A Physician Assistant(PA) is a healthcare professional who is trained and licensed to practice medicine under the supervision of a physician. A PA’s license allows one to perform any medical or surgical duties that are delegated to him/her by the physician. This usually involves working as part of a team in the big hospitals or being the only medical care provider in smaller, remote and inner city clinics.
A Physician 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. Physician 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 assistants work in hospitals, clinics, and other types of health facilities, and exercise autonomy in medical decision making as determined by their supervising physician. A Bachelor’s degree, often Master’s degree, and clinical internship precede obtaining a license to practice as a Physician Assistant. Renewal of licensure is necessary every few years, varying by state. They are educated in the medical model designed to complement physician training, rather than in the nursing model as nurse practitioners are. Physician assistants are not to be confused withmedical 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. Similar providers have different titles in other countries such as clinical officers in Africa, assistant medical officers in Malaysia, Medical Care Practitioners in the UK, Assistant Doctors in China and Feldsher countries of the former Soviet Union.
Education and certification
As of October 2011, there were 156 accredited PA programs in the United States. The majority are graduate programsleading to the award of master’s degrees 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.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
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.
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 delineated 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 (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 ofcontrolled 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.