what is a pa & how did we get here

what is a pa?

medical professionals trained in rigorous postgraduate education programs to evaluate, diagnose, and treat patients

what do PAs do?

serve alongside doctors in providing medical care to patients

PAs prescribe medications, order and interpret medical tests, and perform diagnostic and therapeutic procedures

in the US, PAs practice in every state and every specialty

provide care for patients with acute and chronic illnesses across the lifespan

what did AAPA change our title to

physician associate

where else do PAs work

europe, africa, and south asia

due to differing healthcare systems, the PA profession looks similar, but not identical, to PAs in the US

what is the medical model of PA

medical model

what is the medical model of NP

nursing model

what is the education length & clinical training hours of PA

4 +2 BS + MS

3 + 2 5 yr pre-pa/pa

2000+ hours

what is the education length & clinical training hours of NP

4 +2 BS + MS

3 + 1-2 5 yr BS + MS

500-700 hours

what is the education style of PA

general, board, multiple specialties

what is the education style of NP

population based (women's health, peds)

specializes early

what is the certification licensing of PA

NCCPA national cert exam

what is the certification licensing of NP

national board certification exam ANCC or AANP

what is the practice style of PA

collaboration with physician, flexible supervising agreements

what is the practice style of NP

variable scope, many states with "full practice authority"

what are similarities of PA and NP

order, interpret lab and imaging

diagnose and tx acute & chronic illness

prescribe meds

perform procedures

work in hospitals, clinics, surgery, uc, and specialities

what is the medical model

focuses on cause & effect

acknowledges the presence of disease (cause) and how to treat the disease (effect)

disease centered

what is the social model

psychosocial factors that contribute to care and health outcomes

society centered

what is the nursing model

focuses more on the whole person and things that impact a patient overall

person centered

who began the PA profession

russian feldshers

what was the progression of the PA profession

russian feldshers

us military corpsman

dr. amos johnson and mr buddy treadwell

chinese barefoot doctors

duke university, dr. eugene stead

first 16 programs in 1965-1971

how many programs are there today

300+ PA programs

what are russian feldshers

retired military personnel who lived in small rural communities and contributed to healthcare access by extending the care of physicians

how did former us military corpsmen contribute to the PA profession

they received on the job training from the federal prison system to extend the services of prison physicians

how did dr. amos johnson and mr. buddy treadwell contribute to the PA profession

he trained his assistant by having buddy observe all of his work, then see patients on his own

how did chinese barefoot doctors contribute to the PA profession

physician substitute due to physician shortage and recognization of the health care system

2-3 mont training courses in hospitals/health centers

who was the doctor from duke university who officially began PA programs

dr. eugene stead

what did dr eugene stead do?

he developed a program at duke university hospital to extend the capabilities of nurses

he also trained several firemen, ex-corpsmen, and other non-college grads to solve personnel shortages in clinical services at the hospital

what was dr. stead's vision for PAs

-to be trained in labs and clinics to perform an array of procedures, diagnostic test, and medical therapies

-physician to direct activities and would be legally responsible for all acts of the PA

-PAs would provide medical care in clinics, hospital settings, patient homes, and outlying communities

-responsible for administrative duties and organization of medical care units

- pas would not be involved with the clinical diagnosis, decision making, or treatment of medical problems

what is the significance of gasoline alley & the vietnam war vets?

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

gasoline alley: introduce the concept of the PA to the public

what has changed in the PA profession?

- authorized to practice medicine in all 50 states

- mandate physician supervision or collaboration as a part of PA practice, changes to the definition and degree of supervision have occurred

- the need for increased efficiency and effectiveness of health care delivery with the prevalence of PAs

what is dependent practice?

Relying on one practitioner to supervise a single PA, limiting the scope of practice

what is interdependent practice?

PAs and physicians rely on each other

cost effective, dynamic, and medically sound approach to health care

presumes the physician will see the most complex and critical problems

PA receive the appropriate support when needed

PAs must know the limit of their experience

what is the PA scope of practice generally defined by four determinants?

- PA education, experience, and preference

- physician delegation

- facility credentialing and privileging

- state law and regulations

What are the factors in determining a PA's individual scope of practice?

- type of practice

- setting

- acuity of the patients

- physician's needs and preferences

- PA's training & experience

what is the concept of physician supervision?

the responsibility that the PA is acting in accordance with ethical, legal and medical standards is shared and reciprocal between PA and physician

what are non-negotiables with physician supervision?

- PAs must know their limits and understand when physician input is required

- Physician-PA teams must clearly delineate the role and tasks the PA is authorized to perform

- physicians must be available to assist with or assume care of patients is necessary

what is the agency relationship?

PAs act as agents of the physician, meaning the PA acts on behalf of the physician

what does agency mean?

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

what are the three factors that must be present for an agency relationship to exist between two parties?

assent: physician consents to the relationship

benefit: physician accrues some degree of benefits from the acts of the PA

control: physician has some degree of control

who is liable for the acts of the PA?

both the PA and physician

what is autonomy

having the right or power to self-govern or to carry on without outside control

what is delegated autonomy

based on physician & resident relationship; includes clear lines of accountability and reciprocal responsibilities of seeking and providing supervision and consultation

what is autonomy of practice

the extent to which PAs can determine independently the range of tasks they will perform

what are the four components of FPAR (full practice authority & responsibility)?

- emphasize the PA profession's continued commitment to team based practice

- support the elimination of provision in laws and regulations that require a PA to have and/or report a supervisory, collaborating, or other specific relationship with a physisican in order to practice

- advocate for the establishment of autonomous state boards, with a voting membership comprised of a majority of PAs, to license, regulate and discipline PAs

- ensure that PAs are eligible to be reimbursed directly by public and private insurance

what is optimal team practice?

PAs, physicians, and other health care professionals working together to provide quality care without burdensome administrative constraints

what are the six key elements of a modern PA practice act?

1. licensure as the regulatory term

2. full prescriptive authority

3. scope of practice determined at the practice level

4. adaptive 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

what are the three core components of modern optimal team practice?

1. no legally required physician supervision written agreement

2. licensure based practice authority

3. employer-team determines collaboration structure

what are the PA organizations?

AAPA

State organizations

NCCPA

ARC-PA

PAEA`

AAPA

American Academy of Physician Assistants. Recognized as the national voice for PAs in medical and surgical specialties.

what does the AAPA do

-political representation and lobbying

-continuing medical education

-conferences

-journals

-networking

-job postings

-benefits

-student academy

what are state organizations

-affiliates of AAPA on the state level

-PSPA or NJSSPA (shout of jersey)

-similar structure

what is NCCPA

National Commission on Certification of Physician Assistants

the only certifying org for PAs in the US

creators and admin of the PANCE and PANRE as well as certificate of added qualification exams and the new PANRE-LA

logging CME credits and renewing certification throughout career

verify a PA's certification

volunteer opportunities

educational workshops

PA career center

what is ARC-PA

Accreditation Review Commission on Education for the Physician Assistant

the accrediting agency for PA education/programs

protects the interests of the public & PA profession by defining the standards for PA education and evaluating PA programs to ensure compliance

what is PAEA

Physician Assistant Education Association

national org representing PA educational programs

services for faculty, students, and applicants

conferences/educational opportunities

networking/support

volunteer

Pi Alpha honor society

creators and admin of PACKRAT, end of rotation exams