Physician Associate /Assistant World Committed to excellence in their medical practice and patient care for the love of medicine and patients winning the heart of medicine and patients-one patient at a time©

CONTENTS
Combat Medics Build Physician Assistant Foundation
Physician Assistants in the United States
The New Profession: The Physician Assistant
Physician Assistants: Monster.com

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Raymond St. Jacques portrays a Combat Medic
pictured with John Wayne in 1968 movie "Green Beret"

Our Physician Assistant / Associate profession owes its formation to a physician in NC who found that he was able to train a young man who worked in his office to do many of the less complex tasks that he performed as a physician. Several NC physicians expanded on this idea. They proposed utilizing the same fast track model that prepared physicians for deployment in World War II.

Duke University felt that this new physician assistant concept could help alleviate the increasing shortage of primary care physicians in rural areas. The nursing profession, who had no interest in developing this idea, turned them down. They decided then that an even better candidate would be corpsmen or medics who were being used in the Viet Nam war. Duke proved that they were able to successfully train these individuals using the WW II fast track model and the PA profession was born.

The excitement of this discovery resulted in a national magazine coming out with an article: "Less than a Doctor, More than a Nurse." [editor: click here for today's definition of a PA]  This got the nursing profession interested in getting in on the concept that they had earlier turned down.
 

Combat Medic Memorial Ft. Sam Houston Museum San Antonio, Texas "We need to be proud of who we are and where we came from. We came from physicians and we came from an extreme interest in helping the under served." John H. Faulkner, PA-C, MPH

Physician Associates /Assistants
Committed to excellence in their medical practice and patient care...
for the love of medicine and patients winning the heart of medicine and patients-one patient at a time© ...

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. Prescribing and referring patients for specialized consultation.
4. Performs high quality sophisticated medical and surgical procedures.
5. Using prescriptive authority to write prescription medicines for patients.
6. Write/Dictate progress notes on patients' charts indicating patient status and treatment procedures performed.
7. Conducting follow-up patient care.
8. Providing health education to patients and families.
9. Supervising and/or coordinating the activities of patient care and support staff within the clinic.
10. Training and supervising medical residents engaged in specific clinical activities.
11. Teaching and training illness prevention.
12. Actively participate in community health education.
13. Performing emergency life saving procedures in cases such as cardiac arrest, respiratory arrest, massive hemorrhage, or similar emergencies.
14. Are among front line medical providers in emergency disaster services.

 

PATIENT'S EVALUATION: Patients highly value PAs for their exceptional people skills in uniting their advanced medical expertise with outstanding quality patient care by:

• 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 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 manage more acute and complex problems." Benjamin G. Druss, MD, MPH Jan. 8, 2003 https://www.medscape.com/viewarticle/447608

PAs KNOWLEDGE, SKILLS and ABILITIES INCLUDE:

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.

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.©

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.

PATIENT'S EVALUATION: Patients highly value PAs for their exceptional people skills in uniting their advanced medical expertise with outstanding quality patient care by:

• 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...

"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.

PAs KNOWLEDGE, SKILLS and ABILITIES INCLUDE:

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.

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.©

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The United States has since the 1960s developed a cadre of physician assistants to work in primary care. They mainly work semi-autonomously in association with individual doctors, but an increasing number work in hospitals. They seem to be well accepted by both doctors and patients and can reasonably expect to take on any unfilled roles for which their training qualifies them

During the mid-1960s a new cadre of providers of medical care, physician assistants, was developed in the United States in an effort to relieve a nationwide shortage of doctors in primary care and to increase access to health care for people in under served areas. The first trainees were highly skilled military paramedics. Today, there are more than 44 000 physician assistants in America. Internationally, the physician assistant model has been in place since 1992 in the Canadian forces, and a somewhat comparable profession exists in India. In different countries, however---Germany, for example---a similar name may be used for a substantially different cadre.

