Expanding the Use of Non-Physician Providers: Physician Assistants

Abstract

A physician assistant, or PA, is a medical provider who cares for patients under the oversight of a licensed physician. To become a PA, a bachelor’s degree in a health or science related field is required. Then application to an accredited PA school. After two to three years of a clinical and classroom learning, PA students must pass the Physician Assistant National Certifying Examination (PANCE). Physician assistant employment is projected to grow more than 30% over the next decade. The median annual PA wage in the U.S. in 2018 was $108,610. PA’s work in physicians' offices, hospitals, or outpatient clinics. Job duties include examining patients, ordering diagnostic tests, and writing prescriptions. Usually, PAs work under the supervision of a physician or surgeon, however some states, rural areas, and inner-city areas allow physician assistants to work independently, consulting with physicians only when necessary. PA’s offer medical care at a lower cost, while increasing access to medical services/treatments.

A physician assistant (PA) provides medical care to patients under the supervision of a licensed physician, or doctor. A physician assistant holds less authority than a doctor but has more authority than a nurse. Those interested in pursuing a career as a physician assistant must first earn a bachelor’s degree. No specific four-year degree is required; however, health or science related undergraduate degrees are preferred because prerequisites like chemistry, anatomy, physiology, or microbiology are essential stepping-stones in any health profession. At least two years of behavioral and basic sciences must be completed before an individual can apply to PA school. Typical PA school attendees have a four-year bachelor’s degree and at least three years of experience working or volunteering in healthcare, specifically hands-on patient care. Certified nursing assistants (CNA), surgical technicians, or registered nurses are a few jobs which make solid foundations for future PA students (Jones, 2007).

The accrediting agency solely responsible for establishing the standards for United States physician assistant education and for evaluating programs is the Accreditation Review Commission on Education for the Physician Assistant, Inc. (ARC-PA). Acceptance into an ARC-PA accredited school is highly competitive, therefore prospective students should begin looking into programs as early as freshman year of college. PA programs generally take two or three years to complete and are a combination of clinical and classroom learning. Many PA programs require students to complete a minimum of 2,000 clinical hours. Oftentimes, internships are set up through participating health practices as a means of completing these hours. At the end of their post-graduate training, prospective physician assistants will have a Master’s in Science. Passing the Physician Assistant National Certifying Examination (PANCE) is the final step to becoming a certified physician assistant. The PANCE examination is administered by the National Commission on Certification of Physician Assistants (NCCPA). If a passing score is not earned, the exam can be retaken six times within a six-year period. If those attempts remain unsuccessful, an individual must redo the PA school education process in order to requalify for the PANCE (Cawley, 2007).

Physician assistants can specialize in medical practices, which can lead to higher pay. Some specialties include pathology, dermatology, emergency medicine, or surgical subspecialties (i.e. obstetrics, gynecology, neurology). Specialties require physician assistants to maintain ongoing education and re-certification. As the demand for health services continues to grow, PA employment in the United States is projected to increase by 31 percent from 2018 to 2028 (10 years). This is a much faster rate than the average health profession. In 2018, the median annual wage for physician assistants was $108,610 – which is roughly $52.22 per hour. Recent surveys suggest, “women typically expect lower pay and systematically undervalue their contributions and skills in comparison to men,” (Streilein, 2018).

A physician assistant usually can be found working in a physicians' office, hospitals and/or outpatient clinics. No matter which setting they choose to practice in, PA’s work in teams with PAs, physicians, surgeons, nurses, and other health professionals to provide the best possible patient care. Although the extent to which they must be supervised varies state by state, general physician assistant duties include taking or reviewing medical histories of patients, conducting physical exams, recording patient progress in medical records, ordering diagnostic test (i.e. x-rays, blood tests, PET scans), interpreting diagnostic tests, and assisting in surgeries. PAs have the authority to diagnose a patient's injury or illness and give the proper treatment. Unlike a nurse, a physician assistant is competent to prescribe medicines to patients. Often, it is the responsibility of the physician assistant to give counsel to patients and family members as well as educate them on their care. For example, answering questions of a patient diagnosed with diabetes. When they are not directly caring for their patients, PAs participate in medical research or clinical trials for the latest treatments (Timmons, 2017).

The degree to which physician assistants are supervised is largely dictated by Medicare Parts A, B, and C, and state Medicaid fiscal intermediaries –whose interpretation depends on state law. The Centers for Medicare & Medicaid Services (CMS) delineates three levels of supervision for physician assistants in outpatient departments. General supervision, level 1, requires the direction of a supervisory physician for a procedure, however they are not required to be present during the procedure, which is performed by the physician assistant. At level 2, direct supervision, the physician must be “immediately available” and “uninterruptable” to provide assistance during the procedure if needed, but they are not required to be physically present. Personal supervision obligates the physician to be present in the room during the procedure (Verhovshek, 2010).

Furthermore, differing state regulations determine the licensing requirements of certain health professions. For example, the Board of Medicine or Accreditation Council for Graduate Medical Education (ACGME). To make things more complex, many healthcare organizations are supported by private payers who may have their own stipulations regarding physician assistant supervision (Timmons, 2017).

 Physician assistants help control healthcare costs and provide a staffing solution amidst physician shortages. PA’s offer increased access to medical services for many Americans which can lead to reduced emergency room visits or hospitalizations. The availability of physician assistants means many medical facilities can offer same-day appointments. In addition to increasing the availability of medical care and services, physician assistants provide continuity of care and overall coordination (Hooker, Cawley, & Everett, 2017).

References

• Cawley, J. F. (2007). Physician assistant education: An abbreviated history. Journal of Physician Assistant Education (Physician Assistant Education Association), 18(3).
• Hooker, R. S., Cawley, J. F., & Everett, C. M. (2017). Economic assessment of physician assistants. Physician Assistants: Policy and Practice. 4th ed. Philadelphia, PA: FA Davis, 184-214.
• Jones, P. E. (2007). Physician assistant education in the United States. Academic Medicine, 82(9), 882-887. Retrieved from https://journals.lww.com/academicmedicine/Fulltext/2007/09000/Physician_Assistant_Education_in_the_United.14.aspx
• Streilein, A., Leach, B., Everett, C., & Morgan, P. (2018). Knowing your worth: salary expectations and gender of matriculating physician assistant students. The Journal of Physician Assistant Education, 29(1), 1-6.
• Timmons, E. J. (2017). The effects of expanded nurse practitioner and physician assistant scope of practice on the cost of Medicaid patient care. Health policy, 121(2), 189-196. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S016885101630344X \
• Verhovshek, J. (2010). Understand Medicare physician supervision requirements. American Academy of Professional Coders. Retrieved from https://www.aapc.com/blog/26162-understand-medicare-physician-supervision-requirements/