Medical Informatics: History of PA Profession 1
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What is a Physician Assistant?
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a licensed healthcare professional that assist/takes the role of a doctor, under their supervision, in his/her scope of practice to take care of patients
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What is PA supervision?
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continuous ability to come in contact with the physician that supervises you whenever you are treating patients. *always know your supervising physician*
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What is Scope of Practice?
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PA is allowed to do 'whatever' their supervising physician allows credentials allows them to do in their field of practice.
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PA's are _______________ practicioners; they must be able to contact their ________________ whenever they are working. __________ contact is not necessary..
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dependent; supervising physician; direct
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Give 4 reasons why there is a shortage of physicians and how this lead to the development of the PA program.
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o Technology advances- live longer and needed more care )techniques and transplants/artificial life support, etc o Medical Education- 3-5 year residencies for specialization o Social Policies- Medicare/Medicaid (1964) allowed more access to healthcare o Population shifts- baby boom→ cities
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How did the Vietnam War lead to the development of the PA program.
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an availability of medics and corpsmen returning home
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What program rejection lead to the development of the PA program?
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initial \"nurse clinican\" program
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What role did Dr. Charles Hudson play in development?
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in 1961, he calls for \"mid-level\" providers from military corpsmen
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What role did Dr. Henery McIntosh play in development?
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in 1962, Duke University trains firemen/corpsmen in emergency procedures, catheterization, and classified as PA's on Duke's payroll
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What role did Dr. Amost Johnson and Henry Treadwell play in development of PA?
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active in AMA and medical politics and trained Henry as a PA
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Who is the founder of the PA profession?
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Dr. Eugene Stead Jr.
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When was the PA profession founded?
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April 21, 1964
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How long was the first experimental program?
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2 years
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What is the original PA job description?
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The physician's assistant would be able to differentiate in many ways. He could, under the doctor's direction, make home calls and see patients in the office. The physician would be responsible for determining the extent of his duties. In the hospital setting, he could be responsible for drawing blood, giving infusions, administering oxygen, performing bladder catheterizations, and given emergency resuscitation. He would perform most of the straight service functions not done by medical students and interns.
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Describe the importance of July 1, 1964?
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can not expand out preset programs to meet needs; creation of a new person in the health field: PA
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Who developed MEDEX?
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Dr. Richard Smith
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When was MEDEX's first class and when did they graduate?
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started in 1969; graduated in 1970
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Describe the original MEDEX program.
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mostly on the job training; required more prerequisite experience than Duke; 15 month program; 15 students; located at the University of Washington (still only PA program called MEDEX)
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What law was changed in 1971 that aided the profession?
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the Medical Practice Act allowing PA's to practice under the supervision of a licensed physician
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When did New York State change the Medical Practice Act?
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1973
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List the Original PA programs.
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Dartmouth, Penn State, UCLA Charles Drew, Howard U, U of Utah, Medical U of South Carolina, U of North Dakota, U of Washington
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What were the White House Conference Proceedings of 1965?
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Discussion of The assistant Medical Officer; Not a physician, but assume duties as his ranking assistant, he would not be a nurse, highly trained.
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Who did the Duke program accept for their first graduating class?
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navy corpsmen
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List the classes and hours of Duke curriculum.
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Six month of Didactic- o Anatomy and Physiology- 60 hrs o Metabolism- 60 Hrs o Pathophysiology and Pharmacology- 60 hrs o Animal Surgery- 48 hrs o Equipment and Instruments/visits/nursing/CPR/Phlebotomy/Lab Skills o 18 months or clinical rotations- Renal Dialysis, Hyperbaric Unit, Cardiac Cath Lab, Cardiac Intensive care, Recovery, Clinical research
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Describe the initial scope of practice of a PA (1965).
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Final diagnosis and prescription would be reserved for Physician and PA's would be mostly technical
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When was the Duke PA program started?
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1965
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How does government funding affect the expansion of PA programs?