The concept of a paramedical health care provider did not originate in the United States. In the 17th century, medical care was provided in Europe by "feldshers," and the Russian army adopted the model a century later. In the 1960s, China trained more than 1.3 million "barefoot doctors" to improve the delivery of health care. ¹² Recently several countries have become interested in adapting the concept of physician assistants to their needs. In the United Kingdom interest in the concept is increasing, as shown by the call by the NHS and the Royal College of Physicians for an early start of pilot projects. ³⁴ We describe how physician assistants are trained and the role they play in American medicine.
 

Summary points Physician assistants are interdependent semi-autonomous clinicians practicing in partnership with physicians, and are found in almost every medical and surgical specialty  They perform similar tasks to their physician partners, including examination, diagnosis, diagnostic testing, treatment (including referral), and prescribing  Research shows them to be capable of giving care comparable to that of physicians for similar services  Physician assistants have improved access to health care for populations in rural, inner city, and other medically under served areas  With their training modified as needed to integrate with local health systems, physician assistants are a viable alternative to physicians in areas with shortages of doctors, such as the United Kingdom

 

Physician assistants' role

Physician assistants are clinicians who are licensed throughout the United States to practice medicine in association with physicians. They perform many of the tasks previously done solely by their physician partners, including examination, diagnosis, and carrying out investigations, as well as treatment and prescribing. All physician assistants must be associated with a physician and must practice in an interdependent role, described as "negotiated performance autonomy."⁵ They are not to be confused with "medical assistants," who in the United States are support workers.

Physician assistants are not independent practitioners but practice-focused autonomous professionals delivering care in partnership with physicians, in a role described as "negotiated performance autonomy."5 This relationship allows them to staff satellite clinic offices, provide on-call services in the practice, and deliver care in rural areas, as in most states the physician partner need not be physically present for the physician assistant to practice. They may work as house staff in large academic teaching centers, replacing physicians whose posts are no longer funded, and they also serve as commissioned officers in all branches of the American armed forces. They have demonstrated social responsiveness by focusing on primary care practice, thus fulfilling the original intent of the profession's founders to improve access to health care for populations in rural, inner city, and other medically underserved areas.

Numerous studies have shown that the quality of care given by physician assistants is at the level of that given by physicians in comparable situations, with high levels of patient satisfaction.^6-11 Actuarial data do not show any increased liability as a result of using physician assistants.¹² A growing body of research and extensive clinical experience shows that they are accepted by both patients and doctors and that their performance in terms of quality of care, expanded access, and cost effectiveness is satisfactory.^13-20
 
 

Training and certification

Physician assistants spend an average of 25 months studying an intensive core curriculum. This resembles a shortened form of traditional medical education, and emphasizes a primary care, generalist approach. Most students have had four years of medical experience before they start their training.²¹ The United States has 130 training programs in universities, medical schools, teaching hospitals, colleges, and the armed forces. In 2001, about 4500 physician assistants graduated.²¹ Competition for training is intense---in 2001 there were five applications for every place. ^{21 22 On} graduation from accredited training physician assistants mustpass the national certifying examination of the National Commissionon Certification of Physician Assistants, an independent accrediting agency, after which they must complete 100 hours of continuing medical education every two years and pass a rectification examination every six years.
 
 

Clinical duties

The licensing boards in 50 states and the District of Columbia recognize physician assistants as health care practitioners authorised to perform diagnostic and therapeutic tasks delegated to them by physicians. From a legal perspective, enabling legislation empowers physician assistants to perform any clinical task within the scope of practice of, and sanctioned by, their supervising physicians. This wide latitude acknowledges the broad basis of physician assistants' abilities and recognizes their physician partners as the best judges of individual physician assistants' knowledge and skills.

This conceptual framework has led to physician assistants providing virtually every clinical service, excluding primary responsibility for major surgery. ¹⁴¹⁶¹⁸ This does not mean that every physician assistant is qualified to provide every service, even though they may be able to do so "legally."

Physician assistants treat most primary care illnesses on their own without direct supervision by their physician partner.There are no "physician patients" as opposed to "physician assistant patients." Physician assistants routinely deal with uncomplicated sprains, strains, hypertension, bronchitis, depression, allergies, asthma, gynecological problems, family planning, and trauma.

