Physician assistant
Encyclopedia
A physician assistant/associate (PA) is a healthcare professional
trained and licensed to practice medicine
with limited supervision by a physician
.
Physician associates/assistants work in hospital
s, clinic
s, and other types of health facilities, and exercise autonomy in medical decision making as determined by their supervising physician, surgeon or medical practitioner. 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. Physician associates/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, or nursing assistants.
In the United States
, the profession is represented by the American Academy of Physician Assistants
. The equivalent type of provider may also go under different titles in different countries, such as clinical officer
, clinical associate
, assistant medical officer
medical care practitioner or Feldsher
.
, 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
.. 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 Duke University Medical Center Archives has established the Physician Assistant History Center, dedicated to the study, preservation, and presentation of the history of the PA profession.
leading to the award of master's degree
s in either Physician Assistant Studies (MPAS), Health Science (MHS
), or Medical Science (MMSc), and require 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. Professional licensure is regulated by the medical boards of the individual states
. 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 both 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, 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. In addition, a PA must earn and log 100 Continuing Medical Education
(CME) hours and reregister his or her certificate with the NCCPA every two years. Every six years, a PA must also recertify by successfully completing the Physician Assistant National Recertifying Exam (PANRE). NCCPA eliminated the Pathway II as a means of recertifying in 2010."Physician Assistant National Recertifying Exam (PANRE)" - NCCPA
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). PAs in Florida, Kentucky, Puerto Rico and the U.S. Virgin Islands, are not allowed to prescribe, order, dispense, or administer any controlled substances
. Several other states place a limit on the type of controlled substance
or the quantity that can be prescribed, dispensed, or administered by a PA.
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 hospital
s. 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.
For PAs in primary care practice, malpractice
insurance policies with $100,000–300,000 in coverage can cost less than $600 per year; premiums are higher for PAs in higher-risk specialties.
Money magazine, in conjunction with Salary.com, listed the PA profession as the "fifth best job in America" in May 2006, based both on salary and job prospects, and on an anticipated 10-year job growth of 49.65%. According to the American Academy of Physician Assistants (AAPA), in 2008 the mean total income for physician assistants working at least 32 hours per week was $89,987. Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn $100,000–200,000 per year.
U.S. Army
PAs typically serve as Medical Specialist Corps officer
s within Army combat or combat support battalion
s 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 medic
s 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.
, Duke University Health System
, University of Oklahoma
--Oklahoma City, and Our Lady of the Lake College
(which has a provisionally-accredited PA program) offer "physician associate programs" for students who will go on to become licensed as physician assistants. The name change has been publicly supported by 100 of the nation's leading and founding physician assistants, as well as the Association of Family Practice Physician Assistants. In July 2011, over six thousand of the nations PAs mailed a statement to the AAPA asking for a change to physician associate. The AAPA Board refused to endorse this issue and suggested it go to the 2012 House of Delegates.
in Perth, Western Australia, offers a two-year Master of Medical Science (Physician Assistant); James Cook University
in Northern Queensland offer a gradaute-entry Bachelor of Health Science (Physician Assistant) and University of Queensland
in Brisbane offer a 2-year Master of Physician Assistant Studies
The Master of Physician Assistant Studies program at the University of Queensland is not currently taking further enrolments; however, James Cook University School of Medicine and Edith Cowan University will commence their first cohort in 2012.
, where Canadian military
PAs are gaining legislative changes allowing them to work in the civilian world after retirement. Education programs are now offered at Canadian Forces Base Borden at the Canadian Forces Health Services Training Centre, the University of Manitoba
in Winnipeg, McMaster University
in Hamilton, Ontario
, and the University of Toronto
. Programs are 24 months in length.
, 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 perceived need. 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 either the UK's General Medical Council or the Health Professions Council expected to become the registering body. Programs are 24 months in length and award a Post-Graduate Diploma with some programmes offering 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.
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. A physician assistant is 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. Physician assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care and assist in surgery. 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.
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.
are underway, but no official educational programs have been implemented as of 2008.
are offered in South Africa at the Walter Sisulu University and University of the Witwatersrand
.
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
trained and licensed to practice medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
with limited supervision by a physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
.
