What is a Physician Assistant (PA)?

What is a PA? Are you a medical assistant? Are you a doctor? Are you a nurse? Are you going to go back to medical school to become a doctor?  What does the “C” mean in  PA-C?

These are just a few of the questions that I get from some of the patients that I see here at Avail Dermatology. So…I thought I’d write a short article to try and answer some of these questions.

Physician Assistants [aka Midlevel Provider, Medex (medical extender) and Physician extender] are healthcare providers that are licensed to “practice medicine” under physician supervision. PAs work very closely with their supervision physicians to a) provide quality healthcare and b) increase access to medical care – either by allowing a practice to see more patients (reducing the wait time for an appointment) or by working in rural or inner-city areas where no doctor is on site.  In the latter situation, PAs often serve as the primary providers of health care. They are in touch with their supervising physicians and other health care providers, as needed, and as required by law.

After the Vietnam War was over, there were many corpsmen and medics that had a lot of medical skills and knowledge but nowhere to apply this knowledge once retiring into civilian life. During this time, it was recognized that there was a shortage/uneven distribution of primary care physicians in the United States.  To help expand delivery of healthcare and capitalize on the knowledge and skills of these new civilians, the concept of the Physician Assistant was born.  The goal was to train these individuals under the “medical model” (same way physicians are trained) to work in primary care (Family Practice, Internal Medicine, Emergency Medicine, Pediatrics and Surgery). The PA profession was the first medical profession to officially share the knowledge base that was formerly the exclusive “property” of physicians.

The first PA program originated at Duke University in 1965 under Dr. Eugene Stead. There were four students (all ex-navy corpsmen) in the first class.  Now there are more than 140 PA programs and about 68,100 practicing PAs in the United States. PAs work in group or solo physician practices, hospitals, rural clinics, community health centers, free standing surgical facilities, nursing homes, school or college-based facilities, industrial settings and correctional settings. PA functions include but are not limited to taking medical histories, performing physical exams, ordering and interpreting laboratory tests, diagnosing and treating illness, assisting in surgery, counseling patients and promoting wellness and writing prescriptions. As part of the Physician-PA team, physicians can delegate to PAs those duties that are within the physician’s scope of practice and the PA’s training and experience. State laws allow a good deal of flexibility in this area to facilitate customized team practice. All 50 states, the District of Columbia, and Guam authorize PAs to prescribe medications. Physicians are required to “sign-off” on both prescription orders as well as patient charts within a specified time-frame determined by each state. The American Academy of Physician Assistants estimated that in 2008 about 257 million patient visits were made PAs and about 332 million medications were prescribed or recommended by PAs.

Prerequisites for entering a PA program usually require at least a B.S. degree (many applicants also have a least one M.S. degree as well) with emphasis on basic/medical sciences and some sort of previous healthcare experience or experience in community/rural based programs designed to improve access of healthcare to indigent populations. Many of the applicants have experience in mission work and have worked with the homeless or on reservations, etc.  The application process can be quite competitive and it is not unusual to have several hundred applicants each year for sometimes as few as 35 slots in a PA class. The average program lasts about 26.5 months. The first 12 months is didactic, the second 12 months is clinical, and the remaining months are devoted to research or public health. In the state of Georgia there are four PA programs:  Emory University, Atlanta; Medical College of Georgia, Augusta; University of the South, Savannah; and Mercer University, Atlanta.

Graduates of an accredited PA program will earn a M.S. degree and are required to pass the certification exam administered by the National Commission on Certification of the Physician Assistants (NCCPA) before being able to practice as a PA-C.  The “C” means certified. Graduation from an accredited PA program and passage of the NCCPA exam are required for state licensure. To maintain certification, PAs must pass a recertification exam every 6 years in primary care and log a minimum of 100 hours of Continuing Medical Education (CME) every two years.  Georgia also requires documentation of a least 100 CME hours for licensure every 2 years.

Due to the fact that the PA profession is so unique, a movement to document its’ history culminated in the development of the Physician Assistant History Center which is located in Durham, N.C. Our national professional organization is called the American Academy of Physician Assistants (AAPA).

Now, to answer to some of your questions: No, we are not medical assistants. No, we are not nurses. No, we are not going to go back to medical school to become a doctor (although some do). So, what are we? We are “Physician Assistants.” What do we do? We assist, we diagnose, we treat, we prescribe, we counsel, we listen, we care.

Sandra Morris, PA-C

References

  1. www.pahx.org
  2. www.aapa.org
  3. Ballweg, Ruth, ed et al. “Physician Assistant – A Guide to Clinical Practice.  Chapter 1.  History of the Profession.  W.B. Saunders Company, Philadelphia, PN. 1994,ppl-5.