Orthopaedic physician assistants (OPAs) and physician assistants (PAs) are two different professions despite having similar titles. To understand the use of the common title requires a brief review of the history of the professions.

In 1967, the AAOS developed a board to review and accredit orthopaedic assistant programs in training individuals who could assist orthopaedic surgeons in managing patient care and assisting with fracture immobilization and surgery. Beginning in 1971, these individuals were known as OPAs.

At the same time, PA programs began to include primary care medicine. PAs who practice in orthopaedics are commonly known as physician assistants in orthopaedic surgery.

Many factors need to be considered in hiring or employing a physician extender, including the following:

• Investment potential (What can this person do for me or my practice?)
• Training (How much time will be required to train this person?)
• Reimbursement potential
• Scope of practice (What is the person able to do?)

How OPAs can be measured in each of these areas follows.

Investment
Approximately 10 percent of the members of the American Association of Physician Assistants work in orthopaedics. Although PAs and OPAs have some overlap in scope of practice, they often have very different roles, making direct comparisons difficult. PAs can and do work in a semi-autonomous role directed by the orthopaedic surgeon. OPAs work directly with the surgeon in a supportive role. OPAs do not diagnose or prescribe. Rather OPAs are an extension of the surgeon who assist with patient management and fracture immobilization and provide assistance in surgery.

The main benefit of hiring an OPA is to help balance the professional workload of the orthopaedic surgeon. An OPA can provide significant assistance in documenting and proving medical necessity for most treatments. They may also modify risk, because the surgeon sees every patient and has complete control of the message being delivered to the patient.

Training
The University of St. Augustine for Health Sciences has the nation’s only OPA training program. Applicants must have a Bachelor’s degree and prior shadowing experiences in health care. This is a two-year Master’s level program that offers training unlike any other program in the country. Students complete a year of clinical science courses coupled with surgical skills training in orthopaedic procedures. The second year includes formal rotations in orthopaedic subspecialties such as upper extremity, lower extremity, spine, and trauma. Graduates are eligible to take the national certifying examination offered by the National Board for Certification of Orthopaedic Physicians Assistants to earn the OPA-C designation. OPAs are required to complete 120 hours of continuing medical education every 4 years to recertify.

OPAs can be easily assimilated into an orthopaedic practice following graduation and certification because they have the skills and knowledge to provide immediate assistance to the surgeon. Comparatively, PAs may have completed a 6-week elective rotation in orthopaedics before graduation. Additional postgraduate fellowship programs in orthopaedics are available for PAs.

Reimbursement
One of the most common cited differences between PAs and OPAs is that PAs are recognized by Medicare (and Medicaid) for reimbursement, whereas OPAs are not. OPAs, however, do not see patients independently of the physician as PAs do. OPAs are eligible for surgical assistant reimbursement under many third-party payers.

The benefit of the OPA working directly with the supervising surgeon is that patient satisfaction can be higher for more patients, which can lead to increased practice revenues. A well-trained OPA can enable the physician to spend more time with patients who have complex problems.

Scope of practice
OPAs are licensed in Tennessee and must register in New York. Other states, including California and Minnesota, recognize some OPA graduates, depending on when they completed training. In most of the country, however, the practice of OPAs fall under physician oversight laws for supervised medical personnel. Hospital privileges for OPAs are determined at the local level in accordance with state laws.

General duties for an OPA include assisting with history and physical assessment, fracture immobilization techniques, injections, dictations, coding, first assistant for surgical procedures, and providing patient education. Employing an OPA may eliminate the need for other full-time support staff because the OPA can assist with all phases of care.

Summary
The decision to hire an OPA or other physician extender is determined by a number of factors and is practice- or surgeon-specific. The goal is to provide the highest quality of care to the orthopaedic patient while maximizing revenues and providing a balance to the surgeon’s workload.

In some practices, PAs, OPAs, and nurse practitioners work together to achieve these goals. In other practices, these providers work one-on-one with the orthopaedic surgeon. Each of these providers has a different skills set, with varied inherent advantages, so that all types of physician extenders can work in orthopaedics. OPAs strongly support a collaborative effort with other physician extenders to improve patient care and meet the needs of orthopaedic surgeons.

Jason Mazza, MSc, OPA-C, CSA, SA-C, OTC, CCRC, is the immediate past president and liaison to the AAOS from the American Society of Orthopaedic Physician’s Assistants (ASOPA). He can be reached at Orthoopa@mindspring.com

Editor’s Note: Recently, AAOS Now took a look at the differences between physician assistants (PAs) and orthopaedic physician assistants (OPAs), in an article written by a PA. (See “PAs and OPAs: What’s the Difference?” AAOS Now, October 2012.) This article, written by an OPA, presents another viewpoint.