Physician Assistant (PA)
medical professional trained in rigorous postgraduate education programs to evaluate, diagnose, and treat patients.
prescribe medications, order and interpret medical tests, and perform diagnostic and therapeutic procedures.
What is the role of a physician assistant?
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Physician Assistant (PA)
medical professional trained in rigorous postgraduate education programs to evaluate, diagnose, and treat patients.
prescribe medications, order and interpret medical tests, and perform diagnostic and therapeutic procedures.
What is the role of a physician assistant?
yes
In the U.S., can PAs practice in every state & every specialty?
Europe, Africa, South Asia
Where else do PAs exist?
medical model
What model of care is described?
Focuses on cause & effect; acknowledges the presence of disease (cause) & how to treat the disease (effect)
social model
What model of care is described?
Psychosocial factors that contribute to care & health outcomes.
nursing model
What model of care is described?
Focuses more on the whole person & things that impact a patient overall.
medical model
What model of care is followed by PAs?
medical; nursing
Physician assistants are certified by a _____________ board, whereas nurse practitioners are certified by a _____________ board.
Russian Feldshers (huge ties to military)
What group of people gave rise to PAs in the 1600-1700s? (originating in European military in 17th and 18th centuries)
Russian Feldshers
- Retired military personnel who lived in small rural communities & contributed to health care access
- Formal training programs for feldshers started in the late 19th century
Chinese Barefoot doctors
- Originated in 1965 by Chairman Mao due to a physician shortage & reorganization of the health care system
- China trained 1.3 million barefoot doctors over the subsequent 10 years
- 2-3 month training course in hospitals/health centers
- People chosen from rural communities
Dr. Amos Johnson and Mr. Buddy Treadwell
- In the 1960s, Dr. Amos Johnson trained his “assistant” Mr. Henry Lee ”Buddy” Treadwell in Garland, North Carolina
- Buddy observed all of Dr. Johnson’s work, then was able to see patients on his own while Dr. Johnson was away with the American Medical Association
former US military corpsman
in the 1930s, who received on-the-job training from the Federal Prison System to extend the services of prison physicians?
- in a 4-month program during WWII, the US Coast Guard trained 800 purser's mates to perform health care on merchant ships
Duke University
Where was the first PA program?
Dr. Eugene Stead
Who developed a program at Duke University Hospital to extend the capabilities of nurses?
- also trained several firemen, ex-corpsmen, and other non-college grads to solve personnel shortages in clinical services at the hospital
diagnose and treat illnesses
What did Eugene Stead say PAs should not do?
Navy corpsmen
The first 4 Duke PA students were all former ______
Returning highly skilled, independent duty corpsmen from all branches of the uniformed services were disenfranchised as they attempted to find their place in the US health care system
What was the Vietnam war vets contribution to PA Profession?
Gasoline Alley
- Chipper Wallet, PA-C
What comic book introduced the PA profession to the public in 1971?
they would not be involved with the clinical diagnosis, decision making, or treatment of medical problems.
What Dr Steads Vision for PAs was:
PAs would be trained to recognize certain medical conditions such as heart failure and shock, but ________________________
dependent practice
Relying on one practitioner to supervise a single PA, limiting the scope of practice
interdependent practice
PAs and physicians rely on each other to provide high-quality health care to a wide range of patients in all settings.
laws and regulatons
The delegation of appropriate tasks is to be outlined in the scope of practice section of the __________ in each state
1) PA education, experience, and preference
2) Physician delegation
3) Facility credentialing & privileging
4) State law & regulations
Way to remember --> EDCL: Every Doctor Can Lead
What are the four determinants of PAs (profession as a whole) scope of practice?
- Type of practice
- Setting
- Acuity of the patients (how sick they are)
- Physician's needs & preferences
- PA's training & experience
Which factors that determine an individual PA's scope of practice?
- responsibility that the PA is acting in accordance with ethical, legal, and medical standards
- physician is not legally responsible for all of the PAs medical actions anymore
What are the shared responsibilities between PAs and physicians?