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• Rapid Expansion of PA programs (U of Oklahoma, Baylor, U of Texas Southwestern, Yale, U of Alabama, George Washington U, Emory, St. Louis U) • Government funding determines proliferation ('70-'73, '95-'99 [Daemen/D'Youville], '08-'12)
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How many PA programs are in the United States
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174+
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What states do not have PA programs?
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Hawaii, Alaska (MEDEX satellite campus in Wyoming)
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How many programs are in NYS?
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20
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How many programs are in PA? CA? TX? FL?
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16, 10, 8, 12
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How long is the average program?
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18-35 months w/ average of 26.7
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Describe the typical length and organization of a PA program?
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18-35 months with average of 26.7; 96% of programs longer than 24 months; 90% are Master's programs; typical: summer, fall, spring, summer (May to June)
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How long is the didactic portion of Daemen's program?
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1000 hours
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Describe the breakdown of 4 class types and the hours.
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o Basic Sciences 240 hours • Anatomy, Patho, Micro, Pharm, Genetics o Clinical Preparatory Sciences 515 hours • Physical Diagnosis, Medicine, Peds, Geri, CPS, EM, Surgery o Professional Issues, Research and Ethics 165 hours • Med Term, Prof Issues, Med Ethics, Researhc o Social and Behavioral Sciences 45 hours • Psychosocial and Cultural Dynamics
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How many hours is the clinical exposure of Daemen's program?
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2000 hours
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List the core clinicals of Daemen's PA program.
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• Pediatrics, Gyn and Prenatal Care, Emergency Medicine, Behavioral and Mental Health, Internal Medicine, Family Medicine, Surgery
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List some elective clinicals of Daemen's PA program.
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CT Surgery, ID, Endocrinology, HIV, Ortho, Cardiology, Neurosurgery, ENT, Rheumatology, Radiology, Dermatology, Plastic Surgery, NICU, ICU, PICU, Sports Medicine
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Describe how some PA schools are not at the Masters level, but degrees are still given.
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• Some Community Colleges still exist but can not work in NYS (Red Rocks Community College CO, Miami Dade Community College FL, Riverside Community College CA, Cuyahoga Community College OH, Anne Arundel Community College MD, Community College of Baltimore County-Essex MD) but must award graduate degree by 2020
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What is ARC-PA?
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Accreditation Review Commission on Education for the Physician Assistant
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How many commissioners are on the ARC-PA?
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22
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Who set the educational standards for PA programs?
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physicians and PAs on the ARC-PA
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How are commissioners chosen for the ARC-PA?
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o American Academy of Family Physicians x2 o American Academy of Pediatrics x2 o American College of Physicians x2 o American College of Surgeons x2 o American Medical Association x2 o Physician Assistant Education Association x3 o America Academy of Physician Assistants x3 o PA's at Large ??? x3 o + 3 others
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Describe the role and purpose of a commissioner of the ARC-PA.
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In order to evaluate and improve programs, protect the students, protect the program; volunteers w/ no paycheck that examine each institution
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Describe the Admissions Process for a student looking to enter a PA program.
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highly variable, but highschool students/ transfers/ graduates with healthcare experience, development of CASPA (application process)
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The AMA guidelines for Physician/PA Practice:1. The physician is _______________ for managing the health care of patients in all practice settings. 2. Health care services delivered by physicians and Physician Assistants must be within the ______________________________ as defined by state law. 3. The physician is _____________________ for coordinating and managing the care of patients and, with the appropriate input of the Physician Assistant, ensuring the quality of health care provided to patients. 4. The physician is responsible for the _____________ of the Physician Assistant in all settings. 5. The role of the Physician Assistant(s) in the delivery of care should be defined through mutually agreed upon ______________ that are developed by the physician and the Physician Assistant and based on the physician's ____________ style. 6. The physician must be _____________________ with the Physician Assistant _____________ either in person or through telecommunication systems or other means. 7. The ________________ by the Physician Assistant in the assessment and implementation of treatment ______________ on the complexity and acuity of the patient's condition and the ________________________ of the Physician Assistant as adjudged by the physician. 8. Patients should be made clearly aware at all times whether they are being cared for by a physician or a Physician Assistant. 9. The physician and Physician Assistant together should review all delegated patient services on a regular basis, as well as the mutually agreed upon guidelines for practice. 10. The physician is responsible for clarifying and familiarizing the Physician Assistant with his supervising methods and style of delegating patient care.
