ABOUT THE PHYSICIAN ASSISTANT PROFESSION

General Information
PA Education
Scope of Practice
Physicians and PAs
AMA Guidelines
PA Organizations

General Information

Q. What is a Physician Assistant (PA)?
A. Physician assistants are health care professionals licensed to practice medicine with physician supervision. PAs employed by the federal government are credentialed to practice. As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and in most states can write prescriptions. PAs are trained in intensive education programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Because of the close working relationship the PAs have with physicians, PAs are educated in the medical model designed to complement physician training. Upon graduation, physician assistants take a national certification examination developed by the National Commission on Certification of PAs in conjunction with the National Board of Medical Examiners. To maintain their national certification, PAs must log 100 hours of continuing medical education every two years and sit for a recertification every six years. Graduation from an accredited physician assistant program and passage of the national certifying exam are required for state licensure.

Q. How did the Physician Assistant profession begin?
A. In the mid-1960s, physicians and educators recognized that there was a shortage and uneven distribution of primary care physicians. To expand the delivery of quality medical care, Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of PAs in 1965. He selected Navy corpsmen who received considerable medical training during their military service and during the war in Vietnam but who had no comparable civilian employment. He based the curriculum of the PA program in part on his knowledge of the fast-track training of doctors during World War II.

Q. What does "PA-C" stand for? What does the "C" mean?
A. Physician assistant-certified. It means that the person who holds the title has met the defined course of study and has undergone testing by the National Commission on Certification of Physician Assistants (NCCPA). The NCCPA is an independent organization, and the commissioners represent a number of different medical professions. It is not a part of the PA professional organization, the American Academy of Physician Assistants (AAPA). To maintain that "C" after "PA", a physician assistant must log 100 hours of continuing medical education every two years and take the recertification exam every six years.

PA Education

Q. How is a Physician Assistant educated?
A. Physician assistants are educated in intensive medical programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The average PA program curriculum runs approximately 26 months. There are currently more than 130 accredited programs. All PA programs must meet the same ARC-PA standards. Because of the close working relationship PAs have with physicians, PAs are educated in a medical model designed to complement physician training. PA students are taught, as are medical students, to diagnose and treat medical problems. Education consists of classroom and laboratory instruction in the basic medical and behavioral sciences (such as anatomy, pharmacology, pathophysiology, clinical medicine, and physical diagnosis), followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine. A PA's education doesn't stop after graduation, though. PAs are required to take ongoing continuing medical education classes and be retested on their clinical skills on a regular basis. A number of postgraduate PA programs have also been established to provide practicing PAs with advanced education in medical specialties.

Q. What are the prerequisites for applying to a PA program?
A. PA programs look for students who have a desire to study, work hard, and be of service to their community. Most physician assistant programs require applicants to have previous health care experience and some college education. The typical applicant already has a bachelor's degree and approximately 4 years of health care experience. Commonly nurses, EMTs, and paramedics apply to PA programs. Check with PA educational programs of interest to you for a list of their prerequisites.

Scope of Practice

Q. What areas of medicine can Physician Assistants work in?
A. Physician assistants (PAs) are found in all areas of medicine. They practice in the areas of primary care medicine – that is family medicine, internal medicine, pediatrics, and obstetrics and gynecology – as well in surgery and the surgical subspecialties. Physician assistants receive a broad education in medicine. Their education is ongoing after graduation through continuing medical education requirements and continual interaction with physicians and other health care providers.

Q. Where do PAs "draw the line" as far as what they can treat and what a physician can treat?
A. What a physician assistant does varies with training, experience, and state law. In addition, the scope of the PA's practice corresponds to the supervising physician's practice. In general, a physician assistant will see many of the same types of patients as the physician. The cases handled by physicians are generally the more complicated medical cases or those cases which require care that is not a routine part of the PA's scope of work. Referral to the physician, or close consultation between the patient-PA-physician, is done for unusual or hard to manage cases. Physician assistants are taught to "know our limits" and refer to physicians appropriately. It is an important part of PA training.

Q. Can PAs prescribe medications?
A. Forty-eight states, the District of Columbia, and Guam have enacted laws that authorize PA prescribing. In California, PA prescriptions are referred to as written prescription transmittal orders. PAs in Rhode Island have full prescribing powers and are not restricted.

