The Physician Assistant (PA): A historical perspective & Utilizing PAs in the HealthCare Setting

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1 The Physician Assistant (PA): A historical perspective & Utilizing PAs in the HealthCare Setting Randy L. Orsborn, MPAS, PA-C, CLS Physician Assistant Knox Community Hospital Mount Vernon, Ohio

2 Objectives At the conclusion of this program, the participant will be able: Discuss the history of the Physician Assistant (PA) profession Review the role and responsibility of the PA Discuss educational/training requirements of the Physician Assistant Provide knowledge on how the PA can enhance the concept of the healthcare team

3 Quick facts Physician assistants are highly trained healthcare professionals who are authorized by their respective state to practice medicine as part of a team with physician supervision. Certified by the National Commission on Certification of Physician Assistants (NCCPA) Licensed, certified or registered in the state in which they practice All 50 states and the District of Columbia Canada, Europe, U.S. Military

4 Physician Assistants PAs deliver a broad range of medical and surgical services, including: Conducting physical exams Obtaining medical histories Diagnosing and treating illnesses Ordering and interpreting tests Prescribing medications Counseling on preventive health care Assisting in surgery

5 History of the PA Profession The PA profession was created to improve and expand healthcare. In the mid-1960s, physicians and educators recognized there was a shortage of primary care physicians. Dr. Eugene Stead of the Duke University Medical Center put together the first class of PAs in Four Navy corpsmen were selected into this program based upon the considerable medical training they received during their military service to our country.

6 History continued The curriculum of the PA program based on knowledge of the fast-track training of doctors during World War II. The first PA class graduated from the Duke University PA program on Oct. 6, 1967.

7 The PA educational program is modeled on the medical school curriculum, a combination of classroom and clinical instruction. The PA course of study is rigorous and intense. The average length of a PA education program is 27 months.

8 Ohio has 6 accredited Physician Assistant Schools Cuyahoga Community College/Cleveland State University Findlay University Kettering College of Medical Arts Marietta College Ohio Dominican Physician Assistant Studies Program (Newly Accredited) University of Mt. Union University of Toledo

9 Admission to PA school is highly competitive Applicants to PA programs must complete at least two years of college courses in basic science and behavioral science as prerequisites to PA school, analogous to premedical studies required of medical students. Prerequisites include: chemistry, physiology, anatomy, microbiology and biology. Most PA programs require (or prefer) that applicants have prior healthcare experience.

10 The PA Program There are currently 159 accredited PA programs in the United States. The vast majority award master s degrees. Includes anatomy, physiology, biochemistry, pharmacology, physical diagnosis, pathophysiology, microbiology, clinical laboratory science, behavioral science and medical ethics. Must complete more than 2,000 hours of clinical rotations Rotations include family medicine, internal medicine, obstetrics and gynecology, pediatrics, general surgery, emergency medicine and psychiatry

11 Life-long Learning In order to maintain national certification, a PA must complete 100 hours of continuing medical education every two years CAQ: Certificate of Added Qualifications Cardiovascular surgery Orthopedic surgery Emergency medicine Psychiatry Nephrology

12 Physician/PA Team By design, a Physician and a Physician Assistant work together as a team All PAs practice medicine with physician supervision a supervising physician does NOT always have to be present with the PA or direct every aspect of PA-provided care Dependent practitioner

13 Delegated Autonomy Physicians delegate duties to PAs, and within those range of duties, PAs use autonomous decision-making for patient care. The team model is an efficient way to provide high-quality medical care In rural areas, the PA may be the only healthcare provider on-site, collaborating with a physician elsewhere through telecommunication.

14 The PA Role Because of their general medical background, PAs have flexibility in the types of medicine they can practice. PAs are trained and prepared to deliver healthcare to those most in need. PAs extend the care that physicians provide and increase access to care. PAs are creative, compassionate practitioners who strive to treat the whole person.

15 Transforming Healthcare PAs not only treat disease, but they also promote health, decreasing healthcare demand through preventive care: helping people to live longer through preventing disease, eliminating health disparities, creating environments that promote good health, promoting healthy behaviors through all life stages

16 Quality of Care Patients are consistently satisfied with PAprovided care. Studies have also shown that patients are just as satisfied with medical care provided by PAs as with that provided by doctors Patients do not distinguish between types of care providers.

17 Cost-effective Healthcare A practice employing a PA pays less in overhead costs for that PA compared to a physician, while having a healthcare provider on board who can provide most of the same services. A study examining a national sample of patients found that those who saw a PA for most of their yearly office visits had approximately 16 percent fewer visits per year than patients who only saw physicians

18 Overview PA education costs less and takes less time than physician education enter the workforce more quickly. PAs can practice in any medical or surgical specialty, and they can perform almost all the duties that physicians perform. PAs are cost-effective options for practices and hospitals looking to offset physician shortages and trim costs.

19 Insurance PA-provided services are covered by all government-funded public payers, such as Medicare, Medicaid and TRICARE, and nearly all private payers. Each payer has its own guidelines regarding service coverage and payment. By law, Medicare pays for medical and surgical services provided by PAs at 85 percent of the physician fee schedule.

20 Reimbursement Incident is a Medicare provision that allows for certain services provided by a PA in the office to be billed under the physician s provider number and reimbursed at 100 percent. Shared Visit Billing is another Medicare provision that allows for services provided by both the PA and the physician in a hospital to be billed under the physician s provider number with reimbursement at 100 percent.

21 84,066 Nationally Certified PAs

22 The need for care in underserved areas is increasing with the physician shortage

23 Demographics of the Physician Assistant Profession

24 How do PAs differ from Nurse Practitioners (NPs)? PAs and NPs have many similarities Background and training differ Both are highly trained and skilled healthcare providers PAs and NPs provide many of the same services PAs are grounded in medicine, and are often trained at medical schools alongside medical students.

25 How do PAs differ from nurse practitioners (NPs)? NPs are grounded in nursing and receive advanced education after they have completed their registered nurse preparation. NP education programs are usually accredited through one of two major nursing accrediting organizations. NPs are nationally certified in their specialty area NPs must be licensed by their state in order to practice. NPs are usually regulated through the state board of nursing.

26 Physician Assistants PAs deliver a broad range of medical and surgical services, including: Conducting physical exams Obtaining medical histories Diagnosing and treating illnesses Ordering and interpreting tests Prescribing medications Counseling on preventive health care Assisting in surgery

27 Growth of the Profession The Bureau of Labor Statistics predicts that PAs will be the second-fastest-growing profession in the next decade, increasing from 74,800 in 2008 to 103,900 in AAPA projects that in 2020, there will be between 137,000 and 173,000 certified PAs.

28 International Use of PAs Canada has the most established and fastestgrowing network of PAs. The Netherlands has a growing cohort of PAs, with five PA programs and about 400 PAs. India has a growing and promising community of PAs. There are 300 PAs practicing in India. South Africa has a few programs that are similar to PA programs. Instead of physician assistants, program graduates are called clinical associates. Saudi Arabia recently opened its first PA program.

29 Questions?

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