The Physician Assistant (PA) is one of three professions licensed to practice medicine in the state of Michigan. The other two are Medical Doctors (MD) and Doctors of Osteopathy (DO). Physician Assistants are concerned with preventing, maintaining, and treating human illness and injury by providing a broad range of health care services that are traditionally performed by a physician. Evidence shows that PAs help to improve access to health services and overall quality of care.
Physician Assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, perform practical and surgical procedures, assist in surgery, and write prescriptions.
Physician Assistants work in hospitals, clinics, and other types of health facilities, and exercise autonomy in medical decision making as determined by their supervising physician.
The professional requirements typically include at least two years of post-graduate education. They are educated in the medical model designed to complement physician training, rather than in the nursing model as nurse practitioners are.
In the United States, the American Academy of Physician Assistants (AAPA) nationally represents the profession.
Physician Assistants are not to be confused with medical assistants, who perform administrative and simple clinical tasks with limited postsecondary education, under the direct supervision of physicians and other health professionals. Around the world, similar medical provider models can be found under different titles, such as clinical officer, clinical associate, assistant medical officer or Feldsher.
History of the Physician Assistant profession in the United States
The first use of non-physician care providers in the United States was during the Civil War. The term used for the profession during this period was "Surgeon's Assistants". The Union Army utilized these to the extent of making it's own branch called the Surgeon's Assistants Corp.
The PA profession was first proposed when Dr. Charles L. Hudson recommended to the AMA in 1961 the "creation of two new groups of assistants to doctors from nonmedical and nonnursing personnel.”
Dr. Eugene A. Stead, Jr. of the Duke University Medical Center in North Carolina assembled the first class of Physician Assistants in 1965, composed of former U.S. Navy hospital corpsmen. He based the curriculum of the PA program in part on his first-hand knowledge of the fast-track training of medical doctors during World War II. The first Physician Assistant class of four students graduated from the Duke University PA Program October 6th 1967.
October 6th has been designated as National Physician Assistant Day in honor of the first graduating class.
Two other physicians, Dr. Richard Smith at the University of Washington, and Dr. Hu Myers at Alderson-Broaddus College, also launched their own programs in the mid and late 1960s.
It was not until 1970 that the AMA passed a resolution to develop educational guidelines and certification procedures for PAs.
The U.S. Army was also losing many physicians to civilian practice. They quickly saw the benefit of PA's. Congress authorized the training of four hundred Army PA's. The training began in 1971, with the first class graduating in July of 1973. The other services quickly followed the Army's lead and established their own programs.
The Physician Assistant profession has continued to grow and mature here in the United States and around the world where other countries needing the advantages Physician Assistants provide, have begun to incorporate them.
The Duke University Medical Center Archives has established the Physician Assistant History Center that is dedicated to the study, preservation, and presentation of the history of the PA profession. Further information on the Physician Assistant profession can be found on their website: www.pahx.org
Education and certification
As of June 2011, there were 154 accredited PA programs in the United States. The majority are graduate programs leading to the award of master’s degrees in Physician Assistant Studies (MPAS), Health Science (MHS), or Medical Science (MMSc), and requires a bachelor's degree and GRE or MCAT scores for entry. Some PA programs are starting to offer a clinical doctorate degree (Doctor of Science Physician Assistant or DScPA), while a few still award an undergraduate bachelor's, but many of these are transitioning to graduate-level training.
The medical boards of the individual states regulate professional licensure. Many PAs go on to pursue doctorate degrees in healthcare related fields. For example, the ((Doctor of Philosophy)) (PhD) and the ((Doctor of Health Science)) (DHSc) degree are popular choices for PAs interested in continuing their education beyond the Masters level. However, PAs are not required to possess the doctorate to hold license and practice. Doctorate level PAs are also discouraged from being called "doctor" in clinical settings, to avoid misrepresentation and scope of practice of the profession.
