What is a Physician Assistant (PA)?
History
Education
Board Certification
Third Party Reimbursement
Prescribing Privileges
Forecasts
Professional Considerations
Income

What is a Physician Assistant (PA)?
    PAs are licensed health care professionals. They practice medicine with physician oversight. This includes
     — Physicals for school, work, and disability evaluations,
     — Evaluation, diagnosis, and treatment of patients,
     — Interpretation of laboratory, x-ray, and special diagnostic tests, and
     — Prescribing of over the counter, legend, and in many states, scheduled controlled narcotics.

      PAs can be found in a wide variety of medical settings, from family practice offices to university hospitals, from surgery suites to transplant teams. Depending on the location, PAs treat diseases in infants, children, adults, and seniors; in some remote situations they deliver babies.

    In January 2001, 40,500 PAs practiced nationally and could be found in every state. Access to health care services is improved by the average PA seeing 116 patients a week. Collectively, PAs write more than three million prescriptions a week.

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History
    Physician Assistants (PAs) were first trained in 1965 at Duke University to meet the needs of medically underserved areas. Initially, most PAs were former military corpsmen. The sexes became equally represented in PA programs by 1990. Of the current 40,000 practicing physician assistants, more than 7,000 are informally trained-they did not attend a formal PA program.

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Education
    Nationwide, there are about 120 accredited Physician Assistant Programs offered by medical schools, colleges, and universities affiliated with teaching hospitals, the US Public Health Service, and the US armed forces. These programs offer degrees ranging from the Associates to the Masters level, and collectively graduate close to 5,000 students a year. Traditionally, most programs have awarded a Bachelor degree, but now about half offer a Master's degree.

    Most PA programs requires one to two years of documented health care experience for admission to their 24-32 month full time programs. After admission, the curriculum is modeled after a special “fast track” medical school model developed in World War II.

    The first year PA student learns
    • medical anatomy,
    • disease models,
    • pharmacology, and
    • “hands-on” examination techniques.

     The second year involves training in the clinical sciences, to include
    • Internal Medicine,
    • Surgery,
    • Pediatrics,
    • Psychiatry,
    • Family Practice, and
    • Emergency Medicine.

     Accreditation of PA programs is by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).

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Board Certification
    Initial board certification by examination by the National Commission on the Certification of Physician Assistants (NCCPA) is required in most states. Applicants must be graduates of an ARC-PA accredited PA program (See Education above). The initial exam has a failure rate from 10 to 30%.

Following the initial award, certification is maintained by documenting 100 hours of CME (Continuing Medical Education) every two years, and successful passage of the recertification Boards every six years. The Boards are written and administered by the National Board of Medical Examiners under contract to the NCCPA.

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Third Party Reimbursement
    Third party reimbursement for PA services is provided by Medicaid, Medicare (Parts A & B), Tricare (formally Champus), and most commercial carriers. Medicare issues a unique billing number.

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Prescribing Privileges
    Every state, the District of Columbia,and Guam have mechanisms in place to allow physician assistants to prescribe legend medications. Twenty-one states also allow some prescribing of controlled scheduled narcotics.

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Forecasts
    In the early nineties, the US Department of Labor predicted a 36 per cent increase in PA positions from 1992 through 2005. (This estimate was probably too conservative, as 60+ new PA Programs started between 1997 and 2001). More recently, the United States Bureau of Labor Statistics projects the number of positions for PAs will increase by 48% between 1998 and 2008. (Information on the Physician Assistant Profession, American Academy of Physician Assistants, Winter 2001.)

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Professional Considerations
    Eighty six per cent of graduate physician assistants would enter the profession today if able to choose again (AAPA, 2001 Market Survey, reported in AAPA News, September 15, 2001).

    Another study by the National Commission on the Certification of PAs (Practice Survey, as reported in NCCPA News, Fall 2000) found 45 per cent of PAs spend 41-50 hours in practice per week, while 5 per cent work at least 71 hours per week. This survey also found that 62% of PA respondents work in primary care (Family Practice 25%, Medicine 22%, Pediatrics 10%, and OB/GYN 6%).

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Income
    New graduates: mean $58,297, median $56,977. All PAs: mean $68,757, median $65,177. (2000 AAPA Physician Assistant Census Survey, Income from primary employer excluding government and self-employment working at least 32 hours per week.)

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