A typical case A 65 year old man with chest pain is seen by a physician assistant who, after a thorough history and physical examination, orders and interprets appropriate tests, such as chest radiographs and an electrocardiogram. If necessary the patient is then either referred to the supervising physician or, in some practices, directly to hospital. There is no definite point at which the physician must take over. Clinical responsibilities vary depending on physician assistants' experience, postgraduate training, and the confidence the physician partner, the clinic, or the institution have in them.

Physician assistants in community practice typically have a regular schedule of patients according to the needs of the particular practice---interviewing, examining, evaluating, diagnosing, and treating the vast majority of presenting patients---without the physician's presence in the room.¹⁶ This allows the physician to focus on the most difficult and complex cases, while still being available for consultation.

In hospitals, physician assistants provide continuity of care for patients. This may take the form of attending private patients, or filling the role of house officer. The demand for physician assistant house officers continues to expand with the shrinking supply of physicians for such posts. They are authorized to prescribe in 47 states, in the District of Columbia, in Guam, and in all branches of the federal government (for example, the armed forces, the Department of Veterans Affairs).
 
 

Specialty practice

Most physician assistants (55% of graduates in the past 15 years ^{15 22} ) continue to practice in primary care, and studies have conservatively estimated that in such roles physician assistants can provide 80% or more of the services previously provided only by physicians---at the same level of quality. ^{21 23} They can be found in almost every medical and surgical specialty---both in broad specialties such as family medicine and general surgery and in subspecialties like cardiothoracic surgery, interventional neuroradiology, forensic medicine, occupational health, and dermatology. Specialized procedures performed by physician assistants tend to be specific to a particular clinical field or setting, not unlike those undertaken by physicians and commensurate with adequate formal or informal postgraduate training. Examples include insertion of central access lines and chest tubes, invasive diagnostic procedures, ambulatory surgery, harvesting of saphenous veins for bypass procedures, and many others.
 
 

Utilization

Physicians who work with physician assistants claim that the advantages outweigh the disadvantages. The physicians can work fewer hours, both in the office and on call, and as they are able to delegate many tasks they can provide better services. Physician assistants commonly share on-call time, and routinely run satellite clinics in under served areas.

Physician assistants allow the physician to have a colleague close at hand. The relationship creates a bond between the physician assistant and physician that is positive for both the practitioners and their patients. Sometimes physician assistants may be a slight encumbrance, requiring an inconvenient amount of the physicians' time, especially in the early stages of the partnership. Physicians are ultimately responsible for their assistants' work and must provide an adequate educational experience, conduct chart reviews, and ensure regular oversight of their clinical activities.
 
 

Comparison with nurse practitioners

On a daily basis, in the United States physician assistants and nurse practitioners function in similar roles. Both can diagnose, treat, and prescribe, but the training of physician assistants is generalist in nature and modeled on medical school curriculums. All physician assistants learn primary care and rotate through the major specialties while in training. Nurse practitioners, on the other hand, have traditionally been trained in one specialty (paediatrics, women's health, etc.). Recently, family practice as a specialty has gained in popularity. Physician assistants are employed more often as house officers within the hospital setting than are nurse practitioners; surgery and its subspecialties are the most popular in-house specialties. Physician assistants are also more involved in emergency care than are nurse practitioners.

Politically, physician assistants consider themselves to be a part of medicine as a member of the physician-led team, and some physician assistants sit on physicians' state medical boards. In contrast, nurse practitioners come from a nursing background and feel closest to nursing. Most state legislation for nurse practitioners sets up the state board of nursing as their regulatory body. Although both groups seek to be part of the medical care team, most nurse practitioners do not feel a political need to be tied to a physician. This has led some nurse practitioners to seek independent practice, which physician assistants have not done. It is the setting and the specialty that determines how these two professions practice, rather than legislative or professional regulations.
 