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responsible; scope of each practitioner's authorized practice; supervision; guidelines; delegatory; available for consultation; at all times; extent of the involvement; will depend; training and experience and preparation
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Describe the Scope of Practice of PA's by NYS Laws.
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• Each physician assistant's (PA's) scope of practice is defined by education and experience, state law, facility policy and physician delegation. • PA may perform medical services only when under the supervision of a physician and only when such acts and duties are within the scope of the supervising physician's practice • A physician assistant may perform any function in conjunction with a medical service lawfully performed by the physician assistant, in any health care setting, that a statute authorizes or directs a physician to perform and that is appropriate to the education, training and experience of the registered physician assistant and within the ordinary practice of the supervising physician
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What are the state regulations of PA's?
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• Early laws were brief amendments to Medical Practice Acts, which doesn't apply to PA's • Next iteration attempted to list the tasks a PA could perform, which was too limiting • Modern laws allow physician's to delegate tasks within their scope of practice to PAs • Goals of Regulation: Protect the Patient and allow Physician-PA teams to provide efficient and effective care
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What are the 6 Key elements of Modern PA Law?
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1. Licensure as the Regulatory term- term is easily recognized by consumers. Requires PAs to comply with laws governing 'licensed health professionals' 2. Physician may delegate prescriptive authority to include all Schedules of Drugs- PA may prescribe certain classes of drugs (class I-V drugs) for patients as determined by their supervising physician. Important in long-term treatment of many disorders/diseases as well as acute reasons. 3. Scope of Practice is determined by the supervising physician, the PA, and any relevant facility- PA's have different levels of experience and physician is in the best position to evaluate the PA's Competence, not state laws or Regulations 4. Adaptable Supervision Requirements- no ridged laws about physician supervision, which could inhibit care, especially in emergencies or big cities. There must be flexibility in the amount of supervision required (ex: supervision in trauma center vs well child center) 5. Chart co-signature requirements determined by the practice- Uses physician's time well, and use PA's levels of experience in determining methods or oversight and review 6. No PA:Physician Ratio- # of PA that can be safely supervised should be determined at site a. NYS still has 4:1 ratio
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What is Licensure as a Regulatory Term?
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term is easily recognized by consumers. Requires PAs to comply with laws governing 'licensed health professionals'
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Describe how Physicians may delegate prescriptive authority to include all schedules of drugs.
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PA may prescribe certain classes of drugs (class I-V drugs) for patients as determined by their supervising physician. Important in long-term treatment of many disorders/diseases as well as acute reasons.
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How can scope of practice be determined by the supervising physician, the PA, and any relevant facility?
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PA's have different levels of experience and physician is in the best position to evaluate the PA's Competence, not state laws or Regulations
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What are the adaptable supervision requirements?
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no ridged laws about physician supervision, which could inhibit care, especially in emergencies or big cities. There must be flexibility in the amount of supervision required (ex: supervision in trauma center vs well child center)
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How can chart co-signature requirements be determined by the practice?
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Uses physician's time well, and use PA's levels of experience in determining methods or oversight and review
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Why should there be no PA:Physician Ratio?
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# of PA that can be safely supervised should be determined at site (NYS still has 4:1 ratio)
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What is the AAPA?
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America Academy of Physician Assistants
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Who is the president of AAPA?
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Larry Herman, PA-C, DFAAPA
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Describe the AAPA organization.
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national organization that represents the PA profession with over 41,000
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Who started the AAPA and in what year?
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Duke students/graduates; 1968
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What is the mission of the AAPA?
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to improve quality, accessibility, and cost-effectiveness of patient-centered health care
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How many constituent organizations, chapters, and speciality organizations are part of the AAPA?
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100 constituent organizations; 56 chapters (50 states, DC, 5 federals states); 25 specialty organizations, other caucuses, special interest groups
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How does the AAPA advocate at the federal and state level?
