10 Facts about PAs
(and why you should love them!)
REPRINTED WITH PERMISSION OF PHYSICIANS PRACTICE. COPYRIGHT 2014.
William F. Morgan, MD
Randy D. Danielsen, Ph.D., PA-C, DFAAPA
1. PAs are not medical school rejects
The PA profession is very much a highly sought after career in its own right. Potential PAs are often attracted to the profession due to less time spent in graduate school (the average is 27 months), the ability to practice sooner, and less student debt (they tend to incur about half the average debt medical students incur).
PA programs are also highly competitive. Less than 30 percent of those who apply are admitted so you can be confident of the caliber of PAs graduating from accredited PA programs.
2. PAs are trained in the medical model
The medical model focuses on a patient’s medical history, physical exam, and diagnostic tests as the basis to understand the chief complaint and identify specific diagnoses. Because the PA profession was created by physicians, PAs are trained to think like physicians.
A typical PA curriculum includes an average of 54 weeks (about 64 credit hours) of didactic education and an average of 52 weeks (about 1,660 contact hours) in clinical rotations. Clinical experiences include rotations in family medicine, internal medicine, general surgery, emergency medicine, pediatrics, women’s health, and behavioral and mental health. Some PA programs offer additional elective rotations.
When PAs come into your practice, you know they have a strong background in diagnosing and treating patients. Of course, on-the-job experience allows a physician and PA to grow into a cohesive and dynamic team.
3. PAs do not want to be MDs
PAs like being PAs. It is a personal choice in terms of lifestyle — one that many see as offering better work/life balance. In 2013, Money magazine ranked “physician assistant” number 21 out of the 100 best jobs in America giving it an “A” in personal satisfaction. At career site MyPlan.com, a survey of almost 14,000 people ranked physician assistant 16 out of 300 careers in terms of job satisfaction.
PAs are trained, certified, and recertified as generalists and they like the flexibility to work in any clinical setting. They have ample opportunity to treat patients and usually don’t have to deal with the business aspects of the practice. PAs understand the scope of their position, and appreciate the chance to collaborate with a physician.
4. PAs will not open an independent practice
In every state, PAs must practice with physician supervision. While it’s true that some states allow PAs to own a practice, the PAs must hire a physician to supervise them and see patients. They can’t open a practice independently. This differs from the nurse practitioner (NP) model where many states allow NPs to own a practice and work independently without the collaboration or supervision of a physician.
That is often a source of confusion among physicians who view independent practice for nonphysicians negatively.
A PA’s role is regulated by the state and delegated by the supervising physician. The American Academy of Physician Assistants defines six key elements for modern PA practice including three that are determined at the practice level: scope of practice; chart co-signature requirements; and number of PAs supervised per physician.
This map quickly summarizes the extent to which states have adopted these elements allowing PAs to function to the fullest extent of their license.
5. PAs do not always require on-site supervision
When PAs and physicians work closely as a team, they understand each other's expectations and build trust in each other’s judgment.
About half of the states have adaptable supervision requirements, with no on-site provision or even requirement that the physician be within a specified number of miles of the clinical site. In our practice in Arizona, PAs practice independently without a doctor in the office on any given day. However, the PA can always consult with the physician by phone or electronically. With EHRs, it is convenient for the physician and PA to readily share charts and review patient issues.
The common types of supervision used in our practice are:
• Prospective supervision: Writing and reviewing the assessment and treatment guidelines and establishing when and under what circumstances physician intervention is required.
• Concurrent supervision: Reviewing patients on a real-time basis per clinic guidelines or ad hoc.
• Retrospective supervision: After-the-fact review of charts.
6. PAs meet rigorous certification and certification maintenance standards
Once PAs complete their education, they must pass the Physician Assistant National Certifying Exam as a prerequisite for state licensure. Administered by the National Commission on Certification of Physician Assistants (NCCPA), this rigorous, broad-based exam covers medical and surgical conditions across all organ systems.
