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Physician Assistants in USA

Physician Assistants in USA . Taek Yeon Lee, MD, PhD. Associate Professor Division of CV Surgery Severance Cardiovascular Hospital Yonsei University College of Medicine, Seoul, Korea. The author has no financial relationships to disclose. Past – History

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Physician Assistants in USA

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  1. Physician Assistants in USA Taek Yeon Lee, MD, PhD Associate Professor Division of CV Surgery Severance Cardiovascular Hospital Yonsei University College of Medicine, Seoul, Korea

  2. The author has no financial relationships to disclose

  3. Past – History • Present – Definition, Members, Salary, Education, Association • Future – Growth

  4. Memorial Hermann Heart & Vascular Institute- Texas Medical Center

  5. The jurisprudence examination ("JP exam")

  6. Texas Administrative Code Title 22, Part 9 TEXASMEDICAL BOARD BOARD RULES Chapter 185. Physician Assistants §§ 185.1 – 185.26 Chapter 184. Surgical Assistants §§ 184.1 – 184.26

  7. Background • Shortage of medically trained personnel

  8. History

  9. 17th • Feldshers (German:Feldscher, Russian: Фельдшер) are introduced into Russian armies by Peter the Great in the 17th Century 1672-1725

  10. 1778 • 1778, John Wall, to assist medical officers on the USS Constellation The American Revolutionary War( 1775-1783)

  11. 1650-1900 • Officiers de Sante (1803-1892) The Napoleonic War(1803-1815)

  12. 1900- 1960 • 1925 Mts in Kentucky • 1940 Alaska, Eskimos and other native Americans • Dr. Amos N. Johnson employs Henry B. Treadwell in Garland, NC • 1942 • Dr. EA Stead - fast track to educate physicians at Emory University for military service during WW II 1908-1975 1908-2005

  13. Eugene A. Stead, Jr.MD(1908-2005) • Late 1950s • masters program for nurse clinicians with Thelma Ingles, a nurse educator, had established at Duke • 1965 • first formal educational program for PA at Duke • National PA Day is celebrated each year on his birthday - October 6th.

  14. 1966-1972 • 1966  PA concept on “Look” "More than a nurse, less than a doctor“

  15. 1966 - 1972 • 1967 • Dr. John Webster Kirklin, first formal program for SA (UAB) • First Class of three PAs graduate from Duke VH. Germino, KF. Ferrell and RJ. Scheele • 1968 • Duke University – first of 4 national conferences • American Association of Physician's Assistants (AAPA) 1917-2004

  16. 1966-1972 • 1971 • American Association of Physician's Assistants (AAPA) - first official journal

  17. 1966-1972 • 1972 • National Board of Medical Examiners ( NBME) begins the process of developing a certification exam.

  18. 1974 • APAP  Association of Physicians’ Assistant Programs

  19. 1975 • The National Commission on Certification of Physician's Assistants (NCCPA) • Registered every 2 y • Recertified every 6 y

  20. Certifying Exam • 1983 PANCE • NCCPA's Physician Assistant National Certifying Examination (PANCE) was redesigned to include three components: 1 .a general knowledge/core component 2. extended core component in surgery or primary care 3. a clinical skills problems component (CSPs). • 1985 PANRE

  21. 1988

  22. 1999 • CB-PANCE

  23. 2000 • CB – PANRE

  24. 2003 • Texas becomes 41st State to authorize controlled substance prescribing for PAs.

  25. Other Countries • 1992 • The Canadian National Forces begin training and using PAs. • 2002 • Canadian, Dutch and British

  26. China • Barefoot doctor • 赤脚医生 • 1968-1981

  27. Present

  28. Definition • PA / SA • LPNs - Licensed Practical Nurses • PA-C / SA-C • CST - Certified Surgical Technologist • CFA - Certified First Assistants • CRNFAs - Certified Registered Nurse First Assistants

  29. PA Nomenclature • Early years : ’s – physician’s assistant • physician’s associate – Duke Univ. • new health practitioners, clinical or health associates, physician extenders, mid-level practitioners, and non-physician health care providers. • In the 1980's, AAPA refer to themselves as PA (physician assistants) • Physician Assistant is the current term used to describe the profession.

  30. Applying to PA Programs • health care experience • Bachelor’s degrees, Master’s degrees degree • college-level courses include basic sciences; math; English/writing; some specialized science courses, such as anatomy/physiology, microbiology, physics; computer sciences; and medical terminology.

