIONAL INFORMATION:  Shift to specialty Physicians are increasingly employing physician assistants in their solo and group practices, signaling a slight job shift from hospitals and other facilities. In 2003, PAs found jobs in several different specialties: Family/general medicine 30.9%  Surgical subspecialties 20.4%  Emergency medicine 10%  Internal medicine subspecialties 9.5%  General internal medicine 7.8%  Obstetrics and gynecology 2.8%  General pediatrics 2.7%  Industrial/occupational medicine 2.7%  General surgery 2.6%  Pediatric subspecialties 1.3%  Other 9.3%  Source: American Academy of Physician Assistants source:http://www.ama-assn.org/amednews/2003/11/17/prsd1117.htm  Back to Top

Eden, a local physician assistant and registered diagnostic  cardiac sonographer, is using this cardiovascular ultrasonic machine to look at the heath levels of the heart and blood vessels.  CNJ staff photo: Eric Kluth Arterial health is only a scan away By Gary Mitchell gary_mitchell@link.freedom.com  Although his new business, Clinical Diagnostic Services, is only a couple of weeks old, owner/manager Troy Eden is setting up branch offices in three states.  Clients come to his centers to get a computerized scan, similar to a sonogram used to take pictures of a baby in a mother’s womb, of a blood vessel in the neck or a blood vessel in the leg.  “It’s our goal for the business in Clovis to be the central analysis site for the acquisition centers in other areas,” said Eden, who is a physician assistant, a registered vascular technologist and a registered diagnostic cardiac sonographer.  “The technicians send it to me here via our telephone hookups, and I send a report back the next day,” Eden said. “We have office sites in Billings, Mont., Salt Lake City, Utah, and we’ll soon have one in Las Vegas, Nev.”  That scan can tell a lot about the person’s cardiovascular health, Eden said.  “My belief is that we typically deal on the wrong side of heart disease,” he said. “We wait until people have already had a heart attack or stroke. People need to have this kind of testing prior to any symptoms occurring because there’s something we can do about it, especially with the medications we have now.”  Taking these tests have been proven scientifically to reduce people’s risks up to 60 percent, Eden said.  “But people say, ‘Why would I want to know that (I have high risk factors)?’ That’s based on the assumption there’s nothing you can do about it,” he said. “But that’s not true. You can do something about it. This test is by far the earliest indicator of arteriosclerosis. We try to find people in their 30s or 40s to let them know how their cardiovascular health is progressing. Then they have more opportunity to get back on a right road. We offer them the opportunity for greater information they can share with their doctors.”  Eden said 25 to 30 percent of people who have heart attacks have normal cholesterol levels, so it’s the other factors that make the difference.  “People say, ‘It’s just a man’s disease,’ but it’s the number one killer of women,” he said. “Everybody preaches early detection. Well, this is a way of early detection.”  Eden’s sister, Tuni Theonnes, is a registered nurse who operates a satellite site in Billings, Mont.  “The public is really receptive, and people want the test,” she said. “We’ve been getting a lot of calls, and we have a lot of scans scheduled. We’ve been open a little more than a week. We don’t have an office yet, so we take the test to where the people are. They love the idea of a technician coming to their home.”  Theonnes said she needed a change after serving for 29 years in critical care.  “It’s time for people to get proactive — and not reactive — about health care,” she said. “It may take a while for the medical community to accept the idea of it. It’ll just take time.”  Eden said his office offers four tests to people — all based on research and scientific literature.  Digital sonography offers the best way of identifying risk factors for the least money, Eden said. The primary screening — known as quantitative intima media thickness — measures the average thickness of a portion of the carotid artery, a vessel that supplies blood to the brain. Numerous studies show thicker blood vessel walls mean higher risk for heart attacks. The images also show buildup of plaque on the wall of the artery, which increases the risk for stroke.  “It may sound complex, but everything we do is simple, inexpensive and backed up by tons of literature,” he said. “We want to work with people’s doctors to institute a primary cardiovascular (heart and stroke) prevention program. That’s what we do.”  In 2000, the American Heart Association endorsed the procedure as part of a complete cardiovascular diagnostic evaluation. Clients at risk will be urged to talk to a doctor about possible treatment options, Eden said.  Patients are given a copy of an image of their blood vessel along with a chart comparing the thickness of their carotid artery to ideal thickness, Eden said.  “We look at the sum of all your risk factors, and how those risk factors are affecting your arterial health today,” he said.  Eden stressed that Clinical Diagnostic Services of Clovis will not provide patient care or treatment recommendations. Only a doctor’s office should provide that, he said.  Eden came to the Clovis-Portales area not long ago.  “My wife, Dr. Kirin Madden, is a doctor, a family physician at Cannon Air Force Base,” he said. “She just finished her residency at the University of Utah, and Cannon was her first duty assignment. I started my business there in Salt Lake City.”  Eden said Clovis has been enjoyable so far.  “It hasn’t been that bad,” he said. “I love the people of Clovis. Right now, I’m doing all the cardiovascular diagnostics out of Roosevelt General Hospital, and I’m also doing the cardiac diagnostics in Tucumcari. I go there once a month. My business here in Clovis is just getting started. I still want to meet with the doctors in the area. I’ve been doing what I do for 20-plus years.”  source:http://cnjonline.com/engine.pl?station=clovis&template=storyfull.html&id=2285   Back to Top Posted on Fri, May. 14, 2004  EDITORIAL: Calling all PAs, NPs OUR VIEW: Turn to physican assistants and nurse practitioners as one solution to the rural hospital crisis. As Herald staff writer Ryan Bakken showed, rural hospitals are vital to a community's economic health. No wonder small towns pull out all the stops to save their local hospital. Here's another idea to help them in this fight: Let nurse practitioners and physician assistants and paramedics carry more of the medical load. Bakken's series documented two key trends. First, most small-town hospitals are having a hard time recruiting doctors. They're getting important relief from federal programs that encourage foreign-trained physicians to work in rural areas; those programs should be expanded. But the other trend suggests that in addition, a new staffing response is called for. This second trend shows hospitals in small towns giving up many traditional services, such as delivering babies. These hospitals contract until they're down to the most basic service of all: emergency care. As Bakken wrote, "When asked for the No. 1 reason for maintaining small-town hospitals, residents' answer is always the same: for the emergency room." The insight that should be debated in Congress and elsewhere is that as hospitals lose their advanced services, they lose their need for a physician, too. Why not rely more on other primary-care providers such as physician assistants and nurse practitioners? Physician assistants, for example, are the senior medical officers aboard some Coast Guard cutters. If a sailor gets hurt at sea in the middle of the Pacific, the PA shoulders the load. Could small-town emergency rooms be staffed on the same principle? Could physician assistants and/or nurse practitioners - working closely with physicians at a metro hospital, and quickly transferring critically ill or injured patients after stabilizing them - deliver the needed care? It costs less money to train a physician assistant than a full physician, and less to pay the PA's salary, too. So a federal initiative to ramp up the supply of these practitioners would be more affordable than an effort to train more doctors. Small towns need to save their hospitals and must think creatively to do so. And as they pare the hospital down to its most basic mission, they should be empowered to pare down the staffing requirements, too. -------------------------------------------------------------------------------- Tom Dennis for the Herald  source: http://www.grandforks.com/mld/grandforksherald/news/opinion/8662952.htm   Back to Top

