“Partnering” with other health care providers can benefit your orthopaedic practice in several ways. With more than 3,000 physician assistants (PAs) currently working in orthopaedics, many practices already benefit from the enhanced efficiency and continuity of care that PAs provide. In 2005, PAs working in orthopaedic practices conducted more than 15 million patient visits, an average of 75 a week per PA.

Q. What is a physician assistant (PA)?
A. PAs are healthcare professionals licensed to practice medicine with physician supervision. As part of their responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel patients on preventive health care, and assist in surgery. Within the physician-PA relationship, PAs exercise autonomy in medical decision making and provide a broad range of diagnostic and therapeutic services. A physician assistant’s practice may also include education, research, and administrative services.

Q. How did the physician assistant profession begin?
A. To meet the growing demand for patient care services and free up time for community-based physicians to attend CME classes, Eugene A. Stead Jr., MD—then chair of the department of medicine at Duke University in North Carolina—put together the first class of PAs in 1965. He selected several ex-military corpsmen who had received considerable medical training during their military service but who had no comparable civilian employment. The curriculum of the two-year PA program was based in part on Dr. Stead’s knowledge of the fast-track training of doctors during World War II.

For more information about the history of the PA profession, visit the Physician Assistant History Center Web site at www.pahx.org.

Q. How many PAs are there? Where do they practice?
A. As of January 2005, approximately 55,000 PAs were in clinical practice in the United States. PAs are located in almost all healthcare settings and in every region of the country. They work in the inner city as well as the most remote rural areas, where they may be the only full-time providers of care (state laws stipulate the conditions for remote supervision by a physician).

Physician assistant education
Q. How are PAs trained?
A. Physician assistants must complete an intensive medical program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Because of the close working relationship that PAs have with physicians, PAs are educated in a medical model designed to complement physician training. Like medical students, PA students are taught to diagnose and treat medical problems.

Education consists of intensive classroom and laboratory instruction in the basic medical and behavioral sciences, followed by clinical rotations in medical and surgical specialties. The average PA program curriculum runs approximately 26 months.

Nationwide, more than 130 PA programs are currently accredited by the ARC-PA. A number of postgraduate PA programs also have been established to provide practicing PAs with advanced education in medical specialties.

Q. What are the prerequisites for applying to a PA program?
A. Most physician assistant programs require applicants to have previous healthcare experience and some college education. The typical applicant already has a bachelor’s degree and approximately 4 years of healthcare experience. Nurses, emergency medical technicians, and paramedics often apply to PA programs. 

Q. How are PAs certified and licensed?
A. Upon graduation, PAs take a national certification examination developed by the National Commission on Certification of Physician Assistants (NCCPA) in conjunction with the National Board of Medical Examiners. Graduation from an accredited physician assistant program and passing the national certifying exam are required for state licensure.

Q. What does “PA-C” stand for? What does the “C” mean?
A. Physician assistant-certified—or PA-C—signifies that the individual has met the defined course of study and has undergone testing by the NCCPA. To maintain that “C,” a PA must log 100 CME hours every 2 years and undergo recertification every 6 years.

Scope of practice
Q. What areas of medicine can physician assistants work in?
A. PAs are found in all areas of medicine—in primary care as well as all of the surgical subspecialties. The largest proportion of PAs work in primary care (40 percent), and about one quarter practice in surgical specialties. The outpatient setting is the primary work site for more than three quarters (77 percent) of PAs. More than 3,000 PAs currently work in orthopaedic practice.

Q. Where do PAs “draw the line” as far as what they can treat?
A. A physician assistant’s scope of practice corresponds with the supervising physician’s practice and varies with the PA’s training, experience, and state law. A PA will typically see many of the same types of patients as the physician. Cases handled by physicians only tend to be more complicated medical cases or cases requiring care that is not a routine part of the PA’s scope of work. Referral to the physician—or close consultation between the patient, PA, and physician, is made for unusual or hard-to-manage cases. A key aspect of PA training is learning to “know their limits” and to refer to physicians appropriately.

Q. Can PAs prescribe medications?
A. Every U.S. state (except Indiana), the District of Columbia, and Guam have enacted laws that authorize PA prescribing; 45 states allow PAs to prescribe controlled substances.

Q. What is the working relationship between a physician and a physician assistant?
A. Ideally, the relationship between a PA and the supervising physician is one of mutual trust and respect. The PA is a representative of the physician, treating the patient in the style and manner developed and directed by the supervising physician. The physician and PA practice as members of a medical team.

For more information on managing your orthopaedic practice, visit the AAOS practice management center at http://www3.aaos.org