  31. Education • 149 education programs for PA • medical schools and centers, hospitals, colleges and universities

  32. PA Education • similar to that for medical students, although shorter in duration • (medical school education averages 155w; PA 111w) • 24 - 27 m • part-time education • ½ classroom studies, ½ clinical rotations.

  33. Licensure • 1. graduates of accredited PA education programs • 2. pass the PANCE (Physician Assistant National Certifying Examination) • To remain certified • 100 hours of continuing medical education every 2 years • must pass a recertification examination every 6 years

  34. Members By AAPA, US Department of Labor's Bureau of Labor Statistics 2008-2009 1993 - 26,400 PAs 1997 - 28,500 PAs 2002 - 45,000 PAs 2006 - 86,000 PAs • CRNFAs 1,621 / SA 10,000 / CFAs 1,425 / SA-Cs 948 / CSAs 805

  35. Scope • RULE §185.10 (PA) • (1) obtaining patient histories and performing physical examinations; •   (2) ordering and/or performing diagnostic and therapeutic procedures; •   (3) formulating a working diagnosis; •   (4) developing and implementing a treatment plan; •   (5) monitoring the effectiveness of therapeutic interventions; •   (6) assisting at surgery; •   (7) offering counseling and education to meet patient needs; •   (8) requesting, receiving, and signing for the receipt of pharmaceutical sample prescription medications and distributing the samples to patients in a specific practice setting where the physician assistant is authorized to prescribe pharmaceutical medications and sign prescription drug orders at a site, as provided by the Medical Practice Act, Chapter 157, and its subsequent amendments, or as otherwise authorized by this Act or board rule; •   (9) the signing or completion of a prescription as provided by the Medical Practice Act, Chapter 157; and •   (10) making appropriate referrals.

  36. Scope • RULE §184.12 (SA) • These generally include the following tasks: aid in maintaining adequate exposure in the operating field, cutting suture materials, clamping and ligating bleeding vessels, and, in selected instances, actually performing designated parts of a procedure... • The practice of surgical assisting is limited to surgical assisting performed under the direct supervision of a physician who delegates the acts. A surgical assistant may practice in any place authorized by a delegating licensed physician, including, but not limited to a clinic, hospital, ambulatory surgical center, or other institutional setting.

  37. Scope • AmericanCollege of Surgeons (ACS) • American Medical Association (AMA) • (e) Ideally, the first assistant to the surgeon at the operating table should be a qualified surgeon or resident in an education program that is accredited by the Accreditation Council for Graduate Medical Education (ACGME) and/or the American Osteopathic Association (AOA). • The AMA recognizes that attainment of this ideal in all surgical care settings may not be practicable. In some circumstances it is necessary to utilize appropriately trained and credentialed unlicensed physicians and non-physicians to serve as first assistants to qualified surgeons (emphasis added).

  38. Scope • Physician / Surgeon’s scope • Direct supervision • In selected ….. • May practice …. • Ideally …../ Practically ….. • In some circumstances, …..

  39. Supervision • (a) Supervision shall be continuous, and shall require that the delegating physician be physically present and immediately available in the operating room to personally respond to any emergency until the patient is released from the operating room and care has been transferred to another physician. Telecommunication is insufficient for supervision purposes. (§184.13. Supervision) • (a) Supervision shall be continuous, but shall not be construed as necessarily requiring the constant physical presence of the supervising physician at a place where physician assistant services are performed while the services are performed. Telecommunication shall always be available. (§185.14. Supervision)

  40. Supervision • PA (§185.14. Supervision) not constant physical presence Telecommunication be available • SA (§184.13. Supervision) continuous, physically present and immediately available in the operating room Telecommunication is insufficient

  41. Earning • May 2008 • Median $81,230 ( $68,210 - $97,070 ) • The lowest 10 percent ≤ $51,360 • The highest 10 percent ≥ $110,240 • http://www.bls.gov/oco/ocos081.htm • Median $85,710 ; median income for first-year $74,470 • Income varies by specialty, practice setting, geographical location, and years of experience. • By AAPA 2008 Census Report

  42. $ 85,710 • * 1209.00 ( 2010-06-01) • ₩ 103,623,390

  43. PAs practice • 2008 • family and general medicine (25.9 %) • general surgery and surgical subspecialties (25.1 %) • general internal medicine and its subspecialties (15.6 percent) • emergency medicine (10.5 percent) • pediatrics and pediatric subspecialties (4.3 percent) • dermatology (3.6 percent) • occupational medicine (2.3 percent) • obstetrics and gynecology (2.3 percent) • and other areas of medicine.

  44. Future

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