Want to improve quality? Increase income? Decrease stress? Team with a PA
By Peggy Peck

There's a simple solution for family physicians who are stressed by patient overload, worried about declining revenues and unable to remember the last time they took a vacation. The solution? Hire a physician assistant, says family physician Keith White, M.D., of Independence, Ore.

"A PA is essential for any family physician who wants to improve practice revenue, improve patient quality of care and improve quality of life," says White, the primary presenter at yesterday's core practice management and professional development course titled "Enhancing Practice Revenue, Productivity & Lifestyle Utilizing Team Practice with PAs."

White says that his PA costs the practice $78,095 a year, an amount composed of salary ($50,000) and a generous benefits package including pension, 401K and health insurance. "But the annual profit generated by my PA is $65,682, which works out to $5,474 a month that is added to my income," he says. [PAworld: PAs average salary about  $72,000/yr-clearing by this example an annual profit of $ 43,682 yielding additional income of $3,640/mo.] 

While some practices encourage PAs to develop their own patients, White says that he prefers a team approach in which "we each see the same patients, which means that the patients know both of us and we know all the patients." For new patients, White does the initial physical and takes time to explain that he works with a PA, who may be the provider that the patient sees on the next visit.

In White's practice, the PA participates at every level. For example, White says, "when I'm on call, she takes first calls." This top-to-bottom integration of the PA "keeps me happy, keeps my staff happy and keeps my family happy," he says. "Plus it improves my cash, and when I return from vacation, there is no flood of patients or paperwork greeting me."

Likewise, when the PA is on vacation, White is at the office.

White's co-presenters were Lynn Caton, PA-C, an assistant professor at Oregon Health Sciences University in Portland, and Michael Powe, director of health systems and reimbursement policy at the American Academy of Physician Assistants in Alexandria, Va. They discussed the PA-physician team from the PA's viewpoint.

Caton says PA training takes roughly 26 months, with "nine to 12 months devoted to classroom work and 55 weeks rotating through 11 specialties." He says the most popular PA specialty is family medicine, with 31 percent of PAs practicing in that area. As a group, PAs are the third fastest-growing profession, says Caton, who added, "the number of PAs is expected to increase by 50 percent in the next five years."

Powe says that most insurers will reimburse PAs directly, although at a lower rate than payment to physicians. For Medicare billing, PAs need a separate Medicare provider number. Medicare reimburses PAs at 85 percent of the physician reimbursement, he says.

For physicians who are anxious for a quick fix to an overburdened practice, Powe says that an experienced PA can "almost hit the ground running. My wife is an internal medicine PA, and she can be up to speed in a new practice in about three weeks." 

source: http://www.aafp.org/fpr/assembly2004/1015/6.html   Back to Top

Working alongside physicians, Bill Mahaffy has harvested arteries and treated patients in cardiac-care units, but he's not a physician; he's a physician assistant (PA), an occupation that is expected to be one of the fastest-growing over the coming years. 

PAs, who work under the supervision of doctors, are highly trained, licensed healthcare professionals who treat and diagnose patients, perform various medical procedures and act as a liaison with nurses, lab techs and others on the healthcare team. In 48 states and the District of Columbia, PAs can even prescribe medication. 

With greater demand for healthcare services, Mahaffy says PAs are “taking care of about 80 percent of what the doctors used to,” freeing doctors to focus on more complicated cases. 

For those willing to undergo the rigorous required medical training, the PA profession offers excellent prospects and a variety of opportunities for specialization. 

Fast-Growing Field

Mahaffy, a certified physician assistant (PA-C) at Evangelical Community Hospital in Columbia, Pennsylvania, became a PA about 10 years ago after 25 years as a paramedic. “I had colleagues who were PAs, and it seemed like a logical progression,” he explains. “It was the best career choice I ever made.” 

It's a promising one as well. According to the US Bureau of Labor Statistics, the occupation will be the third fastest-growing professional job in the nation through 2012, when the number of PAs is expected to increase to 94,000, up 49 percent from 2002. The median annual salary is about $65,000, with the top 10 percent earning more than $90,000. 

While salaries are high, aspiring PAs must be willing to tackle one of the more extensive health education programs outside of traditional medical school. Most physician assistant programs [http://www.aapa.org/pgmlist.php3] require applicants to have previous healthcare experience and some college education. The typical applicant holds a bachelor's degree and has worked in healthcare for four years, according to the American Academy of Physician Assistants [http://www.aapa.org/]. PA training usually takes about two years full-time. In addition, graduates must pass a national certifying exam to obtain their state licenses. Continuing education is also required. 

Like Mahaffy, many PAs segue naturally into the occupation from other healthcare fields. Mahaffy has seen former nurses, exercise physiologists, fitness trainers and even two mortuary technicians become PAs. 

The Adrenaline Rush

PAs can be generalists or specialize in areas such as cardiology, pediatrics, psychiatry or trauma. [https://members.aapa.org/extra/constituents/special-menu.cfm]

Mahaffy, who is president of the American Association of Surgical Physician Assistants, [http://www.aaspa.com/] is a surgical PA specializing in cardiothoracic procedures. He's harvested arteries for cardiac surgeons, put in dialysis catheters and inserted feeding tubes. Today, as a hospitalist (another specialty), he works anywhere outside the OR where surgical expertise is needed. For example, one of his duties in the cardiac-care unit is providing chest drainage to patients with congestive heart failure. 