The recognition that the physician is the more comprehensively trained member of the team.
The responsibility that the PA is acting in accordance with ethical, legal, and medical standards is shared and reciprocal between PA and Physician
what is the central theme of the PA/Physician relationship?
1) PAs must know their limits and understand when physician input is required
2) Physician-PA teams must clearly delineate the role & tasks the PA is authorized to perform
3) Physicians must be available to assist with or assume care of patients if necessary
What are the three non-negotiables of a PAs practice?
agents
Legally, PAs act as _____ of the physician
agency
a fiduciary relation which manifests from the consent of one person to another that the other shall act on his behalf and subject to his control, and consent by the other so to act.
assent, benefit and control
What are the three factors of an agency relationship
control
What factor of an agency relationship states the following: Physician has some degree of control
benefit
What factor of an agency relationship states the following: Physician accrues some degree of benefits from the acts of the PA
assent
What factor of an agency relationship states the following: Physician consents to the relationship
True
True/False: Both the PA and physician are liable for the acts of the PA
autonomy
having the right or power to self-govern or to carry on without outside control
delegated autonomy
based on physician & resident relationship; includes clear lines of accountability and reciprocal responsibilities of seeking and providing supervision & consultation
Autonomy of Practice
the extent to which PAs can determine independently the range of tasks they will perform
Modern PA Practice Act
What aims to optimize PA practice by promoting Optimal Team Practice, establishing autonomous PA boards, allowing direct reimbursement, removing supervisory agreement requirements, and updating state laws?
These established changes enhance access to care, improve healthcare delivery, elevate professional recognition, and support a robust PA workforce.
1. "Licensure" as the regulatory term
2. Full prescriptive authority
3. Scope of practice determined at the practice level
4. Adaptable collaborative requirements
5. Co-signature requirements determined at the practice level
6. Number of PAs a physician may collaborate with determined at the practice level
Key points of the Modern PA Practice Act?
optimal team practice (OTP)
PAs, physicians, and other health care professionals working together to provide quality care without burdensome administrative constraints described the idea of __________________
Full Practice Authority & Responsibility (FPAR)
What was OTP originally known as?
1. Emphasize the PA profession's continued commitment to team-based practice
2. Support the elimination of provision in laws & regulations that require a PA to have and/or report a supervisory or specific relationship with a physician in order to practice
3. Advocate for the establishment of autonomous state boards, with a voting membership comprised of a majority of PAs, to license, regulate, and discipline PAs
4. Ensure that PAs are eligible to be reimbursed directly by public & private insurance
Original four components of FPAR?
2017 house of delegates resolution
Established optimal team practice
The __________________ was based on FPAR.
What did this establish?
1. Emphasize a commitment to team practice.
2. Remove supervisory agreement laws from a specific relationship between the PA and physician in order to practice.
3. Create separate or majority-PA boards to oversee PA licensure, regulation, and discipline.
4. Authorize PAs to be directly reimbursed by public and private insurers.
Describe the four pinnacles of the 2017 house of delegates resolution
How it affects education
- What do new graduates need to know? This will vary depending on practice, supervision, etc.
- Ultimately supported OTP, but with “collaboration at the practice level.”
What was PAEA's concern about FPAR/OTP?
Do they ultimately support or reject OTP?
- less strict physician supervision, although it still exists
- direct PA reimbursement from insurance
What are the results of OTP?
AAPA (American Academy of Physician Assistants)
Which organization is a national organization supporting & representing PAs and PA students?
Roles include:
•Political representation & lobbying
•House of Delegates
•Board of Directors
•Continuing medical education
•Conferences
•Journals
•Networking
•Job postings
•Benefits (discounts, etc.)
•Student academy
American Academy of Physician Assistants
What does the AAPA stand for
The AAPA strongly supports Optimal Team Practice as a means to modernize PA practice, improve healthcare delivery, and enhance professional recognition for PAs. The organization actively promotes and advocates for OTP through policy initiatives, legislative efforts, and support for state-level implementation, with a focus on improving access to care and fostering effective team-based healthcare.