 

The future

Although it is difficult to predict how physician assistants will further evolve and progress, they can reasonably expect to take on any unfilled roles for which their training qualifies them. Undoubtedly, demand for health care will continue to escalates the population ages and new treatments and techniques are developed and the inexorable development of new forms of treatment and new techniques. Thus, the position of physician assistants in the United States seems secure and growing---the numbers of practising physician assistants are projected to reach 53 200 by 2005 and 79, 000 by 2015.^{14 15} The evolution of the profession, as it matures and barriers to practice continue to be removed, is likely to involve a degree of innovation not yet conceptualized. With their continuing commitment to competency based primary care, improved access to care, and dynamic lifelong learning, physician assistants are well positioned to remain integral to the 21st century US health care network.
 

Acknowledgments

Contributors: DM conceived the idea for the paper and coordinated the writing and editing. All authors discussed the core ideas and contributed to the writing and editing. JC researched references and provided citations. WF researched references and provided guidance. DM is guarantor.
 
 

References

1.	Hooker RS, Cawley JF. Physician assistants in US medicine. New York: Churchill Livingston, 1997.
2.	Ballweg R, Stolberg S, Sullivan EM, eds. Physician : a guide to clinical practice. 2nd ed. Philadelphia: WB Saunders, 1999:1-2.
3.	Stationery Office. The NHS plan: a plan for investment, a plan for reform. London: Stationery Office, 2000.
4.	Royal College of Physicians. Skill mix and the hospital doctor; new roles for the health care workforce. London: RCP, 2001. (Working party report.) www.rcplondon.ac.uk/pubs/wp_skillmix_summary.htm (accessed 14 Aug 2002).
5.	Schneller ES. The physician: innovation in the medical division of labor. Lexington: Lexington Books, 1978:18.
6.	Hooker RS, Potts R, Ray W. Patient satisfaction: comparing physician assistants, nurse practitioners and physicians. Permanente Journal 1997; 1: 38-42.
7.	Counselman FL, Graffeo CA, Hill JT. Patient satisfaction with physician assistants (PAs) in an ED fast track. Am J Emerg Med 2000; 18: 661-665[Medline].
8.	Miller W, Riehl E, Napier M, Barber K, Dabideen H. Use of physician assistants as surgery/trauma house staff at an American College of Surgeons-verified level II trauma center. J Trauma 1998; 44: 372-376[Medline].
9.	Hooker RS, McCaig LF. Emergency department uses of physician assistants and nurse practitioners: a national survey. Am J Emerg Med 1996; 14: 245-249[Medline].
10.	Ruby EB, Davidson LJ, Daly B, Clochesy JM, Sereika S, Baldisseri M, et al. Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison. Am J Crit Care 1998; 7: 267-281[Medline].
11.	Oliver DR, Conboy JE, Donahue WH, Daniels MA, McKelvey PA. Patients' satisfaction with physician assistant services. Physician Assist 1986; 10(7): 51-54[Medline], 57-60.
12.	Cawley JF, Rohrs FC, Hooker RS. Physician assistants and malpractice risk: findings from the national practitioner data bank. Fed Bull 1999; 85: 242-246.
13.	Hooker RS, McCaig LF. Use of physician assistants and nurse practitioners in primary care, 1995-1999. Health Aff (Millwood) 2000; 20: 231-238.
14.	American Academy of Physician Assistants. Into the future: physician assistants look to the 21st century. Developed for the Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. April 1999. (accessed 14 Aug 2002.)
15.	Cooper RA, Laud P, Dietrich CL. Current and projected workforce of nonphysician clinicians. JAMA 1998; 280: 788-794[Medline].
16.	Cooper RA, Henderson T, Dietrich CL. The roles of nonphysician clinicians as autonomous providers of patient care. JAMA 1998; 280: 795-802[Medline].
17.	Cawley JF, Jones PE. Nonphysician clinicians in the health workforce. JAMA 1999; 281: 509-510.
18.	Cawley JF. Nonphysician supply and requirements in the health workforce: personnel and policy. N Y Health Sci J 1998; 2: 117-127.
19.	Jones PE, Cawley JF. Physician assistants and health system reform: clinical capabilities, practice activities, and potential roles. JAMA 1994; 271: 1266-1272[Medline].
20.	Hooker RS. Cost-benefit analysis of physician assistants [thesis]. In: Portland: Portland State University, 1999.
21.	Simon AF, Link MS. Seventeenth annual report on physician assistant educational programs in the United States, 1999-2000. Alexandria: Association of Physician Assistant Programs, 2001.
22.	American Academy of Physician Assistants. 2000 general census. Alexandria: AAPA, 2000.
23.	Pew Health Professions Commission and the Center for the Health Professions. Charting a course for the 21st century: physician assistants and managed care. San Francisco: Centre for the Health Professions, University of California at San Francisco, 1998.

