The Use of Physician Assistants in Health Care Delivery

Trish Kelly, PhD, MMSc, PA-CUAMS Dept. of PA StudiesAMDPA Conference 2013

Medical providers who are nationally certified and state- licensed to practice medicine state- licensed to practice medicine

with the supervision of a physicianwith the supervision of a physician.

Trained in the medical modelTrained in the medical model at nationally accredited educational programs. Not independent clinicians. Work as a team with physician. PAs are trained and educated similarly to physicians

Share similar diagnostic and therapeutic reasoning.

What is a Physician Assistant?

What is a Physician Assistant?

PAs and Physicians work together as a teamPAs and Physicians work together as a team Supervision does not mean, that a supervising physician

must always be present with the PA or direct every aspect of PA-provided care.

Have the ability for autonomous decision making and patient management Can practice at site 60 miles from supervising

physician in Arkansas

This team model is an efficient way to provide high-quality medical care.

What is a Physician Assistant?

Must complete 100 hours of continuing medical education (CME) every two years.

Complete re-certification every 10 years

PAs can practice in any discipline of medicine and change disciplines without additional trainingMakes PAs more versatileDecreases attrition rate with

profession

Elicit medical historiesPerform physical examsOrder & interpret labs and diagnostic testsManage acute illness & chronic diseasesPrescribe medicationMake rounds in hospital & write patient ordersMake referralsPerform specific procedures Assist in surgeryPerform patient education

What Can PAs Do?

Venipuncture IV Access Arterial Puncture Intradermal, Subcutaneous,

Intramuscular injections Suturing & Stapling Shave & Punch Biopsy Incision & Drainage Lumbar Puncture Nasogastric Tube

Placement

Splinting Casting Urinalysis & Microscopy Wet Prep Analysis Urinary Catheter Placement Surgical Drain Placement &

Removal Bursal & Joint Injections

Central Line Placement Chest Tube Insertion Thoracentesis

Types of Procedures

2010 AAPA Annual PA Census Report:

86,500 PAs in US (5,964 new graduates)

Mean age: 38 years

Demographics of PAs

2010 AAPA Annual PA Census Report:

$93,105 – Total mean income

PA s completed 257 million patient visits

PAs wrote 332 million prescriptions

Demographics of PAs

Where PAs Work….

PA Distribution by Specialty

Family PracticeInternal MedicinePediatric MedicineWomen’s HealthEmergency MedicineOrthopedic MedicineBehavioral MedicineGeneral SurgeryCardiologyDermatologyEndocrinologyGastroenterology NeurologyHyperbaric Medicine OphthalmologyInfectious DiseasePulmonology

NephrologyHematology/ OncologyRheumatologyTransplant ServicesCT Surgery & VascularCritical CareNephrologyENTPathologyRadiologyUrologyPain ManagementSleep MedicineInterventional RadiologyAcademic MedicinePlastic SurgeryNeurosurgeryOccupational MedicineUrgent Care

Disciplines of Practice

Where PAs Practice……..

Physician Solo or Group Office Hospital Community Health Center Surgical Center Nursing Home Long Term Care Facility Home Health Agency Hospice Correctional Facility Research Education Medical Sales

Industrial Work Sites Armed Forces Dept of Veteran Affairs Indian Health Service Public Health Federal Government

CDC CIA

Management Medical Staffing Agency International Medicine

Areas of Practice

Arkansas 49th Out of 50 States

Health Care in Underserved Areas

Need for care in underserved areas is increasing with the physician shortage.

Only about 10 percent of physicians practice in rural areas Where approximately 20 percent of the U.S. population lives.

Access to care is a major concern in most rural areas.About 17 percent of PAs practice in underserved areas.

How are PAs reimbursed? 

PA-provided services are covered by all

government-funded public payers Medicare, Medicaid and TRICARE

Nearly all private payers. Each payer has its own guidelines regarding service

coverage and payment.Medicare pays for medical and surgical services

provided by PAs at 85% of the physician fee schedule. Rate applies to all practice settings, including hospitals,

ERs, nursing facilities, homes, offices, clinics, and first-assisting in surgery.

How are PAs reimbursed?  "Incident-to”

Medicare provision Allows for certain services provided by a PA in the office to be

billed under the physician’s provider number and reimbursed at 100 percent. 

Shared visit billing Medicare provision that allows for services provided by both the PA

and the physician in a hospital to be billed under the physician’s provider number with reimbursement at 100 percent. 

Nearly all private payers cover medical and surgical services provided by PAs. Some payers will separately credential or enroll PAs. Others require that PA services be billed under the supervising

physician’s name.

U.S. News & World ReportU.S. News & World Report: Identified the Physician Assistant Profession as

one of the “best careers” in the nation

CNN:CNN: Ranked Physician Assistant # 2 in its “Best Jobs

in America” listing

Interesting PA Facts

Physician Assistant Program

Graduate Professional Program 28 Month Program

13 months didactic (classroom) phase15 months clinical phase

Students enroll one time annually

Location – UAMS Campus, College of Health Professions Degree – Master of Physician Assistant Studies (MPAS)

Start Date: May Enrollment: 26 Students

Eventually grow to 40 students

UAMS Physician Assistant Program

The mission of the UAMS Physician Assistant Program is to educate students who will practice

patient-centered medicine while embracing cultural diversity, ethical integrity,

professionalism and collaboration with other members of the health care team. The program

fosters lifelong learning through emphasis on critical thinking, clinical application of knowledge and evidence-based medicine. Through innovative educational practices, the students will be prepared to enter into any discipline of medicine with the ability to serve any community and contribute to the profession

through leadership, education, and service.