How does the AAPA feel about optimal team practice?
PSPA (Pennsylvania Society of Physician Assistants)
If you're a practicing PA in Pennsylvania, you would be a member of the _________________.
-this is an affiliate of the AAPA on the state level
-similar organizations exist for each state
Pennsylvania Society of Physician Assistants (PSPA)
PSPA stands for?
NCCPA (National Commission on Certification of Physician Assistants)
The _____________ is the creator & administrator of the Physician Assistant National Certifying Examination (PANCE) & recertifying exam (PANRE), as well as Certificate of Added Qualification (CAQ) exams and the new PANRE-LA
More roles include:
- Logging CME credits & renewing certification throughout career
- Verify a PA’s certification
-Volunteer opportunities
-Educational workshops
- PA career center
National Commission on Certification of Physician Assistants
What does NCCPA stand for?
They are the only certifying organization for PAs in the US
What is significant abt the NCCPA?
NCCPA
When you're logging your CME hours as a practicing PA, you're doing this through _____________.
ARC-PA (Accreditation Review Commission on Education for the Physician Assistant)
Which organization is the accrediting agency for PA education/programs?
- Protects the interests of the public & PA profession by defining the standards for PA education & evaluating PA programs to ensure compliance
Accreditation Review Commission on Education for the Physician Assistant
ARC-PA stands for...
PAEA (Physician Assistant Education Association)
What is the national organization representing PA educational programs?
- Services for faculty, students, & applicants
- Conferences/educational opportunities
- Networking/support
-Volunteer
- Pi Alpha honor society
- Creators & administrators of PACKRAT, End of Rotation exams
Physician Assistant Education Association
What does PAEA stand for?
c) PAEA
When you are taking your PACKRAT, it is administered by the:
a) NCCPA
b) ARC-PA
c) PAEA
d) AAPA
a) PAEA
When you are taking your EORs, it is administered by the:
a) PAEA
b) ARC-PA
c) NCCPA
d) AAPA
Dr. Davis
Who is MU's Program Director?
PA-C
What must the program director be?
MD
What must the medical director be?
Dr. Blondek
Who is MUs medical director?
Dr. Welby
Who is MU's Academic Director?
cardiovascular
What is the largest area of the PANCE?
- Medical Knowledge (MK)
- Interpersonal Skills (IS)
- Clinical/Technical Skills (CTS)
- Professional Behaviors (P)
- Clinical Reasoning/Problem-Solving (CR/PS)
What are the core competencies for new PA graduates?
- Clinical Sites
- Expansion of PA Programs
- Faculty Development
- Diversity
- Distance Education
- Doctoral Degree
- Cost and Debt
- OTP
- Simulations
- Technology in Medicine
- Leadership
What are the current and emerging issues in PA education?
stress
a state of worry or mental tension caused by a difficult situation
short-term stress
What type of stress provides motivation to accomplish a task or goal?
- Can be beneficial
chronic stress
What type of stress leads to fatigue, over-reactive emotions, and anxiety?
- Can contribute to a plethora of negative physical outcomes
burnout
What is a consequence of long-term, chronic stress?
burnout
–Emotional exhaustion
–Low sense of accomplishment
–Depersonalization & Detachment: loss of empathetic connections
emotional exhaustion
– Generalized fatigue that can be related to devoting excessive time and effort to a task or project that is not perceived to be beneficial.
low sense of accomplishment
- The tendency to negatively evaluate the worth of one's work
- Feeling insufficient in regard to the ability to perform one's job
- Generalized poor professional self-esteem
depersonalization and detachment
– A distant or indifferent attitude toward work
– Manifests as negative, callous, and cynical behaviors; or interacting with colleagues or patients in an impersonal manner
compassion fatigue
– The emotional strain of exposure to working with those suffering from the consequences of traumatic events (including illness)
– Causes a low level, chronic clouding of caring & concern for others in your life
– Causes emotional blunting (you react to situations differently than one would normally expect)
– Short-term or early stage of burnout
excessive workload
What is the #1 contributor to burnout?
