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10 Things Physicians Should Know About PAs: Part 1

March 21, 2014

By William Morgan, MD
Randy Danielsen, Ph.D., PA-C

Blog

Article

PAs have been part of the healthcare scene for almost 50 years, yet some physicians still express apprehension or even resistance about working with them.

The PA profession was created by physicians to fill a void in access to healthcare. Certified PAs have been part of the healthcare scene for almost 50 years, yet some physicians still express apprehension or even resistance about working with them.

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PAs are an integral part of our asthma and allergy practice where eight physicians collaborate with four PAs across five locations in Arizona. In this two-part blog we hope to dispel myths and explain how PAs can make a positive impact in your practice.

1. PAs are not medical school rejects: The PA profession is very much a highly sought after career in its own right. Potential PAs are often attracted to the profession due to less time spent in graduate school (the average is 27 months), the ability to practice sooner, and less student debt (they tend to incur about half the average debt medical students incur).

PA programs are also highly competitive. Less than 30 percent of those who apply are admitted so you can be confident of the caliber of PAs graduating from accredited PA programs.

2. PAs are trained in the medical model: The medical model focuses on a patient’s medical history, physical exam, and diagnostic tests as the basis to understand the chief complaint and identify specific diagnoses. Because the PA profession was created by physicians, PAs are trained to think like physicians.

A typical PA curriculum includes an average of 54 weeks (about 64 credit hours) of didactic education and an average of 52 weeks (about 1,660 contact hours) in clinical rotations. Clinical experiences include rotations in family medicine, internal medicine, general surgery, emergency medicine, pediatrics, women’s health, and behavioral and mental health. Some PA programs offer additional elective rotations.

When PAs come into your practice, you know they have a strong background in diagnosing and treating patients. Of course, on-the-job experience allows a physician and PA to grow into a cohesive and dynamic team.

3. PAs do not want your job: PAs like being PAs. It is a personal choice in terms of lifestyle - one that many see as offering better work/life balance. In 2013, Money magazine ranked “physician assistant” number 21 out of the 100 best jobs in America giving it an “A” in personal satisfaction. At career site MyPlan.com, a survey of almost 14,000 people ranked physician assistant 16 out of 300 careers in terms of job satisfaction.

PAs are trained, certified, and recertified as generalists and they like the flexibility to work in any clinical setting. They have ample opportunity to treat patients and usually don’t have to deal with the business aspects of the practice. PAs understand the scope of their position, and appreciate the chance to collaborate with a physician.

4. PAs will not open an independent practice: In every state, PAs must practice with physician supervision. While it’s true that some states allow PAs to own a practice, the PAs must hire a physician to supervise them and see patients. They can’t open a practice independently. This differs from the nurse practitioner (NP) model where many states allow NPs to own a practice and work independently without the collaboration or supervision of a physician.

That is often a source of confusion among physicians who view independent practice for nonphysicians negatively.

A PA’s role is regulated by the state and delegated by the supervising physician. The American Academy of Physician Assistants defines six key elements for modern PA practice including three that are determined at the practice level: scope of practice; chart co-signature requirements; and number of PAs supervised per physician.

This map quickly summarizes the extent to which states have adopted these elements allowing PAs to function to the fullest extent of their license.

5. PAs do not always require on-site supervision: When PAs and physicians work closely as a team, they understand each other's expectations and build trust in each other’s judgment.

About half of the states have adaptable supervision requirements, with no on-site provision or even requirement that the physician be within a specified number of miles of the clinical site. In our practice in Arizona, PAs practice independently without a doctor in the office on any given day. However, the PA can always consult with the physician by phone or electronically. With EHRs, it is convenient for the physician and PA to readily share charts and review patient issues.

The common types of supervision used in our practice are:
• Prospective supervision: Writing and reviewing the assessment and treatment guidelines and establishing when and under what circumstances physician intervention is required.
• Concurrent supervision: Reviewing patients on a real-time basis per clinic guidelines or ad hoc.
• Retrospective supervision: After-the-fact review of charts.

Next week, we will cover the remaining five things physicians should know about PAs. What do you think should be added to the list?

William F. Morgan, MD, is the founding physician of the Arizona Asthma and Allergy Institute. He is board certified by the American Board of Allergy and Immunology and by the American Board of Pediatrics. He has been named one of the “Top Docs” in Phoenix Magazine for several years. He is also a certified life coach, specializing in life transitions. He has spent more than 30 years working with and supervising physician assistants.

Randy D. Danielsen, Ph.D., PA-C, DFAAPA, is professor and dean of the Arizona School of Health Sciences at A.T. Still University, and a clinician, author, and editor. He has served on the board of directors of the American Academy of Physician Assistants and as a board member and chairman for NCCPA. He co-authored “The Preceptor's Handbook for Supervising Physician Assistants” in 2012.