General description
A physician associate/assistant is concerned with preventing, maintaining, and treating human illness and injury by providing a broad range of health care services that were traditionally performed by a physician or medical practitioner. Physician associates/assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, give medical orders and write prescriptions.Physician associates/assistants work in hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s, clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
s, and other types of health facilities, and exercise autonomy in medical decision making as determined by their supervising physician, surgeon or medical practitioner. The professional requirements
Healthcare provider requisites
Healthcare provider requisites refer to the regulations used by countries to control the quality of individual healthcare workers practicing in their jurisdictions and to control the size of the health labour market...
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. Physician associates/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, or nursing assistants.
In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, the profession is represented by the American Academy of Physician Assistants
American Academy of Physician Assistants
The American Academy of Physician Assistants is the largest professional organization of physician assistants in the United States of America. It was founded in 1968 and currently has approximately 39,000 members in all 50 states, District of Columbia, US Virgin Islands and Northern Marianas...
. The equivalent type of provider may also go under different titles in different countries, such as clinical officer
Clinical officer
Clinical officers are health care providers who practice modern medicine. They practice independently but may be supervised by a physician in some settings....
, clinical associate
Clinical associates
Clinical associates are a category of healthcare providers found in South Africa. They assess patients, make diagnoses, prescribe treatment and perform minor surgery under the supervision of a physician....
, assistant medical officer
Assistant Medical Officer
Assistant Medical Officers are health care providers in countries like Tanzania and Malaysia. They work independently or with limited supervision of a physician to provide healthcare services to largely underserved populations....
medical care practitioner or Feldsher
Feldsher
Feldsher is the name of a health care professional who provides various medical services in Russia and other countries of the former Soviet Union, mainly in rural areas...
.
History of the profession
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. SteadEugene A. Stead
Dr. Eugene Anson Stead Jr. is best known as a medical educator, researcher, and the founder of the Physician Assistant or P.A. profession. He served on the faculty at Harvard, Emory , and Duke universities...
, Jr. of the Duke University
Duke University
Duke University is a private research university located in Durham, North Carolina, United States. Founded by Methodists and Quakers in the present day town of Trinity in 1838, the school moved to Durham in 1892. In 1924, tobacco industrialist James B...
Medical Center in North Carolina
North Carolina
North Carolina is a state located in the southeastern United States. The state borders South Carolina and Georgia to the south, Tennessee to the west and Virginia to the north. North Carolina contains 100 counties. Its capital is Raleigh, and its largest city is Charlotte...
assembled the first class of Physician Assistants in 1965, composed of former U.S. Navy
United States Navy
The United States Navy is the naval warfare service branch of the United States Armed Forces and one of the seven uniformed services of the United States. The U.S. Navy is the largest in the world; its battle fleet tonnage is greater than that of the next 13 largest navies combined. The U.S...
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
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
.. 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 Duke University Medical Center Archives has established the Physician Assistant History Center, dedicated to the study, preservation, and presentation of the history of the PA profession.
Education and certification
As of June 2011, there were 154 accredited PA programs in the United States. The majority are graduate programsPostgraduate education
Postgraduate education involves learning and studying for degrees or other qualifications for which a first or Bachelor's degree generally is required, and is normally considered to be part of higher education...
leading to the award of master's degree
Master's degree
A master's is an academic degree granted to individuals who have undergone study demonstrating a mastery or high-order overview of a specific field of study or area of professional practice...
s in either Physician Assistant Studies (MPAS), Health Science (MHS
Master of Health Science
The Master of Health Science degree is a specialized master’s degree. Depending on the department and specific area of study, the MHS degree provides opportunities for advanced study and research or prepares individuals to begin or advance their careers as public health professionals...
), or Medical Science (MMSc), and require a bachelor's degree
Bachelor's degree
A bachelor's degree is usually an academic degree awarded for an undergraduate course or major that generally lasts for three or four years, but can range anywhere from two to six years depending on the region of the world...
and GRE
Graduate Record Examination
The Graduate Record Examinations is a standardized test that is an admissions requirement for many graduate schools in the United States, in other English-speaking countries and for English-taught graduate and business programs world-wide...
or MCAT
Medical College Admission Test
The Medical College Admission Test is a computer-based standardized examination for prospective medical students in the United States and Canada. It is designed to assess problem solving, critical thinking, written analysis, and writing skills in addition to knowledge of scientific concepts and...
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
Undergraduate education
Undergraduate education is an education level taken prior to gaining a first degree . Hence, in many subjects in many educational systems, undergraduate education is post-secondary education up to the level of a bachelor's degree, such as in the United States, where a university entry level is...
bachelor's
Bachelor's degree
A bachelor's degree is usually an academic degree awarded for an undergraduate course or major that generally lasts for three or four years, but can range anywhere from two to six years depending on the region of the world...
