AAOS Now

Published 5/1/2008
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Jerry Nelson, OPA-C; Gail Haas, OPA-C

What is an “OPA-C,” anyway?

Are you bewildered by the “alphabet soup” of credentials used to designate certification or licensure of allied health providers and physician extenders?

Let’s clear up one of those titles right now: The “OPA” or “OPA-C.”

The certified orthopaedic physician’s assistant (OPA-C) is a professional, mid-level physician extender who works strictly in the field of orthopaedic medicine under the supervision of an orthopaedic surgeon. The title “OPA-C” can be used only by an individual who has successfully passed the certification exam set forth by the National Board for Certification of Orthopaedic Physician’s Assistants (NBCOPA).

Earning the “OPA-C”
To be eligible to sit for the examination, OPA-C candidates must have at least 5 years of experience in orthopaedic medicine encompassing anatomy, physiology, pharmacology, and knowledge of musculoskeletal disease processes and treatments. Candidates also must have demonstrated proficiency in technical skills related to patient care, casting, bracing, splinting, and surgical assisting.

Candidacy may be achieved through completion of a recognized OPA program or, in some cases, through cross-training of other certified or licensed healthcare personnel. In a study commissioned by the American Society of Orthopaedic Physician Assistants (ASOPA), most certified OPAs have a bachelor’s or more advanced degree, as well as formal training as an orthopaedic nurse, certified orthopaedic technologist, or military corpsman/corpswoman.

Individuals who receive a passing score on the exam are awarded with the “OPA-C” title. Certification is maintained by voluntary participation in continuing medical education (CME) programs that meet American Medical Association guidelines. Certification is valid for 4 years, at which time the OPA-C must have earned 120 hours of CME credit or must retake and pass the examination.

Scope of practice
An OPA-C works within the scope of practice as defined by his or her supervising physician. The employing physician takes the OPA-C’s experience and expertise into account when delegating duties. The ASOPA, in conjunction with the NBCOPA, has drafted Standardized Guidelines of Practice for OPAs, which list duties the OPA-C should be competent in performing, based on the areas covered by the certifying examination.

Currently, the scope of an OPA-C’s practice is governed by the medical staff, hospital credentialing committees, and applicable state laws. Due to the high demand for these individuals, some states—such as Tennessee, California, and New York—have adopted practice guidelines for OPA-Cs. Many more states are currently reviewing these guidelines and establishing uniform criteria with the help of OPA-Cs and the orthopaedic community.

Although many orthopaedic surgeons would prefer to hire a trained assistant with solid orthopaedic background who would require less time to assimilate into the surgeon’s practice, they are limited because fees for services provided by OPA-Cs are not reimbursable under Medicare or Medicaid guidelines. This is largely a political issue that still needs to be resolved. Currently, many third-party payors will reimburse for OPA services, but the refusal by Medicare/Medicaid to reimburse for OPA services remains a problem.

For more information on the OPA-C, call the ASOPA at (800) 280-2390 or visit www.asopa.org

Jerry Nelson, OPA-C, is president of the ASOPA; Gail Haas, OPA-C, is ASOPA liaison to the AAOS and a past president of the ASOPA.

From Vietnam to today: A history of the OPA
The orthopaedic physician assistant (OPA) role was initially established in the mid-1960s—about the same time that physician assistant (PA) programs arose. As the highly skilled members of the medical corps returned from active duty in Vietnam with extensive on-the-job training, they found their skills could not be utilized to their full potential.

This situation, combined with a projected physician shortage, led to the creation of medical extender (MEDEX) programs. Military medics and corpsmen were given additional training to enable them to practice as physician extenders in the civilian sector.

In orthopaedics, surgeons were looking for individuals to serve as first assistants at surgery, to apply immobilization devices, and to provide general patient care. Because neither the MEDEX nor the “primary care” PA programs provided focused orthopaedic education, the AAOS began looking at ways to train physician extenders in the field.

A program curriculum and accreditation/certification procedures were approved by the AMA and the AAOS. Nine orthopaedic assistant education programs were established in the civilian sector, with a tenth program in the U.S. Army.

Changes afoot
In May 1971, the AMA recommended changing the title “orthopaedic assistant” to “orthopaedic physician’s assistant,” so that physician extenders had uniform titles that also identified the specialty they were trained in. The AAOS adopted the change and awarded the OPA title accordingly.

OPA training programs continued with both AMA and AAOS accreditation until 1974, when the AAOS determined that accrediting educational programs was a violation of its bylaws and recommended that accreditation be completely undertaken by the AMA and the American College of Surgeons. At the same time, the AMA decided that accrediting a specialist program was not in its best interest and chose to focus on accreditation of “primary care” PA programs instead.

Even without accreditation, OPA educational programs continued until 1990. Many colleges and universities are interested in reopening OPA programs, due to the continuing demand for trained orthopaedic assistants, but cannot due to lack of funding.

In 1976, the American Society of Orthopaedic Physician’s Assistants (ASOPA) was incorporated. By 1979, the NBCOPA—an independent certifying body for OPAs—had also been created. Composed of orthopaedic surgeons and OPAs who work with the Professional Testing Corporation, NBCOPA established and updates the OPA certification exam. The board reviews the exam annually to ensure that the test questions remain relevant to current trends in orthopaedics.

The first OPA-C exam was conducted in 1980 at Tulane University in New Orleans. The examination is still given semiannually at sites across the United States. The OPA-C exam is administered and managed by the Professional Testing Corporation.