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AAPA Advocacy and Government affairs staff lobby policymakers and third-part payers so you can deliver quality healthcare with minimal barriers
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How does the AAPA help with reimbursement of PA coverage?
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academy reimbursement staff work diligently to ensure that insurance companies and other third-party payers cover the medical and surgical services you provide
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What occurs at the Legislative Action Center of the AAPA?
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resources to help change laws at the Federal Level
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What occurs at the political action committee of the AAPA?
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provide campaign support to legislators
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Describe how federal bills will become laws.
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House of Representatives + Senate → President (sign/veto)
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How do NY state bills become laws?
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Assembly + Senate → Governor
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How does AAPA encourage Continuing Medical Education (CME)?
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• AAPA continually assesses the CME market to bring you the latest ground-breaking resources • Members receive free post test processing and deep discounts on programs • Annual AAPA Conference
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What is the NCCPA?
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National Commission on Certification of Physician Assistants
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What is the only certifying organization for PA's?
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NCCPA
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When was the NCCPA established?
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1975; as a non-for profit organization
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What is the role of the NCCPA?
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Assures that certified PA's meet established standards of clinical knowledge an cognitive skills
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Do all US states rely on the NCCPA?
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yes
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How many PAs are currently members of the NCCPA and how many are currently certified?
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100,000+ PA members and 92,000 currently certified
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What is the PAEA?
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Physician Assistant Education Association
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When was the PAEA founded?
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1972
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What is the only national organization representing PA Educational Programs?
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PAEA
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What is the mission of the PAEA?
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- to pursue excellence, foster faculty development, advace the body of knowledge that defines quality education and patient centered care, and promote diversity in all aspects of PA education
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List some functions of the PAEA.
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Pa Program Directory, CASPA, PACKRAT, Annual report, end of rotation exams, conferences/workshops for PA educators, legislative activism
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What is the NYSSPA?
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New York State Society of Physician Assistants
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List some recent accomplishments of NYSSPA.
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• Successful lobbying for and passage of the Re-statement of Physician Assistant Practice Act • Successfully lobbied for the legislative removal of the 24-hour Counter-Signature Requirement for PA's • Secured DEA Licensure for the PA privilege to prescribe Schedule II-V Medications • Protected Physician Assistants' rights to First Assist in surgery • Obtained Licensure for Physician Assistants from the Department of Education • Awarded over $60,000 in PA student scholarships over the past decade • Supported appointment of a PA Representative on the board of the OPMC • Increased supervisory ratio from 2:1 to 4:1 for PA's in private offices
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What organizations nominate PA educators of the year?
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NYSSPA
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Why did the PA profession develop?
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1. Shortage of physicians 2. availability of medics/ corpsmen from Vietnam 3. rejection of initial nurse clinician proposal by organized nursing
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How did the shortage of primary care physicians develop?
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1. Great advances in technology 2. transition from generalist to specialist 3. Social policies 4. population shifts
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What influenced the advances in technology that caused the shortage of primary care physicians?
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Americans began to live longer and needed more medical care. (life expectancy in 1900 was only 47 years)
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Some examples of what were the new technological advances...
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Transplants, intensive-care artificial life support, dialysis, surgical advancements mastered from WWII, cardiac bypass surgery, paramedics, CPR
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About the transition from generalists to specialists that caused the shortage of primary care physicians...
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1 year internships were replaced by 3-5 year residencies.*Created a gap in new physicians entering the physician workforce. Physicians work longer in urban teaching hospitals and also focused on researching.
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What were the social policies of the 60's that influenced the shortage of primary care physicians?
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1. War on poverty 2. Civil rights movement 3. Social equality 4. Medicare and Medicaid (1964)
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How did Medicare and Medicaid influence shortage of physicians?
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Millions could now access medical care for the 1st time because previous healthcare was limited to charity and religious organizations.
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Examples of current Hospitals that were started as the charity and religious organizations...
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-Kenmore Mercy Hospital -Sisters of Charity Hospital -Mount Sinai Hospital -Methodist Hospital
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Who is more likely to need medical care?
