 What
is a Physician Assistant (PA)?
Physician assistants are health care professionals
licensed to practice medicine with physician supervision.
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 write prescriptions. Within
the physician-PA relationship, physician assistants
exercise autonomy in medical decision making and provide
a broad range of diagnostic and therapeutic services.
A PA's practice may also include education, research,
and administrative services.
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.
How did the Physician Assistant profession begin?
In the mid-1960s, physicians and educators recognized
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.
What areas of medicine can Physician Assistants
work in?
Physician assistants 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.
Where do PAs "draw the line" as far as
what they can treat and what a physician can treat?
What a physician assistant does varies with training,
experience, and state law. In addition, the scope of
the PA's responsibilities 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 scopeof 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 education.
Can PAs prescribe medications?
All fifty 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.
What do physicians think about Physician Assistants?
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."
What is the working relationship between a physician
and a physician assistant?
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:
Health care services delivered by physicians and Physician
Assistants must be within the scope of each practitioners
authorized practice as defined by state law.
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.
The physician is responsible for the supervision of
the Physician Assistant in all settings.
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 physicianand the
Physician Assistant and based on the physician's delegatory
style.
The physician must be available for consultation with
the Physician Assistant at all times either in person
or through telecommunication systems or other means.
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.
Patients should be made clearly aware at all times whether
they are being cared for by a physician or a Physician
Assistant.
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.
The physician is responsible for clarifying and familiarizing
the Physician Assistant with his supervising methods
and style of delegating patient care.
What's the difference between a PA and a physician?
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.
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