, but many of these are transitioning to graduate-level training. Professional licensure is regulated by the medical boards of the individual states
U.S. state
A U.S. state is any one of the 50 federated states of the United States of America that share sovereignty with the federal government. Because of this shared sovereignty, an American is a citizen both of the federal entity and of his or her state of domicile. Four states use the official title of...
. 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 both 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, 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
Northeastern United States
The Northeastern United States is a region of the United States as defined by the United States Census Bureau.-Composition:The region comprises nine states: the New England states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont; and the Mid-Atlantic states of New...
; The "A" indicates completion of the Army Flight Surgeon
Flight surgeon
A flight surgeon is a military medical officer assigned to duties in the clinical field variously known as aviation medicine, aerospace medicine, or flight medicine...
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
Pancé
Pancé is a commune in the Ille-et-Vilaine department in Bretagne in north-western France.-Demographics:Inhabitants of Pancé are called Pancéens.-References:* ;* -External links:*...
) before becoming a PA-C; this certification is required for licensure in all states. In addition, a PA must earn and log 100 Continuing Medical Education
Continuing medical education
Continuing medical education refers to a specific form of continuing education that helps those in the medical field maintain competence and learn about new and developing areas of their field. These activities may take place as live events, written publications, online programs, audio, video, or...
(CME) hours and reregister his or her certificate with the NCCPA every two years. Every six years, a PA must also recertify by successfully completing the Physician Assistant National Recertifying Exam (PANRE). NCCPA eliminated the Pathway II as a means of recertifying in 2010."Physician Assistant National Recertifying Exam (PANRE)" - NCCPA
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. 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
Mid-level practitioner
The term mid-level practitioner is an identifier used by the United States Drug Enforcement Administration to monitor and control the diversion of controlled substances in the U.S...
(which include PAs) by State and the licensing authority granted to each category within that particular State through the Drug Enforcement Administration
Drug Enforcement Administration
The Drug Enforcement Administration is a federal law enforcement agency under the United States Department of Justice, tasked with combating drug smuggling and use within the United States...
(DEA). PAs in Florida, Kentucky, Puerto Rico and the U.S. Virgin Islands, are not allowed to prescribe, order, dispense, or administer any controlled substances
Controlled substance
A controlled substance is generally a drug or chemical whose manufacture, possession, or use are regulated by a government. This may include illegal drugs and prescription medications ....
. Several other states place a limit on the type of controlled substance
Controlled Substances Act
The Controlled Substances Act was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970. The CSA is the federal U.S. drug policy under which the manufacture, importation, possession, use and distribution of certain...
or the quantity that can be prescribed, dispensed, or administered by a PA.
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
Telecommunication
Telecommunication is the transmission of information over significant distances to communicate. In earlier times, telecommunications involved the use of visual signals, such as beacons, smoke signals, semaphore telegraphs, signal flags, and optical heliographs, or audio messages via coded...
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.
Employment
The first employer of PAs was the then Veterans Administration, known today as the Department of Veterans Affairs. Today VA is the largest single employer of PAs, employing nearly 2000 PAs. One of the first three graduates of the Duke program in 1967 was Mr. Vic Germino who was employed after graduation by the Durham, NC VA Medical Center, where he remained for over 25 years. In July 2010 Mr. Germino was honored by the Veteran Affairs Physician Assistant Association (VAPAA) with an honorary membership and assigning him the special membership number 0001 in honor of Mr. Germino being the first PA employed by the VA.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 hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s. The remainder were employed in public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
clinics, nursing homes, schools, prisons, home health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
agencies, and the United States Department of Veterans Affairs
United States Department of Veterans Affairs
The United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...
Fifteen percent of responding PAs work in counties classified as non-metropolitan by Economic Research Service of the United States Department of Agriculture
United States Department of Agriculture
The United States Department of Agriculture is the United States federal executive department responsible for developing and executing U.S. federal government policy on farming, agriculture, and food...
; approximately 17% of the US population resides in these counties
County (United States)
In the United States, a county is a geographic subdivision of a state , usually assigned some governmental authority. The term "county" is used in 48 of the 50 states; Louisiana is divided into parishes and Alaska into boroughs. Parishes and boroughs are called "county-equivalents" by the U.S...
