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What is a PA?
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What is a PA?

The Physician Assistant (PA) is one of three professions licensed to practice medicine in the state of Michigan (the other two are MD’s and DO’s).  PAs also maintain national certification and perform an extensive range of medical procedures and duties, from primary care to sub-specialized surgical assisting.  Evidence shows that PAs help improve access to health services and overall quality of care.

 

PA functions:

-          Obtain medical histories and conduct physical exams

-          Diagnosis and treat illnesses

-          Order and interpret tests/studies

-          Counsel on preventative health care

-          Assist on all surgical procedures

-          Develop treatment plans

-          Write prescriptions

 

Physician Assistants work in multiple clinical settings, including hospitals, clinics, private practices and other types of health facilities; PAs also exercise autonomy in medical decision making as determined by their supervising physician.  In the U.S., the AAPA nationally represents the PA profession; on a state level- MAPA represents PAs in Michigan.

 

Educating and Certifying PAs

The PA profession has requirements that include at least two years of post-graduate education.  PAs are educated in the medical model designed to complement physician training.  Admission to a PA program is highly competitive with prerequisites comparable to pre-med requirements.  However, most students entering a PA program have a background of health care experience.  The average length of a master’s level PA program education is approximately 27 months, with a combination of didactic (classroom) and clinical rotations.

 

The Flexibility of PAs:

-          PAs are educated as generalists and recertify as such

-          PAs collaborate with physicians and other healthcare professionals to deliver team-based quality health care

-          PAs manage patients, provide treatment plans and preventive health care

-          PAs increase access to health care and yield positive patient outcomes

-          PAs are usually the first and last health care professional a patient sees and receives health care from

 

The didactic training of PA students consists of classroom and laboratory instruction in medical and behavioral sciences, such as: anatomy, microbiology, pharmacology, pathophysiology, hematology, pathology, clinical medicine and physical diagnosis.  This first year is followed by a second year of clinical rotations in health care settings that total over 2000 hours of clinical training.  Rotations include: internal medicine, family medicine, surgery, pediatrics, OB/GYN, emergency medicine and psychology, as well as elective rotations.

During training, PA students are designated PA-S; the use of PA-C is limited to those PAs who are certified and in compliance with the regulations of the NCCPA.  A PA program graduate must pass the certifying examination- PANCE, offered by the NCCPA; which is required for licensure in all states.  Once a PA is certified, they must take a recertification examination (PANRE) every 10 years and log sufficient number of continuing medical education (CME) credits to maintain their certification.

 

Scope of Practice-

The scope of practice determines exactly what a PA can do in a practice setting.  Michigan Statute states:

 

(1) Except in an emergency situation, a physician’s assistant shall provide medical care services only under the supervision of a physician or properly designated alternative physician, and only if   those medical care services are within the scope of practice of the supervising physician and are delegated by the supervising physician.

Mich. Comp. Laws §333.17076(1)

 

(2) A physician’s assistant may make calls or go on rounds under the supervision of a physician in private homes, public institutions, emergency vehicles, ambulatory care clinics, hospitals, intermediate or extended care facilities, health maintenance organizations, nursing homes, or other health care facilities.  Notwithstanding, any law or rule to the contrary, a physician’s assistant may make calls or go on rounds as provided in this subsection without restrictions on the time or frequency of visits by the physician or the physician’s assistant.

Mich. Comp. Laws §333.17076(2)

 

A PA’s scope of practice is determined by education and experience, facility or hospital policies, state law and physician delegation, plus the needs of the patients at the practice site.  ‘Needs of the Practice’- the PA’s scope of practice is determined by the team of health care providers at the practice and credentialing decisions are made by the facility.  This allows for a flexible and customized scope of practice definition.  Some states authorize a PAs scope of practice to be determined at the practice level; this flexibility maximizes patient access to health care.  In Michigan, the scope of practice is determined at the practice level, with the supervising physician and PA jointly establishing a written agreement authorizing the PA’s scope of practice.

 

Employment

According to the AAPA, there was an estimated 108,000 PAs in clinical practice as of January 2016.  The U.S. Department of Labor Bureau of Labor Statistics report on PAs states, “…Employment of Physician Assistants is expected to grow 27 percent from 2006 to 2016, much faster than the average for all occupations, and this growth is expected to continue for some time…”  This is due to several factors, including an expanding health care industry, an aging baby-boomer population, concerns for cost containment, and newly implemented restrictions to shorten physician resident work hours.

 

PAs are found in the private sector, community hospitals and medical centers, in correctional facilities, home care agencies and the military and the U.S. Department of Veterans Affairs.  The utilization of PAs and PA programs are not limited to the U.S.  PAs are found practicing in Australia, Canada, England, Germany, Netherlands, Scotland and South Africa.

 

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