Those who pass become certified PAs and use the designation of certified physician assistant (PA-C) after their name. Certification is required by all 50 states, the District of Columbia, and U.S. territories for PAs seeking initial licensure.
To maintain certification, certified PAs must complete 100 credits of CME every two years, including credits earned through self-assessment and performance improvement activities. In addition, PAs must pass the Physician Assistant National Recertifying Exam (which is just as broad-based as the initial certification exam) every six to 10 years to maintain the PA-C credential. That means that even certified PAs practicing in specialties maintain a strong base of generalist knowledge throughout their careers.
7. PAs are held to the same standard of care as physicians
Legally, PAs are held to the same standards of care as physicians. PAs understand their scope of practice, their role on the healthcare team, and their limitations. A PA will readily consult with a physician just like a physician will consult with another physician or specialist.
Certified PAs must also adhere to NCCPA’s Code of Conduct which holds them to high standards of ethics and professionalism. NCCPA can, and does, revoke certification for PAs who breach the Code of Conduct. Physicians and the public can verify a PA’s certification very quickly at www.nccpa.net.
8. PAs boost patient satisfaction
Healthcare today is about access, quality outcomes, and cost reduction. Team-based care can improve each of these metrics. Studies show most patients will see a PA instead of a doctor if they want to be seen quickly. We cannot find broad-based research studies on PA outcomes compared to those of a physician, but smaller studies and anecdotal evidence seems to say they are comparable particularly since, by design, PAs work in collaboration with physicians.
We know from our own experience that physician/PA teams increase satisfaction as they enable additional access to care and follow up. Over time, PAs almost develop their own practice within a practice as patients ask for them, just as they request a certain physician. Shaping Great Physician-PA Teams is an excellent video that highlights five components that truly bond strong physician/PA teams. They are: shared priorities; frequent and effective communication; physician accessibility and approachability; consistency of the delivery of patient care; and mutual trust and respect.
9. PAs do specialize
PAs have followed physicians into every specialty area and clinical setting. Today there are more than 95,000 certified PAs in the United States; approximately 33 percent practice in primary care, and 67 percent practice in a subspecialty.
In our allergy practice, we send our critical staff, which includes PAs, to semiannual national meetings. They are expected to attend the same meetings and lectures as our M.D.s and D.O.s, so they keep up to date in our specialty area.
In seven specialty areas, NCCPA offers a voluntary credential that allows PAs to demonstrate and document their experience, skills, and advanced knowledge in the specialty area. Those specialties and the percentage of certified PAs in those specialties are as follows:
10. PAs are necessary in today’s environment
About 35,000 physicians a year are retiring and only 25,000 a year are graduating from medical school. The problem is further exacerbated by the Affordable Care Act adding 32 million newly-insured patients into the healthcare system. The Association of American Medical Colleges predicts 45,000 too few primary-care physicians and 46,000 too few specialists and surgeons by 2020.
This workforce shortage demands a team-based approach to extend the physician’s reach. The American Medical Group Association and healthcare human resources consultant Sullivan, Cotter and Associates, report that two-thirds of the large multispecialty healthcare organizations surveyed in 2013 increased their PA workforce and are projecting that they will hire more in the next 12 months.
PAs not only provide access to care, they also generate substantial revenue at a lower cost of employment. There is more than enough work for everyone.
ABOUT THE AUTHORS
William F. Morgan, MD, is the founding physician of the Arizona Asthma and Allergy Institute. He is board certified by the American Board of Allergy and Immunology and by the American Board of Pediatrics. He has been named one of the “Top Docs” in Phoenix Magazine for several years. He is also a certified life coach, specializing in life transitions. He has spent more than 30 years working with and supervising physician assistants.
Randy D. Danielsen, Ph.D., PA-C, DFAAPA, is professor and dean of the Arizona School of Health Sciences at A.T. Still University, and a clinician, author, and editor. He has served on the board of directors of the American Academy of Physician Assistants and as a board member and chairman for NCCPA. He co-authored “The Preceptor's Handbook for Supervising Physician Assistants” in 2012.