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The elderly, disabled, and impoverished.
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What were the \"population shifts\" that influenced shortage of primary care physicians?
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1. The huge baby-boom after WWII (76 million babies were born between 1945-1964) 2. The growth of cities (Loss of agricultural society -> urbanization -> physicians fled to urbanized cities and left small towns forever)
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Proposal of Dr. Charles Hudson?
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In 1961, in JAMA, he called for a \"mid level\" provider from the ranks of former military corpsmen. he wanted to extend the usefulness of these army and navy vets.
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Dr. Henry McIntosh's role?
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A cardiologist at Duke University. In 1962, he trained local fireman in emergency procedures for the community. -In exchange, off duty firemen staffed the cardiac catheterization lab.
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New trends started at Duke University in 1962?
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Former navy hospital corpsmen are hired for similar roles as the trained local fireman and are classified as physician's assistants by Duke's Payroll Dept.
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About Dr. Amos Johnson and Henry Treadwell?
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Dr. J was a solo physician in Garland, NC. (President of American Association of Family practice, active in AMA and NC medical politics, and knew Dr. Stead from Duke and Dr. Smith of MEDEX) *Dr. J trained an assistant, Henry Treadwell who functioned like a contemporary PA (1962)
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Who is the founder of the PA program?
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Dr. Eugene Stead, Jr. (1964)
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Proposal of Dr. Eugene Stead, Jr?
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*In 1964, he was disillusioned by organized nursing's rejection of the nurse clinician program. He decided that... -Ex-military corpsmen, with their previous training and experience would be good candidates for his 2 year experimental program What were Dr. Stead's proposals of April 21, 1964? -PA could differentiate in many ways (under Doc, he could make home calls and see patients in office) -Physician is responsible for PA's duties -In hospital, PA can draw blood, give infusions, administer O2, do bladder catheterizations, give emergency resuscitation. (Technical and vocational procedures) -PA would do straight service fxns not done by med students and interns
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What were Dr. Stead's proposals of July 1st, 1964?
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-there were not enough facilities or personnel to do a lot of the medical procedure services -It would be difficult to expand the present programs to meet the needs.. -a new person in the health field should be created (PA), who would multiply the services that a doctor can give
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What was role of Dr. Richard Smith?
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In 1964, he was assigned to Pacific Northwest by surgeon general to develop PA training program. *He developed MEDEX model with strong emphasis on development of students and graduates into medically underserved communities
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When was the first class of MEDEX students and when/where did they graduate?
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1969 (first class) 1970 (first class graduated from University of Washington)
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About the MEDEX program of 1969
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15 months, 15 students. -Required more prerequisite experience than Duke -Mostly \"on the job\" training
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-What happened in 1971 in Washington?
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Medical Practice Act was changed to allow PA's to practice under the supervision of a licensed physician.
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When did New York's Law allowing PA's to practice under the supervision of a licensed physician happen?
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1973
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Where were the original MEDEX programs?
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1. Dartmouth- defunct 2. Penn State- defunct 3. UCLA Charles Drew 4. Howard University 5. University of Utah 6. Medical University of South Carolina (closed for many years and reopened in 1990's) 7. University of North Dakota 8. University of Washington
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Where is the only PA program still called MEDEX today?
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University of Washington
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What did the White House Conference proceedings of 1965 address?
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The concept of the Assistant Medical Officer... -would not be a physician, but could have some duties of physician -not be in competition with a physician, but could serve as his ranking assistant -not be a nurse, more highly trained than a nurse
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In 1965, the Duke PA program accepted how many students?
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4 navy corpsmen (3 graduated)
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How long was the Didactic Program at Duke?
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6 months
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What courses did the Didactic program at Duke consist of?
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-Anatomy and Physiology (60 hrs) -Metabolism (60 hrs) -Pathophysiology and Pharmacology (60 hrs) -Animal surgery (48 hours) -Equipment and instruments -visits -nursing -CPR -phlebotomy, Lab skills
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What was the classroom of Duke's 6 month didactic curriculum and who was it led by?
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The house staff's TV room *Led by Dr. E. Harvey Estes, Jr.