Mahaffy works five days on, five days off, starting at 5:30 a.m. or 6 a.m. for what are supposed to be 10 or 12-hour shifts, but he stays as long as he's needed. His specialty can be “a young man's game,” he admits. “You can live on adrenaline and caffeine.” 

In a Family Way

Charlene Morris, MPAS, PA-C, offers another look at a PA's life. A former lab tech, Morris has been a family-practice PA for 24 years. While she has been employed at major medical centers, she now works alongside a family-practice physician at the B.F. Taylor Medical Arts Family Medicine Clinic in the small town of Burkesville, Kentucky. 

She describes the relationship with the doctor she supports as “very complementary” and says she loves the versatility of family medicine. “I'll handle everything from colds and rashes, to sports injuries, to people with diabetes,” says Morris, who is president of the Association of Family Practice Physician Assistants. [http://www.afppa.org/]

Earlier this year, she widened her work's scope by dividing her time between the clinic and the Cumberland County (Kentucky) ER. “I've had to go back and expand my suturing skills, and we have to be up on advanced cardiac life support,” she says. 

Morris and Mahaffy emphasize the flexibility in their careers and agree that they could move into other areas, from neonatal to aerospace medicine. “PAs can work in any and all settings with their physician colleagues,” Mahaffy says.

source: http://healthcare.monster.com/articles/physicianassistant/         Back to Top

By  Miranda Hitti 

Reviewed By Charlotte Grayson, MD
on Monday, November 01, 2004
WebMD Medical News

Nov. 1, 2004 -- The U.S. may need up to 200,000 more doctors than it will have by the years 2020-2025, says Richard Cooper, MD, of the Medical College of Wisconsin.

Writing in the Nov. 2 issue of the Annals of Internal Medicine, Cooper says the U.S. already needs more doctors and that the gap will grow in coming years. 

"In simple numeric terms, the number of physicians is no longer keeping up with population growth," he writes. 

Current doctor shortages "are confined to certain specialties, and the severity of these shortages varies across the nation," says Cooper. 

He says the same problem also faces Canada, the U.K., Australia, and New Zealand but that many of those countries are seeking to add more doctors through strategies such as building more medical schools, finding ways to attract more medical graduates trained overseas, and expanding class size at medical schools.

The potential problem should be considered, writes Alan Gerber, MD, PhD, of Stanford University School of Medicine in an editorial in the same edition of the Annals of Internal Medicine. However, Gerber writes that he isn't sure about a looming doctor shortage since many unforeseeable factors could influence future demand for doctors.

New medical developments could either increase or decrease demand, and there's no way to know that now, writes Gerber. He also writes that tomorrow's senior citizens may be healthier than past generations and that changes in health care financing may also have an impact.

"We need to think carefully about how these factors may change how to use health professionals, including physicians, nurse practitioners, and physician assistants, more effectively," writes Gerber, who says a "prudent strategy" could be to increase America's doctor supply gradually if the need is confirmed.
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SOURCES: Cooper, R., Annals of Internal Medicine, Nov. 2, 2004; vol 
141: pp 705-714. Gerber, A., Annals of Internal Medicine, Nov. 2, 
2004; vol 141: pp 732-734.       Back to Top

I know there are probably many PAs out there who believe that they are not respected for what they do at work, day in, day out.

Well, I'd like to share a story with you about the power of one PA and the changes that can be felt citywide because of ONE SOLE PA who went about her work.

(I'm going to change the identity of some people in the story to protect them from being identified, otherwise everything else is 100% true and I  have verifiable sources for this story.)  

Sandy, had been a PA for 18 years and was working in an academic medical center in the department of medicine, where she ran several out-patient clinics as well as taught at the medical school, precepted NP and PA students, and did clinical research.  Her research results had been presented several times at national physician meetings.  Her writing skills
were such that she had been involved in writing NIH funded training grants as well as other grants.  She was also the author of more than 50 published articles in the commercial and medical journal arena.