Physician Assistant education is based on the medical model although unlike medical school which lasts four years plus a specialty-specific residency, PA training is usually 2 to 3 years in duration, completed during undergraduate education or post-graduate studies, for a total of 4–7 years of postsecondary education. However, most PA students start their medical education with a background of health care experience. The didactic training of PA education consists of classroom and laboratory instruction in medical and behavioral sciences, such as anatomy, microbiology, pharmacology, pathophysiology, hematology, pathology, clinical medicine, and physical diagnosis, followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, oncology, emergency medicine, and geriatric medicine, as well as elective rotations. Many PA schools do not differentiate between the first year PA students and first year medical students, and their classes are taken together. Unlike physicians, who must complete a minimum of three years of residency after completion of medical school, PAs are not required to complete such residencies. Despite this, there are "residency" programs in certain specialties for PAs who choose to continue formal education in such a format.
A Physician Assistant may use the post-nominal initials "PA", "PA-C", "APA-C", "RPA" or "RPA-C", where the "-C" indicates "Certified" and the "R" indicates "Registered". The "R" designation is unique to a few states, mainly in the Northeast; The "A" indicates completion of the Army Flight Surgeon Course. Most PAs use "PA-C". During training, PA students are designated PA-S. The use of "PA-C" is limited only to those PAs currently certified and in compliance with the regulations of the national certifying organization, the National Commission on Certification of Physician Assistants (NCCPA).
A graduate from an accredited PA program must pass the NCCPA-administered Physician Assistant National Certifying Exam (PANCE) before becoming a PA-C; this certification is required for licensure in all states. Once a PA is certified, he/she must complete a continuous six-year cycle to keep her/his certificate current. Every two years, a PA must earn and log 100 CME hours and reregister her/his certificate with the NCCPA (second and fourth years), and by the end of the sixth year, recertify by successfully completing either the Physician Assistant National Recertifying Examination (PANRE). There used to be an alternate option for recertification through what was known as Pathway II. The last administration of Pathway II was held in 2010. All states require passage of the PANCE for state licensure. Forty-three states have provisions for new graduates to practice prior to passage of PANCE.
Scope of practice
PAs are medical professionals. They typically obtain medical histories, perform examinations and procedures, order treatments, diagnose illnesses, prescribe medication, order and interpret diagnostic tests, refer patients to specialists as required, and first or second-assist in surgery. Physician Assistants' scope of practice is spelled out in their PA-Physician practice agreement, and they cannot practice in a manner other than prescribed by their supervising physician. PAs are employed in primary care or in specialties in urban or rural regions, as well as in academic administration. PAs may practice in any medical or surgical specialty, and have the ability to move within and between different medical and surgical fields during their careers.
Physician Assistants have their own medical licenses and do not work under a physician's license. Each of the 50 states has different laws regarding the prescription of medications by mid-level practitioners (which include PAs) by State and the licensing authority granted to each category within that particular State through the Drug Enforcement Administration (DEA).
Depending upon the specific laws of any given state board of medicine, the PA must have a formal relationship on file with a collaborative physician supervisor. The physician collaborator must also be licensed in the state in which the PA is working, although he or she may physically be located elsewhere. Physician supervision can be in person, by telecommunication systems or by other reliable means (for example, availability for consultation). The physician supervision, in most cases, need not be direct or on-site, and many PAs practice alone in remote or under-served areas in satellite clinics.
According to the AAPA, there were an estimated 68,124 PAs in clinical practice as of January 2008.
In the 2008 AAPA census, 56 percent of responding PAs worked in physicians' offices or clinics and 24 percent were employed by hospitals. The remainder were employed in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs. Fifteen percent of responding PAs work in counties classified as non-metropolitan by Economic Research Service of the United States Department of Agriculture; approximately 17% of the US population resides in these counties.
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...” 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 employed by the United States Department of State as Foreign Service Health Practitioners (FSHP). PAs working in this capacity may be deployed anywhere in the world where there is a State Department facility. They provide primary care to authorized members of the state department. In order to be considered for the position of FSHP these PAs must be licensed and have at least two years of recent experience in primary care.
U.S. Army PAs typically serve as Medical Specialist Corps officers within Army combat or combat support battalions located in the continental United States, Alaska, Hawaii and overseas. These include infantry, armor, cavalry, airborne, artillery and (if the PA qualifies) Special Forces units. They serve as the "front line" of Army medicine and along with combat medics are responsible for the total health care of soldiers assigned to their unit, as well as of their family members.
