How PAs Can Contribute in Pediatrics

When I began my career as a PA working in emergency departments of two New York City area hospitals, I treated both children and adults. One of my most gratifying experiences was when a distraught mother came in with a crying child who had nursemaid's elbow. As a PA, I had learned techniques to realign the subluxed joint, and within a minute, the child had a smile on his face.

Today, I get to provide that relief to children and their parents regularly as a PA for a large pediatric urgent care network. With 10 years of experience in this practice, I know how Certified PAs can help streamline operations to improve the quality of care and outcomes of pediatric patients.

Like physicians who specialize in this area, PAs in pediatrics understand that children are not just little adults. Infants, children, and adolescents present with different illnesses from adults. There are varying approaches and holding techniques, developmental issues, and vaccination schedules to know thoroughly. Equally important, pediatric PAs must know how to best relate with worried and curious parents and caregivers. We complement physicians and allow children to have greater access to quality medical care.

PAs are highly educated, certified by the National Commission on Certification of Physician Assistants (NCCPA), and licensed by state medical boards. Their education includes strong diagnostic and procedural training in the classroom and during clinical rotations.

One of the tenets of the PA profession is that the learning never stops. At our urgent care practice I developed a six-month postgraduate pediatric fellowship for PAs that includes both didactic and clinical training.

Certified PAs who want to make a career in this field can also earn a Certificate of Added Qualifications (CAQ) in Pediatrics from NCCPA. The CAQ is an additional credential that requires two years of specialty experience, substantial CME in pediatrics, a physician attestation of the PA's knowledge, and skills and the passing of a national pediatrics exam.

Certified PAs can provide many services to pediatric patients, including:

•Perform well care physical exams and vaccinations. PAs in pediatrics are trained to know the difference between normal and abnormal exam findings and provide anticipatory guidance including answering parental questions about a child's development or behavior.

•Enhance efficiency by collaborating with physicians - but treating patients autonomously. Many pediatric PAs have their patient panel and are the main provider to diagnose and treat these patients, including prescribing and providing follow-up care.

•Order x-rays and lab tests, e.g., CBC, lipid profiles, lead testing, etc. Certified PAs can also interpret these results and provide appropriate intervention if needed.

•Focus on diet and exercise and assess and manage childhood obesity.

•Deliver age-appropriate safety, social, and environmental recommendations on subjects that include newborn safety, bicycle helmets, gun safety, drugs, alcohol, and sex.

•Manage simple and advanced in-office procedures such as laceration repair, suture and staple removal, wound and burn care, abscess incision and drainage, simple digit dislocation/reduction, and foreign body removal.

•Manage pediatric patients in a supervised neonatal or pediatric intensive care unit and general pediatric inpatient units. Most, if not all PAs in pediatrics, are PALS and NALS certified. PAs can help with pre-op clearances, doing rounds, and are often on the admit/discharge team. These PAs can handle emergencies in these settings and recognize when a patient is in distress. We facilitate the care of these patients and work closely with the child's pediatrician.

•Provide care for children in underserved communities. Technology is allowing PAs to use telemedicine routinely in remote areas to provide easier access to a physician or a consult with specialty care.

Certified PAs are strong additions to healthcare teams in any clinical setting. For those of us who enjoy working in pediatrics, the rewards are many and some days are as simple as a child's hug.

Marisa Rodriguez, PA-C, is a full-time clinical PA at PM Pediatrics, a pediatrics urgent care practice with 21 locations that has treated 1.3 million patients. She is director of procedural training for the company, which includes training physician fellows in a one-year pediatric urgent care fellowship, and she is also the director of the PA fellowship in pediatric urgent care. She is a 2003 graduate of the Weill Medical College of Cornell University and was the first PA in New York State to earn a CAQ in Pediatrics.