Assisting M.D.s, going where doctors won’t Looking for a physician assistant program? Do you want one that offers an associate’s degree, bachelor’s, master’s or certificate? Are you looking for a program that places more emphasis on previous medical competency training or one that is traditionally academic? These are the questions you’ll have to answer before narrowing down your search of the 134 accredited P.A. programs in the United States. Why so much variety for one field? The answer lies in the field’s origins, said Hank Lemke, director of the Physician Assistant Studies at the University of North Texas Health Science Center. “The profession was founded by the need to fill a void. It was at a time when health-care professionals were looking at cost-effective ways to get physicians into underserved areas,” Lemke said. But the field has evolved. Now P.A.s can function in many practices, no matter the location, as first consultants, before a patient sees a doctor. They fill a staffing need in the age of managed care and big medical practices where M.D.s are spread thin. The profession began in the mid-1960s at Duke University Medical Center. The curriculum was based in part on the fast-track training of doctors during World War II. The first class consisted of Navy corpsmen who received considerable medical training during the Vietnam War, but for whom there was no comparable civilian employment. In short, they were competent medical practitioners but couldn’t practice once they returned to the United States because the civilian medical community didn’t recognize their credentials. P.A. becomes a degreed field As a result of natural evolution, Lemke said, the profession began to move toward degreed programs. However, there is no general consensus in the P.A. community as to what the exact program or degree should be, resulting in somewhat of an academic something-for-everyone hodgepodge of programs. Regardless of whether a P.A. completed an associate’s or a master’s-level program, they both are qualified to sit for a mandatory certification exam, which is the ultimate test for licensure and practice. Upon program completion, P.A.’s must undergo the National Commission on Certification of Physician Assistants, or NCCPA, exam. A P.A. becomes designated a PA-C, indicating they are licensed and credentialed to practice medicine after passing the exam. Because the programs vary so much, so do the prerequisites for each individual program. However as a general rule, anatomy/physiology and written communication courses are common requirements.  Applying’s never been easier The good news for would-be applicants is that the application procedure itself has simplified, thanks to a central application process known as CASPA. “CASPA is a central application service for physician assistants. It’s in its fourth year and it’s designed to be a clearinghouse for both the applicant and the colleges,” said Jennifer Johnston, administrator, MEDEX, director of the admissions division of physician assistant studies who helped create the system. From an applicant’s perspective, CASPA decreases their cost. For example, they only have to order one set of transcripts, instead of one per school application. CASPA will then send information to the requested schools. “From the school’s and the profession’s perspective, CASPA is desirable because it tells us how many applicants are out there. In the past, when administrators tried to talk about health-care access and needs, we had no idea how many students were in the pipeline,” Johnston said. Not all P.A. programs use the system, although 80 programs out of 134 do. Johnston said applicants should be aware that because schools use CASPA, it does not indicate that they have the same prerequisites. It’s up to students to research that information. Your research can be done at the American Academy of Physician Assistants. See AAPA’s Web site at www.aapa.org/pgmlist.php3 for more information. Much less medical school Typically, a P.A. program is 24 to 26 months with the first year focusing on academics, and the second year on clinical practice. The first year is known as the didactic year, which is a rigorous undertaking of medical courses. P.A.’s are taught to diagnose and treat medical problems and receive a broad medical education. Students may expect to study, anatomy and physiology, basic clinical skills, pathology and other courses related to a P.A.’s scope of practice. Generally in the second year, P.A.’s are divided into specific clinical rotations, varying by school and in some cases by student interest. Rotations may include but are not limited to, internal medicine, family medicine, pediatrics, obstetrics and gynecology as well as surgery.  Many P.A.s practice in underserved communities, consequently clinical rotations can be quite geographically diverse.  Alex Bertelsen is a student in the University of Washington School of Medicine, MEDEX Northwest Division of Physician Assistant Studies and is looking forward to his clinical work. Bertelsen is a sergeant first class in the Washington State Army National Guard and had his schooling interrupted for a deployment to Afghanistan. “Each person gets different rotations. They’ll send people with different desires [for what type of medicine they want to practice] to different places. I’m going to start out in an Indian reservation doing family practice. I’ll also have some rotations in Alaska maybe doing family practice or behavior science,” Bertelsen said. According to the American Academy of Physician Assistants, the typical applicant already has a bachelor’s degree and about four years of health care experience. However, there are programs that remain true to the profession’s origins and actively recruit and encourage applicants with military backgrounds who may be lacking the degree. MEDEX is one such program. “We have always had a fondness and loyalty to help the military transition into P.A. schooling. Former military represented 20 to 30 percent of our students over the last three or four years. MEDEX is a rather competitive program and for three years, the total number of military personnel applying represented 40 percent of our applicants,” Johnston said. As a former Air Force corpsmen and later physician assistant on active duty, Lemke, with the University of North Texas-Health Science Center, said his program also encourages service members in the allied health fields to consider their program. Lemke said that schools can provide the knowledge and tools of health-care delivery. Finding a P.A. school is more than finding a program that will admit you. And P.A.’s will tell you, their field is more than just the means to deliver health care. The profession is unique and most programs have a mission statement they aspire to accomplish beyond the classroom walls, such as ensuring everyone has access to health care regardless of their economic status. It is important as a student that you affiliate yourself with not only the program, but with the philosophy in which they strive to conduct their scope of practice.  https://www.armytimes.com/story.php?f=1-292313-336995.php