Over the years of working in the department of medicine she had come up against numerous MDs who didn't like the idea that the institution employed mid-levels.  She was aware that this attitude came from the very top down, it even included the CEO, who had expressed adamant beliefs that mid-levels didn't belong within the institution.  This belief even extended to the daughter of the CEO (a MD) who had worked with Sandy and had told her mother that she wanted to go to school to become a PA.  Upon hearing this, the CEO told her daughter that she wouldn't pay for her schooling unless she went to
college with the intention of going to medical school.

The second in command under the CEO (just prior to being promoted to his current  position) had been head of the community health clinics (10 of them).  His mission (we shall call him Dr. P ) for the past 4 years had been to get rid of mid-levels within the community clinics.  He had been partially successful, he had gotten rid of 8 of them, and replaced all of them with MDs.

The mid-levels (NPs and PAs) 'ran scared' of him.  They dared not cross him, he was biased, preferring to believe the mid-levels didn't know what they were doing, and choosing not to listen to their concerns.

Then came the time for the leadership retreat, all department heads and higher executives were told to attend.  During the retreat the CEO told everyone in attendance that she was going to implement group patient clinic appts, much like what Kaiser Permanente was doing.  Sandy had already begun to initiate a similar idea in her clinics, especially when her RN had to show patients how to do their injections.

Then it came time for the Department of Medicine head (Sandy's boss' boss) as well as the Division of Orthopedics to do their presentation on the usage of mid-levels within their respective areas.  There were 5 ortho PAs and the surgeon told the audience that they were very useful as surgical first assistants.  He went on to show how financially his division couldn't handle all of the multiple trauma cases they had without the PAs on board.

Then the Department of Medicine Chief got up and did his presentation.  Sandy was the only mid-level within his department.  He explained to the audience (which included the CEO and Dr. P) that he had been so impressed
with what Sandy had accomplished that he was hiring three other mid-levels in his department within the next 3 months.  He went on to explain how financially she had brought in payer sources as well as had the highest rate of remission (compared to the national levels) in the patients she treated.
 

He raved so much about what Sandy had accomplished that two MDs the following Monday caught Sandy in the hallways and told her that they had heard about her work and that there had been quite a bit of talk about her.  Having no knowledge of what they referring to, she just said 'thank you' and went on about her work.  Little did she know that both of these MDs had been at the leadership retreat and heard her boss' boss speak just the prior week.

But, what was most important was that both MD presentations on mid-levels and their usage, turned the heart of the CEO.  At the end of the leadership retreat, she told everyone in attendance (including Dr. P) that the attitude
and emphasis in this academic medical center would henceforth not only be friendly towards mid-levels but that they were to be hired and kept.  Not only were they needed for financial reasons but two of them could be hired for every MD on board.  Therefore twice the amount of patients could be seen for every MD hired.

With this change of heart, the mid-levels in the community health clinics could breath again, relax and go about doing what they did best.  So not only did Sandy's work affect her immediate division within the department of medicine, but it also affected patients having access to healthcare out in the community.  Mid-levels would once more be hired to fill the empty
clinical positions in the clinics.

So if any of you ever think that you don't have an impact on others, or on what is going on around you at work, think again.  A sole PA can indeed make the difference!          Back to Top

 

More Links Here's What Physician Assistants can do:  http://www.paworld.net/whatpadoes.htm Here's the professional Medical Training Physician Assistants receive: http://www.paworld.net/medicaltraining.htm Physician Assistants Are Ready, Willing and Able to Meet Needs: http://www.paworld.net/pasmeetneed.htm Here's the Medical Team of the Physician Assistant:  http://www.paworld.net/pateam.htm Here's an example of the Motivation Physician Assistants have: http://www.paworld.net/whyichosepa.htm Here are the kinds of questions & dynamics that will help make your practice successful: http://www.paworld.net/paemployerquestionnaire.htm Here are some of the contract issues Physician Assistants encounter: http://www.paworld.net/contractissues.htm Here are samples of the quality of Physician Assistant studies: http://www.paworld.net/casestudies.htm Here's where to find a PA in your area: http://www.paworld.net/postresume.htm Here are some sample PA Resumes and contacts:  http://www.paworld.net/resume.htm Here are PA Recruiters that can help:  http://www.paworld.net/recruiters.htm

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