.
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
Baby boomer
A baby boomer is a person who was born during the demographic Post-World War II baby boom and who grew up during the period between 1946 and 1964. The term "baby boomer" is sometimes used in a cultural context. Therefore, it is impossible to achieve broad consensus of a precise definition, even...
population, concerns for cost containment, and newly-implemented restrictions to shorten physician resident
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...
work hours.
For PAs in primary care practice, malpractice
Malpractice
In law, malpractice is a type of negligence in, which the professional under a duty to act, fails to follow generally accepted professional standards, and that breach of duty is the proximate cause of injury to a plaintiff who suffers harm...
insurance policies with $100,000–300,000 in coverage can cost less than $600 per year; premiums are higher for PAs in higher-risk specialties.
Money magazine, in conjunction with Salary.com, listed the PA profession as the "fifth best job in America" in May 2006, based both on salary and job prospects, and on an anticipated 10-year job growth of 49.65%. According to the American Academy of Physician Assistants (AAPA), in 2008 the mean total income for physician assistants working at least 32 hours per week was $89,987. Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn $100,000–200,000 per year.
In the Federal Government, Uniformed Services, and U.S. Armed Forces
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
United States Army
The United States Army is the main branch of the United States Armed Forces responsible for land-based military operations. It is the largest and oldest established branch of the U.S. military, and is one of seven U.S. uniformed services...
PAs typically serve as Medical Specialist Corps officer
Officer (armed forces)
An officer is a member of an armed force or uniformed service who holds a position of authority. Commissioned officers derive authority directly from a sovereign power and, as such, hold a commission charging them with the duties and responsibilities of a specific office or position...
s within Army combat or combat support battalion
Battalion
A battalion is a military unit of around 300–1,200 soldiers usually consisting of between two and seven companies and typically commanded by either a Lieutenant Colonel or a Colonel...
s located in the continental United States, Alaska
Alaska
Alaska is the largest state in the United States by area. It is situated in the northwest extremity of the North American continent, with Canada to the east, the Arctic Ocean to the north, and the Pacific Ocean to the west and south, with Russia further west across the Bering Strait...
, Hawaii
Hawaii
Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...
and overseas. These include infantry
Infantry
Infantrymen are soldiers who are specifically trained for the role of fighting on foot to engage the enemy face to face and have historically borne the brunt of the casualties of combat in wars. As the oldest branch of combat arms, they are the backbone of armies...
, armor, cavalry
Cavalry
Cavalry or horsemen were soldiers or warriors who fought mounted on horseback. Cavalry were historically the third oldest and the most mobile of the combat arms...
, airborne
Airborne forces
Airborne forces are military units, usually light infantry, set up to be moved by aircraft and 'dropped' into battle. Thus they can be placed behind enemy lines, and have an ability to deploy almost anywhere with little warning...
, artillery
Artillery
Originally applied to any group of infantry primarily armed with projectile weapons, artillery has over time become limited in meaning to refer only to those engines of war that operate by projection of munitions far beyond the range of effect of personal weapons...
and (if the PA qualifies) Special Forces
Special forces
Special forces, or special operations forces are terms used to describe elite military tactical teams trained to perform high-risk dangerous missions that conventional units cannot perform...
units. They serve as the "front line" of Army medicine and along with combat medic
Combat medic
Combat medics are trained military personnel who are responsible for providing first aid and frontline trauma care on the battlefield. They are also responsible for providing continuing medical care in the absence of a readily available physician, including care for disease and battle injury...
s 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
United States Air Force
The United States Air Force is the aerial warfare service branch of the United States Armed Forces and one of the American uniformed services. Initially part of the United States Army, the USAF was formed as a separate branch of the military on September 18, 1947 under the National Security Act of...
and Navy
United States Navy
The United States Navy is the naval warfare service branch of the United States Armed Forces and one of the seven uniformed services of the United States. The U.S. Navy is the largest in the world; its battle fleet tonnage is greater than that of the next 13 largest navies combined. The U.S...
as clinical practitioners and aviation medicine
Aviation medicine
Aviation medicine, also called flight medicine or aerospace medicine, is a preventive or occupational medicine in which the patients/subjects are pilots, aircrews, or persons involved in spaceflight...
specialists, as well as in the Coast Guard
United States Coast Guard
The United States Coast Guard is a branch of the United States Armed Forces and one of the seven U.S. uniformed services. The Coast Guard is a maritime, military, multi-mission service unique among the military branches for having a maritime law enforcement mission and a federal regulatory agency...
and Public Health Service
United States Public Health Service
The Public Health Service Act of 1944 structured the United States Public Health Service as the primary division of the Department of Health, Education and Welfare , which later became the United States Department of Health and Human Services. The PHS comprises all Agency Divisions of Health and...