The P.A. is in Physician assistants turn their training into great civilian careers without many years of med school Stories by Regina Galvin Decision Times   If you are a corpsman or medic ready to transition out of the service, you probably know your military training is not directly transferable to a civilian health-care job with similar responsibilities. There is an option that doesn’t require multiple years of medical school. If you’re looking for a way to practice medicine in a high-demand, high-paying career field, consider becoming a physician assistant with only some additional training. And if you are already a P.A. in the military, your path is even clearer. You can transition into the civilian work force almost immediately with little or no additional training and will find a job market eager for your expertise. The profession will see tremendous growth in the coming years, according to the Bureau of Labor and Statistics. It projects the total number of P.A. jobs will increase by 49 percent within this decade. High salaries accompany the high job demand. According to a 2003 survey conducted by the American Academy of Physician Assistants, the median income for P.A.s who are not self-employed is $76,039. Most who make the transition will probably join the ranks of the 90 percent of civilian P.A.s who work in clinical practice. Under a doctor’s supervision P.A.s are health-care professionals licensed to practice medicine under a physician’s watch. Educated in a medical model designed to compliment a physician’s training, P.A.s receive broad medical training and have a wide scope of practice, including primary care medicine and surgery. In every state except Indiana and Ohio, physician assistants can write prescriptions. Unlike traditional medical school, P.A. training is concentrated into a 24- to 26-month curriculum. Graduates must pass a board to be licensed and then they may begin their practice. Like physicians, P.A.s must carry malpractice insurance. If the P.A. works for the federal government, the government picks up the tab for the insurance. Otherwise, a P.A. will either buy his own policy — which can run in the tens of thousands of dollars a year — or will be covered by a supervising physician's policy, a big money-saver for a P.A. But you may ask yourself, “What’s not to like about this profession?” How about whinny, cranky patients? Do you really want to spend eight to 10 hours a day listening to people complain about what ails them? Might you want to practice in less than state-of-the-art clinics in inconvenient locations? These are the types of questions Hank Lemke, director of physician assistant studies at the University of North Texas Health Science Center, advises prospective P.A.s to ask themselves. They are questions he answered earlier in his career when he was a corpsman on active duty in the Air Force. “Becoming a physician seemed like an unreachable goal. It was too expensive and it would take too long. But as a corpsman I was limited to what I could do if I got out to work in the civilian community. In the military I got to do much more than a nurse’s aide would do,” Lemke said. Then he met some physician assistants who introduced him to the field. “I knew this was exactly what I was looking for. I could participate and work with the patients more directly and take a more active role. I could participate in developing treatments and do much more hands-on medical work. I wanted to do more than I could do as a corpsman and being a P.A. was it,” Lemke said. But somewhere between being a corpsman and becoming a P.A. he had a realization, “Oh my gosh, I’m going to be listening to people complaining all day.” For Lemke the desire and interest to take care and work with people, complaints and all, was stronger than the field’s disadvantages. “Medical work is long and hard. When you choose to become a P.A., you are choosing a lifetime dedicated to health care. It calls upon sacrifice of the individual. You have to be comfortable working with all kinds of people. You have to be willing to be near sick people,” Lemke said.  