Physicians and PAs

Q. What do physicians think about Physician Assistants?
A. Most physicians who have worked with physician assistants like having PAs on staff. The American Medical Association, the American College of Surgeons, the American Academy of Family Physicians, the American College of Physicians, and other national medical organizations support the physician assistant profession by actively supporting the PA certifying commission and the PA program accrediting agency. Studies done by the Federal Government have shown that PAs, working with the supervision of physicians, provide care that is comparable to physician care. The Eighth Report to the President and Congress on the Status of Health Personnel in the United States (released in 1992) states, "Physician assistants have demonstrated their clinical effectiveness both in terms of quality of care and patient acceptance."

Q. What is the working relationship between a physician and a physician assistant?
A. The relationship between a PA and the supervising physician is one of mutual trust and respect. The physician assistant is a representative of the physician, treating the patient in the style and manner developed and directed by the supervising physician. The physician and PA practice as members of a medical team. In 1995, the American Medical Association developed suggested guidelines for how physicians and PAs should work as a team in the delivery of medical care.

Suggested Guidelines

(For Physician-Physician Assistant Practice Adopted by the AMA House of Delegates, June 1995)

Reflecting the comments from the American Academy of Physician Assistants, separate model guidelines for Physician/Physician Assistants practice have been developed. These are based on the unique relationship of Physician Assistants who recognize themselves as agents of physicians with respect to delegated medical acts, and legal responsibilities. They are consistent with the existing AMA policies concerning Physician Assistants cited in this report. In all settings, Physician Assistants recognize physician supervision in the delivery of patient care. The suggested guidelines reflect those as follows:

1. Health care services delivered by physicians and Physician Assistants must be within the scope of each practitioner's authorized practice as defined by state law.
2. The physician is ultimately responsible for coordinating and managing the care of patients and, with the appropriate input of the Physician Assistant, ensuring the quality of health care provided to patients.
3. The physician is responsible for the supervision of the Physician Assistant in all settings.
4. The role of the Physician Assistant(s) in the delivery of care should be defined through mutually agreed upon guidelines that are developed by the physician and the Physician Assistant and based on the physician's delegatory style.
5. The physician must be available for consultation with the Physician Assistant at all times either in person or through telecommunication systems or other means.
6. The extent of the involvement by the Physician Assistant in the assessment and implementation of treatment will depend on the complexity and acuity of the patient's condition and the training and experience and preparation of the Physician Assistant as adjudged by the physician.
7. Patients should be made clearly aware at all times whether they are being cared for by a physician or a Physician Assistant.
8. The physician and Physician Assistant together should review all delegated patient services on a regular basis, as well as the mutually agreed upon guidelines for practice.
9. The physician is responsible for clarifying and familiarizing the Physician Assistant with his supervising methods and style of delegating patient care.

Q. What's the difference between a PA and a physician?
A. Physician assistants are educated in the "medical model"; in some schools they attend many of the same classes as medical students. One of the main differences between PA education and physician education is not the core content of the curriculum, but the amount of time spent in formal education. In addition to time in school, physicians are required to do an internship, and the majority also complete a residency in a specialty following that. PAs do not have to undertake an internship or residency. A physician has complete responsibility for the care of the patient. PAs share that responsibility with the supervising physicians.

PA Organizations

Q. What is the American Academy of Physician Assistants (AAPA)?
A. The AAPA is the only national professional society to represent all physician assistants in every area of medicine. Founded in 1968, the academy has a federated structure of 57 chartered chapters representing PAs in all 50 states, the District of Columbia, Guam, and the federal services. AAPA's mission is to provide quality, cost-effective, and accessible health care as well as to support the professional and personal development of PAs. The AAPA pursues these goals through government relations and public education programs, research and data collection efforts, and continuing education activities. The Academy's policies are set by the House of Delegates, which meets once a year, and implemented by the Board of Directors. The House of Delegates is made up of representatives from the chartered chapters, specialty organizations, the Student Academy, and the Association of PA Programs. Member projects and activities are assisted by the AAPA staff. A calendar of upcoming AAPA events is available on this Web site.

Q. What is the Physician Assistant Foundation?
A. As the philanthropic arm of the American Academy of Physician Assistants, the Physician Assistant Foundation's mission is to foster education and research that enhance the delivery of quality health care. Related to this mission are the Foundation's goals to increase the understanding of the physician assistant profession and to develop and promote philanthropic activities. Learn more about the PA Foundation on this Web site.

Q. What is the Association of Physician Assistant Programs (APAP) ?
A. APAP is a national organization whose members are the PA programs and individual PA educators. It includes representation from accredited programs and programs going through the accreditation process.

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