PAs also serve in the Air Force and Navy as clinical practitioners and aviation medicine specialists, as well as in the Coast Guard and Public Health Service. The skills required for these PAs are similar to that of their civilian colleagues, but additional training is provided in advanced casualty care, medical management of chemical injuries, aviation medicine and military medicine. In addition, military PAs are also required to meet the officer commissioning requirements and maintain the professional and physical readiness standards of their respective services.
Education programs are offered in Australia at the Edith Cowan University in Perth, Western Australia, James Cook University in Northern Queensland and University of Queensland in Brisbane.
The PA concept is being explored in Canada, where Canadian military PAs are gaining legislative changes allowing them to work in the civilian world after retirement. Education programs are now offered at the University of Manitoba in Winnipeg, McMaster University in Hamilton, Ontario, and the University of Toronto. Programs are 24 months in length.
In England, U.S.-trained PAs are working in a pilot project in Sandwell and West Birmingham. Education programs are now being offered by St George's, University of London. The University of Warwick and University of Coventry have also explored offering these programs, but did not implement them due to a lack of understanding. However, the NHS trusts in the West Midlands are currently forecasting a large-scale need for PAs.
Also formally referred to as "Medical Care Practitioners", PAs are to be employed by the National Health Service. Though currently not a registered profession, PAs can currently practice under delegation rules and it is expected that the required legislation will be taken before Parliament with the UK's General Medical Council expected to become the registering body. Programs are 24 months in length and are a Post-Graduate Diploma with the option of "topping up" to a Master's degree either by full or part-time study. Training is in the areas of General Medicine (including Emergency/Medical Assessment Units), Emergency Medicine (A&E) and General Practice.
The interests of PAs in the UK are currently being looked after by the UK Association of Physician Assistants.
In Germany, the B.Sc Physician Assistant program is currently offered at the Steinbeis-Hochschule in Berlin, The Mathias Hochschule in Rheine (University of Applied Sciences) and at the Duale Hochschule Baden-Württemberg in Karlsruhe. The standard B.Sc takes 3 years to complete. Most PA students start their medical education with a background of health care experience. They are educated in the medical model designed to complement physician medical training, rather than in the nursing model. Physician Assistants are not to be confused with medical assistants "arztassistents" or "arzthelfer", who perform administrative and simple clinical tasks with limited postsecondary education, under the direct supervision of doctors and other health professionals.
PAs are to be employed within various hospital settings according to their chosen specialities. Though not yet a registered profession PAs are already allowed to practice under delegation rules from a medical doctor ("Approbierter Arzt"). Currently legislation in the advanced thinking southern province of Germany, Baden-Württemberg, are allowing for a registered Physician Assistant (Staatlich annerkanter). The registering body is the "Deutsche Gesellschaft für Physician Assistants e.V." DGPA (German Association of Physician Assistants) under Chairmanship from Chairman Mr Klaus Waibel, who is currently responsible for the registration of National and International Physician Assistants. Currently the "Master of Science" (MSc), the "Doctor of Science Physician Assistant" (DScPA) or "PhD" degree is not available in Germany, in contrast to the USA. Also, Germany is quickly realizing the growing need for Physician Assistants to fill the large deficit of medical doctors in the city hospitals. Included is the growing deficit of the traditional "Family Physician" (Hausarzt), a position which in the future could be successfully filled by a PA. Currently there is no official website for the "Deutsche Gesellschaft für Physician Assistants" DGPA. The official website for the DGPA is currently under construction. More information can be obtained direct from Chairman Mr Klaus Waibel.
The Netherlands has educational programs at the Academie Gezondheidszorg in Utrecht, University of Arnhem/Nijmegen, the University of Groningen and the University of Leiden. Programs are 30 months in length.
Pilot projects in Scotland are underway, but no official educational programs have been implemented as of 2008.
Programs for the training of clinical associates are offered in South Africa at the Walter Sisulu University and University of the Witwatersrand.