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to excellence in their medical practice and patient care...
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
SCOPE OF PRACTICE includes:
PATIENT'S EVALUATION: Patients highly
value PAs for their exceptional people skills in uniting their advanced
medical expertise with outstanding quality patient care by:
Comprehensive physical assessment; evaluating, diagnosing,
and treating new and existing patient's medical and surgical conditions.
Initiating and interpreting labs and x-ray studies
including CTs & MRIs.
Performing medical and surgical procedures.
Prescribing and referring patients for specialized
Assisting Physicians in medical and surgical procedures.
Using prescriptive authority to write prescription
medicines for patients.
Write/Dictate progress notes on patients' charts
indicating patient status and treatment procedures performed.
Conducting follow-up patient care.
Providing health education to patients and families.
Supervising and/or coordinating the activities of
patient care and support staff within the clinic.
Training and supervising medical residents engaged
in specific clinical activities.
Teaching and training illness prevention.
Actively participate in community health education.
Performing emergency life saving procedures in cases
such as cardiac arrest, respiratory arrest, massive hemorrhage, or similar
Are among front line medical providers in emergency
Excellent interpersonal and communication skills.
Giving the patient quality compassionate and empathetic
Giving the patient more time through Active listening.
Giving the patient more easily understood feedback
Promoting greater patient health and wellness.
resulting in patients often preferring medical
treatment by physician assistants-associates...
PAs KNOWLEDGE, SKILLS and ABILITIES INCLUDE:
"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 https://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.
Physician Assistants believe when each medical team
member is honored and celebrated for their skills, abilities, and love
of medicine and patients, the whole team benefits and patients received
the best available medical care making the whole health cares system fundamentally
sound.© Back to Top
Ability to perform medical examinations using standard
Knowledge of drugs and their indications, contraindications,
dosing, side effects, and proper administration.
Knowledge of clinical operations and procedures.
Knowledge of primary care principles and practices.
Knowledge of patient care charts and patient histories.
Knowledge of OR, pre-op and/or post-op procedures.
Knowledge of CPR and emergency medical procedures.
Knowledge of current and emerging trends in technologies,
techniques, issues, and approaches in area of expertise.
Ability to clearly communicate medical information
to professional practitioners and/or the general public.
Ability to maintain quality, safety, and/or infection
Ability to observe, assess, and record symptoms,
reactions, and progress.
Ability to make administrative and procedural decisions.
Knowledge of related accreditation and certification
Ability to react calmly and effectively in emergency
Ability to supervise and train staff, including organizing,
prioritizing, and scheduling work assignments.
Skill in preparing and maintaining patient records.
Ability to educate patients and/or families as to
the nature of disease and to provide instruction on proper care and treatment.
Doctor explains procedure Clinton will undergo
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.
scrub nurse will help the surgeons, while two or three "perfusionists"
will run the bypass machine that maintains blood flow while the heart is
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
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
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
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
opportunities ripe for physician assistants
Tuesday, March 16, 2004
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
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
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
There are a number of PAs, MDs and practices
that are willing to help you toward success...email: email@example.com for
Here's just one of the Success
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.
Here's another success story...
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.,
Call (321) 409-8941
"dramatic improvement of my efficiency in the
Dr. Jonathan Paine
“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
EMERGENCY DEPARTMENTS RELY ON PHYSICIAN ASSISTANTS
Daniel Stern, president of the
Penn Hills-based physician placement and health care consulting firm in
it's 16th The Stern Survey
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.
Back to Top
BUILDING check list for MDs & Staff
Hiring a Physician Assistant
[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
_____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
_____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
By William J. Mazzocco
Published May 1998
Excerpted from: Physician's News Digest
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
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
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
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.
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
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
efforts: Expanding the health care team
Copyright 2001 American Medical
Association. All rights reserved.
The use of physician assistants is growing in clinics
and hospitals as more physicians become comfortable with the team care
concept. By Jay Greene, AMNews staff. July 30, 2001.
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,
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
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
"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,"
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
"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."
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.
legal pitfalls when hiring physician extenders
By Tanya Albert, AMNews staff. July 14, 2003.
Tanya Albert covers legal issues. (312) 464-5748
excerpted from source: https://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
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.
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
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.
Robert M. Blumm, MA PAC
Immediate past president AASPA
Jim Gunther, E-Mail: JJG1@riskmanagementseach.com
Principal, Harvard Aimes Group
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
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
Like all free advice - take the article (and this
response) for what it's worth.
Jim Gunther, Principal
Harvard Aimes Group
Mark Abell, BS, PA Mea305@aol.com
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
Mark Abell, BS, PA Mea305@aol.com
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?”
So why has it been such a struggle to get that message across?
||he physician assistant profession was conceived by physicians, for
physicians, to extend health care beyond the physical reach of the medical
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
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
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
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
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.
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%
Source: American Academy of Physician Assistants
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 firstname.lastname@example.org
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
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
“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
“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
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
“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,
“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.”
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
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,
Tom Dennis for the Herald
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
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."
Back to Top
by Wendy J. Meyeroff
Monster Contributing Writer
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
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 [https://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 [https://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, [https://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. [https://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,”
Back to Top
Doctor Shortage for the U.S.?
America May Need 200,000 More Doctors by 2025, Says Expert
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
"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.
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
Power of One
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
(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
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
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
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!
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