- Financial and economic factors
- Burden of administrative responsibilities
- Low autonomy
- Work-life imbalance
- Setting limits to support balance
Other contributors to burnout?
Emergency Med, Primary Care, oncology, palliative and hospice care
What specialties are at the highest risk of burnout?
- Increased health care costs
- Higher clinician turnover
- Reduced patient adherence & satisfaction
- Poor patient outcomes
Effect of clinician burnout on healthcare?
wellness
"goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life."
resilience
– The process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress.
– Growing through challenges
– Bouncing back, not breaking
– can be developed by anyone & everyone!
wellness; resilience
While both wellness and resilience contribute to overall health and well-being, ______________ emphasizes proactive health practices across multiple dimensions, while ______________ focuses on one's ability to recover and adapt in the face of adversity.
emotional, environmental, physical, social, intellectual, professional
What are the 6 domains of wellness?
skills and abilities, personal factors, learning/practice environment, society and culture, rules and regulations, health care responsibilities, organizational factors
What are the 7 factors affecting clinician well-being and resilience?
internal factors
The descriptions below correlate to _____________(internal/external) factors affecting clinician well-being & resilience.
skills & abilities: empathy, communication skills, coping skills, organization skills
personal factors: personality traits, values, ethics, work-life balance, family, engagement
examples of external factors
The descriptions below correlate to _____________(internal/external) factors affecting clinician well-being & resilience.
learning/practice environment: autonomy, curriculum, workplace safety, mentorship programs
society & culture: alignment of societal expectations & clinical role, media portrayal, discrimination, social determinants of health
rules & regs: accreditation, documentation requirements, HR, licenses, national policies
health care responsibilities: admin responsibilities, clinical responsibilities, learning/career stage, pt population
organizational: bureaucracy, culture, leadership, diversity/inclusion, scope of practice, power dynamics
signs of physical burnout
- Feeling tired most of the time
- Lowered immunity
- Frequent headaches, back pain, or muscle aches
- Change in appetite or sleep habits
signs of emotional burnout
- Self-doubt
- Feeling helpless and hopeless
- Detachment
- Decreased motivation
- Increasingly negative outlook
- Decreased satisfaction & sense of accomplishment
signs of behavioral burnout
- Withdrawing from responsibilities
- Isolation
- Procrastination
- Using food, drugs, or alcohol to cope
- Taking out frustration on others
- Skipping class or work; or coming in late or leaving early
mild, longer lasting, and severe
What are the stages of burnout?
mild symptoms of burnout
Which type of burnout is described?
– Mental fatigue at the end of the day
– Feeling unappreciated, frustrated, or tense
– Physical aches or pains
– Feeling like you are falling behind in work
– Dreading the next day
longer-lasting symptoms of burnout
Which type of burnout is described?
More challenging to reverse these symptoms
- Disillusionment about the job
- Feeling bored, apathetic, or frustrated
- Feeling ruled by a schedule
- Intermittent periods of psychological/physical symptoms that last even when the provoking situation subsides
- Psychological symptoms: irritability, aggression, anxiety, depression, substance abuse, and suicidal thoughts
symptoms of severe burnout
Which type of burnout is described?
Chronic symptoms; if left untreated, can evolve into psychiatric and physical health disorders
- Severe personal consequences
- Substance dependence
- Shorter life expectancy
- Divorce
- High job turnover
three daily must-do's
1. Eat
–Healthy, well-balanced food
–Regular meals
–Feed your body and your brain!
2. Sleep
–6-8 hours per night
–No all-night study sessions!
3. Move your body
–Exercise daily
–It doesn’t have to be a marathon, just do something
–Bonus points if you go outdoors & get some fresh air!
an impaired provider
- A provider who is unable to fulfill professional or personal responsibilities because of psychiatric illness, alcoholism, or drug dependency
- Providers may also be "impaired" due to physical illness, including age-related impairment, and loss of motor skills
- Approximately 15% of physicians will be impaired at some point in their careers - can remain undetected for several years