Some people have the scientific aptitude and an interest in medicine but lack the compassion or perseverance to work in less than ideal circumstances, something P.A.s are often called to do. As a P.A., you might be called to work in a prison, a remote village overseas or an Appalachian holler. The P.A. profession evolved out of a need to provide quality health care to underserved areas. Although there may be pristine upscale medical clinics desiring P.A.s to join the practice, the bulk of the need and demand is in traditionally underserved populations such as veterans hospitals. As an Army Special Forces medic, Alex Bertelsen got a taste of practicing medicine in remote locations under less-than-ideal circumstances. “I got to treat patients in Third World countries, mostly in Asia. I got to do a lot of stuff and I had autonomy. You’re the only medical person. There’s no one else to depend on. You have to know your limitations and know when to depend on your training, which is a lot of what P.A.s do,” said Bertelsen, who is in his second year of P.A. school at the Washington School of Medicine, MEDEX Northwest Division of Physician Assistant Studies. The MEDEX program’s strong clinical focus appealed to Bertelsen. During his clinical rotations, he will serve on a Native American reservation as well as remote Alaskan villages. Bertelsen is a sergeant first class in the Washington State Army National Guard. His education was interrupted by a deployment to Afghanistan. After he returned, he completed the last quarter of his first year and will finish the program. Although not sure where he will end up practicing after completing his program, Bertelsen hasn’t ruled out international work. In addition to his military experience overseas, he has worked with the nongovernmental organization Refugee Relief International. Growing up, Bertelsen said he wanted to either become a doctor or a commando. Given his current circumstances, he said he feels he’s getting to live out a childhood dream. P.A. programs are competitive. Although having a medical background and scientific aptitude are critical for admission into a program, they are no guarantee. Navy Petty Officer Penny Goudelock discovered this when she applied and was turned down.  Goudelock, a corpsman, left the Navy last spring after she deployed with a Marine unit to Kuwait. She described the deployment as one of the worst experiences of her life and it toughened her resolve to become a P.A. in more ways than one. “After Kuwait, I thought to myself anything is possible. It was a tough time, but I came back more determined to become a P.A.,” Goudelock said.  “Even when not on duty I shadowed some P.A.s. We saw a lot of war injuries in a lot of different settings. We didn’t have many supplies; we barely had gloves. I talked with the P.A.s on active duty and I said to myself, ‘This is what I need to be.” As a corpsman I’m trained to do a lot that I couldn’t do in a similar job in the civilian world. I wanted to do more.” “When I interviewed for the second time for admission to MEDEX, I was much more confident. I had just returned from Kuwait a few months earlier and I knew I wanted to be a P.A. and I was determined to get it. And I did.” Goudelock recommended anyone considering applying for a P.A. program to shadow a P.A. to get a realistic idea of the nature of the work. She also suggested that if you took a class needed as a prerequisite and the grade wasn’t what you wanted, retake it before applying for admission.  https://www.armytimes.com/story.php?f=1-292313-336998.php The New Profession: The Physician Assistant  Eugene A. Stead, Jr.  Twenty-six years ago doctors were in short supply. Nurses were even scarcer. The old model of the doctor, a receptionist, and a laboratory technician was inadequate to meet the needs of our increasingly complex society. Learning time had disappeared from the schedule of the busy doctor. The only solution that. the overworked doctor could envisage was more doctors. Only a doctor could do doctors' work. The lengthy educational pathway - college, medical school, internship, residency, and fellowship - must mean that only persons with a doctor's education could carry out a doctor's functions.  I examined in some detail the actual practice of medicine. After sampling the rich diet of medicine, most doctors settled for a small area. If the office was set up to see patients every 10 to 15 minutes and to charge a certain fee, the practice conformed. If the outcome was poor or if the doctors recognized that the problem was too complex for this pattern of practice, the patient was referrd.  