HISTORY OF THE PROFESSION
The first Physician Assistant Training Program was founded in 1965 at Duke University by Dr. Eugene Stead. Currently (2003), there are 134 programs in operation.
Most programs require applicants to have at least 2 years of college experience and 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 initial PA students were primarily military medics or corpsmen, who were able to expand upon the knowledge base they had 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 59% 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.
Numerous studies have documented the ability of PAs to provide high-quality health care, comparable to that of a physician, for about 80% of the conditions seen in primary care settings.
SCOPE OF PRACTICE
The 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.
As of 2003, PAs in 47 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 physician or employer. (See also Types of health care providers).
PAs practice in a variety of settings in nearly every medical and surgical specialty area. The majority (44%) of them practice within primary care areas with 31% 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 nonclinical roles.
PAs may practice in any setting in which a physician provides care, allowing the doctor to focus skill 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 adeptness and willingness of PAs to practice in rural areas, the distribution of health care providers (in relation to the general population distribution) has been enhanced.
REGULATION OF PROFESSION
Like many other professions, physician assistants are regulated at two different levels. Licensure is a process that takes place at the state level in accordance with specific state laws. In contrast, certification is established through a national organization, with requirements for minimal practice standards being consistent across all states.
Licensure: Laws specific to PA licensure may vary somewhat between states; however, nearly all states require national certification prior to licensure. Prescriptive practice privileges for PAs exist in about 47 states, the District of Columbia, and Guam.
All state laws require PAs to have a supervising physician. 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 physicians typically review and sign all visits recorded in the patient’s file by the PA.
Certification: In the early stages of the profession, the AAPA (American Association of Physician Assistants) collaborated 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 inclusive of an entry-level examination and 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 Simon D. Mitin, M.D.
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