Mission of UAMS PA Program

Summer 2013 Fall 2013

PA Gross Anatomy 4 Principles of Medicine 1 8

Clinical Physiology 3 Diagnostic Assessment 1 3

Physical Assessment 5 Pharmacotherapy 1 2

Clinical Pharmacology 3 Behavioral Medicine 3

Patient Communication 1 1 Patient Communication 2 1

Professional Issues 1 1 Professional Issues 2 1

Clinical Reasoning 1 1 Clinical Reasoning 2 118 cr Clinical Nutrition

1

20 cr

Spring 2014 Summer 2014 (6 wk module)

Principles of Medicine 2 8 Principles of Medicine 3 3

Diagnostic Assessment 2 3 Surgical Medicine 2

Pharmacotherapy 2 2 Foundations of EBM 2

Emergency Medicine 3 Medical Genetics 1

Introduction to EBM 2 Medical Ethics 2

Professional Issues 3 1 Professional Issues 4 1

Clinical Reasoning 3 1 11 cr

20 cr

Didactic Curriculum

Students engage in community service Specific learning objectives assigned Student reflection on experience Debriefing weekly with faculty

Non-medical experience across the life-span Seniors, children, domestic violence Students will rotate to a different experience every semester

10 hrs required each semester during 1st year Community Partnerships

Promise Neighborhood – early childhood reading University District/ AARP – senior isolation Safe Places – domestic violence survivor support groups

Service Learning

Clinical Phase (15 months)Core Clinical Rotations (5 weeks each)

Family PracticeInternal Medicine – InpatientInternal Medicine – OutpatientPediatric MedicineWomen’s HealthEmergency MedicineGeneral SurgeryOrthopedic MedicineBehavioral MedicineGeriatric Medicine

Elective Rotations

Clinical Curriculum

Elective Rotations (3 wks)

CardiologyCardiology

DermatologyDermatology

EndocrinologyEndocrinology

Gastroenterology Gastroenterology

Neurology Neurology

NeurosurgeryNeurosurgery

Hyperbaric Medicine Hyperbaric Medicine

OphthalmologyOphthalmology

Infectious DiseaseInfectious Disease

Pain ManagementPain Management

Sleep MedicineSleep Medicine

Interventional RadiologyInterventional Radiology

Plastic SurgeryPlastic Surgery

PulmonologyPulmonology

NephrologyNephrology

Hematology/ OncologyHematology/ Oncology

RheumatologyRheumatology

Transplant ServicesTransplant Services

CT SurgeryCT Surgery

Critical CareCritical Care

NephrologyNephrology

ENTENT

PathologyPathology

UrologyUrology

GeriatricsGeriatrics

Clinical Curriculum

Admissions RequirementsAdmissions Requirements• Cumulative undergraduate GPA 3.0 on a 4.0 scale strongly

recommended.

• Natural Science GPA of 3.0 on a 4.0 scale strongly recommended.

• Bachelor’s of Science/ Arts degree required

• Graduate Record Examination (GRE)

• Pre-requisite courses

• 500 hours of direct patient care

• Application with narratives, letters of recommendation

• On-Campus Interview

Prerequisite CoursesPrerequisite CoursesNatural Science Requirements

General Biology 1&2 with Labs 8 cr

Microbiology with Lab 4 cr

Human Anatomy with Lab 4 cr

Human Physiology with Lab 4 cr

General Chemistry 1& 2 with Labs 8 cr

Organic Chemistry with Lab 4 cr

Medical Genetics/ Genetics 3 cr

Additional Course RequirementsIntro or General Psychology 3

crAbnormal Psychology 3 crStatistics or Biostatistics 3

cr

Clinical Experience RequirementsClinical Experience Requirements Clinical Experience of 500 hours demonstrating direct patient

care is required. The following are some accepted categories of experience:

Paramedic/ EMT Registered Nurse Licensed Practical Nurse Medical Assistant Physical Therapist Occupational Therapist Athletic Trainer Medical Corpsman Respiratory Therapist Pharmacist Hospice Volunteer Radiology Technician Phlebotomist Surgical Technician Nursing Assistant/Aide Emergency Room Technician Peace Corp Volunteer Physical Therapy Assistant Clinical Health Educator Dietician Psychologist Patient Care Technician Ophthalmic Technician

Gender Female 20 Male 6

Ave Age. 25 yrs Ave. Cum GPA 3.47 Ave NS GPA 3.32 Ave GRE 1123 Masters degree 3 Race/ Ethnicity

White 21 Black 2 Asian 1 Asian Indian 1 Persian 1

Patient Care Hrs 2160 MA 6 PCT 1 CNA 9 Rad Tech 1 Health Corp 1 EMT 2 PT Asst 2 Phlebotomist 1

Instate 24 Out of State 2

Current UAMS PA Cohort

Physician Assistant Program

June 7th, 2013

Inaugural White Coat Ceremony

Contact Information

UAMS Physician Assistant Program Websitewww.uams.edu/chrp/pa/

PA Program Contact Information:paprogram@uams.edu501-686-7211

Questions???

“ Where Medicine Lives“