Doctors seeing patients at half-hour or 1-hour intervals also developed practice patterns and set fee schedules to conform. The specialists tended to treat diseases and leave the care of patients to others. Again, they cycled in a narrow path.  The average doctors developed very efficient patterns of practice. They operated 95% of the time in a habit mode and rarely applied a thinking cap. Because they did everything that involved contact with the patients, time for family, recreation, reading, and furthering their own education disappeared.  Why this intense personalization of medical practices? All doctors starting practices ran scared. They wanted to make their services essential to the well-being of their patients. They wanted the patient to depend on them alone. After a few years in this mode, they brainwashed themselves and actually believed that only they could obtain information from the patient and perform services that involved physical contact with the patient.  During this time I was bnilding a house with my own hands. I could use a wide variety of materials and techniques in my building. I reflected on how inadequate my house would be if I was restricted to only four materials. The doctor restricted to a very slim support system could never build a practice adequate to meet the need of modern medicine. He or she needed more components in the system. The physician assistant was born!  Nurses, laboratory technicians, and other health professionals were educated in their own schools, mostly hospital related. The new practitioner----the PA-was to be selected, educated, and employed by the doctor. PA not being geographically bound to the management system of the hospital, the clinic, or the doctor's office could oscillate between the office, the hospital, the operating room, and the home.  A 2-year curriculum was organized at Duke Medical School with the able assistance of Dr. Harvey Estes. who eventually took the program under the wing of his department of Family and Community Medicine. The object of the 2-year course was to expose the student to the biology of humans and to learn how doctors rendered services. On graduation, PAs had learned to perform many tasks previorisly done only by licensed doctors and could serve a useful role in many types of practices. They performed those tasks that they could do as well as their doctor mentors. If the mentor was wise, the PA mastered new areas each year and increased his or her usefulness to the practice.  Setting no ceilings and allowing the PA to grow has made this profession useful and satisfying. Restricting PAs to medical supervision has given them great freedom. Ideally, they do any part of their mentors' practice that they can do as well as their mentors.  Because of the close association with the doctor and patient and the varied duties of the PAs, they have an intimate knowledge of the way of the medical world. They know patients; they are aware of the triumphs and failures of medicine; they know how doctors think and what they do with information collected about patients. For these reasons, they are in demand by all businesses that touch the medical profession. The world is open, and PAs are grasping their share.  We all owe a debt of gratitude to the first five students who were willing to risk two years of their lives to enter a new profession when there was little support from doctors, nurses, or government. From the beginning, patients responded favorably, and each PA gained confidence and satisfaction from these interactions. Patients made and saved the profession. We hope that every new PA will acknowledge this debt and continue the excellent work of the original five.    Eugene A. Stead, Jr., M.D. Florence McAlister  Professor Emeritus of Medicine  Duke University Medical Center  https://monitor.admin.musc.edu/~cfs/stead/profession.html Physician Assistants 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 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 [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,” Mahaffy says. source: https://healthcare.monster.com/articles/physicianassistant/