. 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
Aviation medicine
Aviation medicine, also called flight medicine or aerospace medicine, is a preventive or occupational medicine in which the patients/subjects are pilots, aircrews, or persons involved in spaceflight...
and military medicine
Military medicine
The term military medicine has a number of potential connotations. It may mean:*A medical specialty, specifically a branch of occupational medicine attending to the medical risks and needs of soldiers, sailors and other service members...
. 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.
Name change
There is a movement within the field to change the profession's title to "physician associate." This is similar to the title of physician's associate that was used in the early 1970s, but is not the original title of the profession which was physician assistant. It is argued that the word "assistant" no longer accurately portrays the Physician Assistant profession's responsibilities and causes confusion to patients. Out of the 154 accredited PA training programs, Yale School of MedicineYale School of Medicine
The Yale School of Medicine at Yale University is a private medical school located in New Haven, Connecticut, U.S. It was founded in 1810 as The Medical Institution of Yale College, and formally opened its doors in 1813....
, Duke University Health System
Duke University Health System
The Duke University Health System, combines the Duke University School of Medicine, the Duke University School of Nursing, the Duke Clinic, and the member hospitals into a system of research, clinical care, and education.-Duke University Hospital:...
, University of Oklahoma
University of Oklahoma
The University of Oklahoma is a coeducational public research university located in Norman, Oklahoma. Founded in 1890, it existed in Oklahoma Territory near Indian Territory for 17 years before the two became the state of Oklahoma. the university had 29,931 students enrolled, most located at its...
--Oklahoma City, and Our Lady of the Lake College
Our Lady of the Lake College
Our Lady of the Lake College is a private, independent Catholic institution located in Baton Rouge, Louisiana, United States. It is sponsored by the Franciscan Missionaries of Our Lady, North American Province. It was started in 1923 as Our Lady of the Lake School of Nursing to educate students to...
(which has a provisionally-accredited PA program) offer "physician associate programs" for students who will go on to become licensed as physician assistants. The name change has been publicly supported by 100 of the nation's leading and founding physician assistants, as well as the Association of Family Practice Physician Assistants. In July 2011, over six thousand of the nations PAs mailed a statement to the AAPA asking for a change to physician associate. The AAPA Board refused to endorse this issue and suggested it go to the 2012 House of Delegates.
Australia
Edith Cowan UniversityEdith Cowan University
Edith Cowan University is located in Perth, Western Australia. It was named after the first woman to be elected to an Australian Parliament, Edith Cowan, and is the only Australian university named after a woman....
in Perth, Western Australia, offers a two-year Master of Medical Science (Physician Assistant); James Cook University
James Cook University
James Cook University is a public university based in Townsville, Queensland, Australia. The university has two Australian campuses, located in Townsville and Cairns respectively, and an international campus in Singapore. JCU is the second oldest university in Queensland—proclaimed in 1970—and the...
in Northern Queensland offer a gradaute-entry Bachelor of Health Science (Physician Assistant) and University of Queensland
University of Queensland
The University of Queensland, also known as UQ, is a public university located in state of Queensland, Australia. Founded in 1909, it is the oldest and largest university in Queensland and the fifth oldest in the nation...
in Brisbane offer a 2-year Master of Physician Assistant Studies
The Master of Physician Assistant Studies program at the University of Queensland is not currently taking further enrolments; however, James Cook University School of Medicine and Edith Cowan University will commence their first cohort in 2012.
Canada
The PA concept is being explored in CanadaCanada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, where Canadian military
Military
A military is an organization authorized by its greater society to use lethal force, usually including use of weapons, in defending its country by combating actual or perceived threats. The military may have additional functions of use to its greater society, such as advancing a political agenda e.g...
