For my first educational post under the "For the Public" section, the topic of physician assistant (PA) seemed to be an important one. This site is run by a PA who practices emergency medicine. Answering the question "What is a PA?" comes up rather frequently. Although there are many resources to help answer this question, there is quite honestly no easy answer which fully encompasses the role.
The American Academy of Physician Assistants (AAPA) defines a PA as a nationally certified and state-licensed medical professional. PAs practice medicine as a team with physicians and other providers both in the United States and internationally. In the United States, PAs are allowed to practice and prescribe in all 50 states, Washington D.C., most U.S. territories, and the military.
PAs, like other advanced medical professionals such as physicians and nurse practitioners, are able to take medical histories and perform physicals, order and interpret tests, diagnose and treat illnesses, counsel on preventative care, assist in surgery, write prescriptions (including controlled substances in most locations), and perform rounds both in hospitals and nursing homes.
Duties vary due to state laws, practice setting, level of experience, and specialty. In emergency medicine (EM), PAs work in a variety of settings. It ranges from the main section of the emergency department (ED), fast tracks, urgent cares, pre-hospital field, education, administration, and other settings. No matter the setting, there is at least some form of collaboration between the PA and a physician. This can vary widely by the scope of practice.
According to the Society of Emergency Medicine Physician Assistants (SEMPA), scope of practice is based on four main parameters. The first parameter as discussed above is state law and regulation. Interestingly, federally employed PAs may be excluded from state laws and may only follow the federal employer regulations depending on the situation. Facility policy is the second parameter and can greatly effect how the PA practices based on the site. A third major parameter includes education, experience, and expertise of the PA. Some correlate this to how physicians and other providers evolve over time as most aspects in medicine have parameters change based on the same factors. The final main parameter is determination of the collaborating physician(s) about what tasks are delegated. In many cases, this falls in line with the other parameters but there are exceptions.
Depending on where a PA treats a patient (such as main ED versus fast track), what the PA does on a daily basis can vary. A PA in a critical care or main ED setting could be regularly performing advanced procedures such as intubation (putting a tube in someone's throat to help them breathe on a machine) and thoracostomy tube insertion (placing a tube in a person's chest). In a fast track, the patient is more likely to suture (stitch) lacerations or drain an abscess. No matter the environment, PAs have to be highly intelligent and fast thinking as any patient can present to any of the EM clinical settings. An example would be recognizing a major heart attack in someone who came to the ED and was placed in fast track for a cough with mild chest pain. Failure to recognize this potential could lead to death or serious complications in this patient. However, the PA must be able to further differentiate clinically in order to avoid working up every patient with a cough and mild chest pain for a possible heart attack.
PAs are trained rigorously in advanced programs. In most cases, PAs have previous medical backgrounds including nursing and paramedicine. With the current programs, PAs complete a master's type program. These programs usually last approximately three academic years but most programs are full time and last approximately 27 months. Training is very similar to medical schools and in some cases the students share a classroom. After the period of classroom training, PAs will complete more than 2,000 hours (equivalent to a year of full-time practice) in a number of settings including EM.
After their extensive training, PAs must complete a national certification exam. Once passed successfully, PAs may then apply for state licenses. To maintain certification, the current process is completing 100 hours of continuing education every two (2) years and a re-certification exam every 10 years.
It is not easy to summarize what a PA is and there are always more questions. Did we answer all your questions? If there is something else you would like to explain, please post it in the comments.