The Physician Assistant profession has its beginnings with the
highly trained Hospital corpsmen of the Vietnam War era. Dr. Eugene Stead of
the Duke University Medical Center in North Carolina put together the first
class of PAs in 1965, to expand the availability of medical care in the face of
a shortage of primary care physicians. For his first class, he selected former
Navy corpsmen, who had received considerable medical training during their
military service and during the war in Vietnam but who had no comparable
civilian employment or equivalent. He based the curriculum of the PA program in
part on his knowledge of the fast-track training of medical doctors during
World War II.
Most programs require applicants to have at least 2 years
of college experience. Applicants also need some experience within the health
care setting, such as an emergency medical technician, ambulance attendant,
health educator, licensed practical nurse or associate-degree nurse. However,
because of the competitive environment, the average PA student has a bachelor's
degree in some field and about 4 years of health-related experience.
Educational programs for PAs are typically associated with colleges of
medicine, and vary from 25 to 27 months in length.
The first PA students
were mostly military medics (or corpsmen) who were able to expand on the
knowledge and experience they received in the military to move into a role in
primary care. Over the years, male domination within the profession has
consistently decreased, and about 58% of PAs today are women. The physician
assistant role, legally associated with a supervising physician, has allowed
PAs to perform tasks previously only performed by doctors: history taking,
physical examination, diagnosis, and patient management.
studies have noted the ability of PAs to provide high-quality health care --
comparable to that of a doctor -- for about 80% of the conditions seen in
primary care settings.
SCOPE OF PRACTICE
physician assistant is prepared, both academically and clinically, to provide
health care services with the direction and responsible supervision of a Doctor
of Medicine (MD) or Osteopathy (DO). PA functions include performing
diagnostic, therapeutic, preventive, and health maintenance services.
of 2006, PAs in 48 states, the District of Columbia, and Guam have prescriptive
practice privileges. Physician assistants may not receive direct third-party
(insurance) reimbursement for their services, but their services are billed-for
through their supervising doctor or employer.
PAs practice in a variety of settings in nearly every
medical and surgical specialty area. The majority (45%) of them practice within
primary care areas, with 28% in family practice. Other common practice areas
are general surgery, surgical subspecialties, and emergency medicine. The
remainder are involved in teaching, research, administration, or other
PAs may practice in any setting in which a physician
provides care, allowing the doctor to focus skills and knowledge in a more
effective manner. PAs practice in both rural and inner city communities. About
30% of PAs practice in areas that have less than 50,000 people. Because of the
ability and willingness of PAs to practice in rural areas, the distribution of
health care providers throughout the general population has been
REGULATION OF PROFESSION
other professions, physician assistants are regulated at two different levels.
Licensure takes place at the state level according to specific state laws. In
contrast, certification is established through a national organization, with
requirements for minimal practice standards being consistent across all
Licensure: Laws specific to PA licensure may vary somewhat among
the states. However, nearly all states require national certification prior to
licensure. Prescriptive practice privileges for PAs exist in about 48 states,
the District of Columbia, and Guam.
All state laws require PAs to have a
supervising doctor. This physician does not necessarily have to be on site at
the same location as the PA. Most states allow physician supervision to occur
via telephone communication with periodic site visits. Supervising doctors
typically review and sign all visits recorded in the patient's file by the
Certification: In the early stages of the profession, the AAPA
(American Association of Physician Assistants) joined with the AMA (American
Medical Association) and the National Board of Medical Examiners to develop a
national competency examination.
Later, in 1975, an independent
organization, the National Commission on Certification of Physician Assistants,
was established to administer a certification program that includes an
entry-level examination, continuing medical education, and periodic
re-examination for recertification. Only physician assistants who are graduates
of approved programs and have completed and maintained such certification may
use the credentials PA-C (certified).
by: Kevin D. Bayes, Assistant Director of Information
Services, American Academy of Physician