What is a Physician Assistant?
Physician assistants, or PAs, are health care professionals licensed, or in the case of those employed by the federal government, are credentialed to practice medicine with physician supervision. As part of their comprehensive responsibilities, PAs perform physical exams, diagnose and treat illnesses, order and interpret tests, give advice on preventive health care, assist in surgery, and write prescriptions. Physician Assistants exercise autonomy in medical decision making and provide a broad range of diagnostic and therapeutic services within the Physician-PA relationship. A PA’s practice may also include education, research, and administrative services.
The Physician Assistant profession was founded in 1965 at Duke University in North Carolina to address the shortage and uneven distribution of physicians. Ten years later, there were approximately 1500 practicing physician assistants. The first PA Practice Act in Illinois was passed that same year. Currently, there are close to 150 accredited physician assistant programs, and the AAPA estimates there are 73,893 professionals in clinical practice as PAs throughout the United States (http://www.aapa.org/about-pas/faq-about-pas). Although PAs working in family and general medicine constitute the largest group, PAs are also found in specialities of medicine and surgery. In fact, the November 2009 CNN Best Job report ranked Physician Assistant second in the list of top 50 jobs forecasting a 27% growth in demand for the position in the next decade. (http://money.cnn.com/magazines/moneymag/bestjobs/2009/full_list/index.html).
Increased utilization of Physician Assistants may result in improved distribution and access to health care services, especially in rural and medically underserved areas. Patient waiting times are reduced, and PAs may have more time for questions, counseling and education. This helps to increase the level of patient understanding and compliance, which in turn reduces the cost of health care. Research has demonstrated that PAs provide excellent care and are cost effective ( JAAPA. 2002 Nov;15(11):39-42, 45, 48 passim).
The scope of practice of a physician assistant is determined by their supervising physician and state legislation. PA responsibilities include, but are not limited to:
• Obtaining medical histories
• Performing physical examinations
• Providing preventive health services and promoting wellness
• Ordering, assessing the results and sometimes performing
diagnostic and laboratory tests
• Diagnosing and treating medical or surgical conditions
• Assisting in surgery
• Providing emergency and critical care
• Prescriptive privileges for all legend drugs and controlled substances II-V
• Patient counseling and patient education
PAs always work with the supervision of the physician who maintains the overall responsibility for the patient’s care. In Illinois, the supervising physician is not required to be physically present
when the PA provides services.
Physician Assistants work in a wide variety of health care environments, including:
• Private and group practice settings
• Veterans’ Administration and military settings
• Nursing homes
• Community health centers
• Rural health centers
• School based health centers
• Occupational medicine settings
• Correctional institutions
Physicians and health care organizations are continually expanding where and how PAs can best serve the needs of patients and communities.
Physician assistants receive a broad medical education. Because of the close working relationship the PAs have with physicians, PA education is designed to complement medical training. Criteria for admission to a program include previous health care experience and completion of a variety of basic science as well as other general courses. PA educational programs average 24-27 months in length. They are accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) and sponsored by schools of allopathic or osteopathic medicine, colleges and
universities affiliated with appropriate clinical teaching facilities and medical education facilities of the federal government.
The professional curriculum for PA education includes basic medical, behavioral, and social sciences; patient assessment and clinical medicine; supervised clinical practice; and health policy
and professional practice issues. Supervised clinical practice experiences for students include rotations in emergency medicine, family medicine, internal medicine, general surgery (including operative experiences), geriatrics, pediatrics, prenatal care and women’s health, psychiatry and/or behavioral medicine. Although PA Programs may confer a variety of degrees to their graduates. PA education is conducted at the graduate level. Consequently, a bachelor’s degree and clinical health care experience are prerequisites to most programs.
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 obtain a license in Illinois, a PA must pass this exam. After passing the exam, the Illinois PA uses the credential PA-C. To maintain their national certification, PAs must log 100 hours of continuing medical education every two years and pass a national recertification exam every six years. PA education continues throughout a provider’s career with mandatory continuing medical education as well as the ongoing professional interactions between health care providers.
State laws and regulations define the physician assistants scope of practice as well as serve to establish licensure and competency requirements. The responsibilities of the supervising physician
are also specified. In Illinois, licenses are obtained through the Department of Financial and Professional Regulation. More information about the Illinois PA Practice Act can be found at: http://www.idfpr.com/dpr/WHO/adjmed.asp. PAs provide physician services which are compensated by insurers, Medicare, Medicaid, SCHIP, and other health care payers through payments to PA employers. PAs are not directly reimbursed for their services.