PAs are gaining legislative changes allowing them to work in the civilian world after retirement. Education programs are now offered at Canadian Forces Base Borden at the Canadian Forces Health Services Training Centre, the University of Manitoba
University of Manitoba
The University of Manitoba , in Winnipeg, Manitoba, Canada, is the largest university in the province of Manitoba. It is Manitoba's most comprehensive and only research-intensive post-secondary educational institution. It was founded in 1877, making it Western Canada’s first university. It placed...
in Winnipeg, McMaster University
McMaster University
McMaster University is a public research university whose main campus is located in Hamilton, Ontario, Canada. The main campus is located on of land in the residential neighbourhood of Westdale, adjacent to Hamilton's Royal Botanical Gardens...
in Hamilton, Ontario
Hamilton, Ontario
Hamilton is a port city in the Canadian province of Ontario. Conceived by George Hamilton when he purchased the Durand farm shortly after the War of 1812, Hamilton has become the centre of a densely populated and industrialized region at the west end of Lake Ontario known as the Golden Horseshoe...
, and the University of Toronto
University of Toronto
The University of Toronto is a public research university in Toronto, Ontario, Canada, situated on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution of higher learning in Upper Canada...
. Programs are 24 months in length.
England
In EnglandEngland
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
, 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
St George's, University of London
St George's, University of London is a medical school located in London, United Kingdom and a constituent college of the federal University of London...
. The University of Warwick
University of Warwick
The University of Warwick is a public research university located in Coventry, United Kingdom...
and University of Coventry have also explored offering these programs, but did not implement them due to a lack of perceived need. However, the NHS trusts in the West Midlands
West Midlands (region)
The West Midlands is an official region of England, covering the western half of the area traditionally known as the Midlands. It contains the second most populous British city, Birmingham, and the larger West Midlands conurbation, which includes the city of Wolverhampton and large towns of Dudley,...
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
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
. 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 either the UK's General Medical Council or the Health Professions Council expected to become the registering body. Programs are 24 months in length and award a Post-Graduate Diploma with some programmes offering 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.
Germany
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. A physician assistant is 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. Physician assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care and assist in surgery. 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.
Netherlands
The NetherlandsNetherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
has educational programs at the Academie Gezondheidszorg in Utrecht
Utrecht (province)
Utrecht is the smallest province of the Netherlands in terms of area, and is located in the centre of the country. It is bordered by the Eemmeer in the north, Gelderland in the east, the river Rhine in the south, South Holland in the west, and North Holland in the northwest...
, University of Arnhem/Nijmegen
Radboud University Nijmegen
Radboud University Nijmegen is a public university with a strong focus on research in Nijmegen, the Netherlands...
, the University of Groningen
University of Groningen
The University of Groningen , located in the city of Groningen, was founded in 1614. It is one of the oldest universities in the Netherlands as well as one of its largest. Since its inception more than 100,000 students have graduated...
and the University of Leiden. Programs are 30 months in length.
Scotland
Pilot projects in ScotlandScotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...
are underway, but no official educational programs have been implemented as of 2008.
South Africa
Programs for the training of clinical associatesClinical associates
Clinical associates are a category of healthcare providers found in South Africa. They assess patients, make diagnoses, prescribe treatment and perform minor surgery under the supervision of a physician....
are offered in South Africa at the Walter Sisulu University and University of the Witwatersrand
University of the Witwatersrand
The University of the Witwatersrand, Johannesburg is a South African university situated in the northern areas of central Johannesburg. It is more commonly known as Wits University...
.
See also
- Clinical officerClinical officerClinical officers are health care providers who practice modern medicine. They practice independently but may be supervised by a physician in some settings....
, a similar class of healthcare providers in East AfricaEast AfricaEast Africa or Eastern Africa is the easterly region of the African continent, variably defined by geography or geopolitics. In the UN scheme of geographic regions, 19 territories constitute Eastern Africa:...
. - FeldsherFeldsherFeldsher is the name of a health care professional who provides various medical services in Russia and other countries of the former Soviet Union, mainly in rural areas...
, a similar class of healthcare providers in countries of the former Soviet UnionSoviet UnionThe Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....
. - National Physician Assistant Week
External links
- Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)
- American Academy of Physician Assistants (AAPA)
- National Association of Physician Assistants
- National Commission on Certification of Physician Assistants (NCCPA)
- Journal of the American Academy of Physician Assistants (JAAPA)
- Physician Assistant History Center
- ADVANCE for NPs & PAs journal
- Physician Assistant Education Association
- Physician Assistant in Orthopaedic Surgery (PAOS)
- Inside Physician Assistant Training Career Resource & Forum
- Physician Assistant Forum & News