10 Things Physicians Should Know About PAs: Part 2

March 28, 2014

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

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Important points about the physician assistant profession that could ease physician apprehension about working with them.

Last week, we covered the first five things physicians should know about PAs. In this week’s blog, we will conclude with five additional, important things you need to know about physician assistants.

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1. PAs meet rigorous certification and certification maintenance standards: Once PAs complete their education, they must pass the Physician Assistant National Certifying Exam as a prerequisite for state licensure. Administered by the National Commission on Certification of Physician Assistants (NCCPA), this rigorous, broad-based exam covers medical and surgical conditions across all organ systems.

Those who pass become certified PAs and use the designation of certified physician assistant (PA-C) after their name. Certification is required by all 50 states, the District of Columbia, and U.S. territories for PAs seeking initial licensure.

To maintain certification, certified PAs must complete 100 credits of CME every two years, including credits earned through self-assessment and performance improvement activities. In addition, PAs must pass the Physician Assistant National Recertifying Exam (which is just as broad-based as the initial certification exam) every six to 10 years to maintain the PA-C credential. That means that even certified PAs practicing in specialties maintain a strong base of generalist knowledge throughout their careers.

2. PAs are held to the same standard of care as physicians: Legally, PAs are held to the same standards of care as physicians. PAs understand their scope of practice, their role on the healthcare team, and their limitations. A PA will readily consult with a physician just like a physician will consult with another physician or specialist.

Certified PAs must also adhere to NCCPA’s Code of Conduct which holds them to high standards of ethics and professionalism. NCCPA can, and does, revoke certification for PAs who breach the Code of Conduct. Physicians and the public can verify a PA’s certification very quickly at www.nccpa.net.

3. PAs boost patient satisfaction: Healthcare today is about access, quality outcomes, and cost reduction. Team-based care can improve each of these metrics. Studies show most patients will see a PA instead of a doctor if they want to be seen quickly. We cannot find broad-based research studies on PA outcomes compared to those of a physician, but smaller studies and anecdotal evidence seems to say they are comparable particularly since, by design, PAs work in collaboration with physicians.

We know from our own experience that physician/PA teams increase satisfaction as they enable additional access to care and follow up. Over time, PAs almost develop their own practice within a practice as patients ask for them, just as they request a certain physician. Shaping Great Physician-PA Teams is an excellent video that highlights five components that truly bond strong physician/PA teams. They are: shared priorities; frequent and effective communication; physician accessibility and approachability; consistency of the delivery of patient care; and mutual trust and respect.

4. PAs do specialize: PAs have followed physicians into every specialty area and clinical setting. Today there are more than 95,000 certified PAs in the United States; approximately 33 percent practice in primary care, and 67 percent practice in a subspecialty.

In our allergy practice, we send our critical staff, which includes PAs, to semiannual national meetings. They are expected to attend the same meetings and lectures as our M.D.s and D.O.s, so they keep up to date in our specialty area.

In seven specialty areas, NCCPA offers a voluntary credential that allows PAs to demonstrate and document their experience, skills, and advanced knowledge in the specialty area. Those specialties and the percentage of certified PAs in those specialties are as follows:

5. PAs are necessary in today’s environment: About 35,000 physicians a year are retiring and only 25,000 a year are graduating from medical school. The problem is further exacerbated by the Affordable Care Act adding 32 million newly-insured patients into the healthcare system. The Association of American Medical Colleges predicts 45,000 too few primary-care physicians and 46,000 too few specialists and surgeons by 2020.

This workforce shortage demands a team-based approach to extend the physician’s reach. The American Medical Group Association and healthcare human resources consultant Sullivan, Cotter and Associates, report that two-thirds of the large multispecialty healthcare organizations surveyed in 2013 increased their PA workforce and are projecting that they will hire more in the next 12 months.

PAs not only provide access to care, they also generate substantial revenue at a lower cost of employment. There is more than enough work for everyone.

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.