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What were the lengths of Duke's Clinical rotations?
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Two, 9-month clerkships (18 months total)
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What were the options of Duke's clinicals?
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-renal dialysis -Hyperbaric unit -cardiac cath lab -cardiac intensive care unit -recovery room -clinical research unit
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The initial scope of practice of the PA?
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The PA would enter decision making process (before and after the stages of diagnosis and prescription), but final diagnosis and prescription would be the job of the PHYSICIAN.
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In 1968, what did Dr. Estes propose about the PA?
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In practice, the new assistant would take no part in tradition doctor functions. *PA's would be mostly technical
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Where were the PA programs that began to expand rapidly after duke's program?
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-University of Oklahoma -Baylor -University of Texas Southwestern -Yale -University of Alabama -George Washington University -Emory -St. Louis University -Johns Hopkins (defunct)
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In reality, why were/are PA programs started?
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It comes down to Money.
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When was the first proliferation period of PA programs?
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1970-1973
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In 1972, how many PA schools were started in NY?
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3
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When was the second huge growth of PA programs, and what common schools did this include?
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1995-1999 *Daemen *RIT *D'youville *Lamoine
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When did Daemen's first students graduate?
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1998
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When was the third growth or proliferation of PA programs?
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2008-2012
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In 1993, how many PA programs were there?
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52
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In 2003, how many PA programs were there?
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115
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Today, how may PA programs are there? How many want to start programs?
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174+ and 70 +want to start
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What states DON'T have PA programs?
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Hawaii, Wyoming Alaska (have MEDEX)
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What state has the most PA programs?
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NY (20-21 programs) # of programs in Pennsylvania= 16 # of programs in California= 10 # of programs in Texas= 8 # of programs in Florida= 12 (3 new)
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What states can PAs practice in?
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ALL 50 states
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On what coast are there more PA programs?
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east coast
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Where are 25% of U.S. doctors trained?
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NYC
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How many PA's are practicing in Erie County today?
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500
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What is the diversity of PA programs?
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90% female, white
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PAs DON'T Deliver Babies...
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Specialty of Obstetricians
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The % of PAs that work in Pediatrics=
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1-2%
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Current PA curriculum is how many months?
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18-35 (mean=26.7 months)
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Daemen college's curriculum in Months?
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33
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96% of PA schools have how many months?
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>24
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% of PA schools that award Masters Degree?
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90%
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What were PAs first awarded when graduated?
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Certificates
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What are the reasons that PA's have a Masters degree today?
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1. State institutions go by degree level for pay level 2. Insurance 3. 97% of NPs have Masters
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Educators of PA program=
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Need to have 3 PA's all the time
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List of Community College programs that still exist:
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1. Red Rocks (CO) 2. Miami Dade (FL) 3. Riverside (CA) 4. Cuyahoga (OH) 5. Anne Arundel (MD) 6. Baltimore County-Essex (MD)
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The Problem of PA graduates of community colleges that want to work in NY=
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Can't work in NY until they get Masters in 2020 *Most community colleges already have agreements for students to earn masters degree from another school while also getting a PA certificate
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What does the ARC-PA stand for?
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Accreditation Review Commission on Education for the Physician Assistant
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ARC-PA's regulation of Masters Degree=
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By 2020, EVERY PA will have Masters Degree
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How many Commissioners?
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22, (More Doctors than PAs)
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How many years was Daemen recently accredited for?
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7 years
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Every PA program has these basic Didactics...
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1. Basic sciences (Anatomy, Patho, Pharm, Genetics) 2. Clinical Preparatory Sciences (Phys. Diagnosis, Medicine, Peds, Geri, CPS, EM, Surgery) 3. Professional issues, Research, Ethics 4. Social and Behavioral Dynamics
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About how many hours of Didactics does a PA program have?
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1000
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Daemen's hours of...
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basic sciences= 240 clinical prep sciences= 515 professional issues, research and ethics= 165 social and behavioral sciences= 45
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Daemen's supervised CORE clinical experiences=
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Peds, GYN/prenatal, EM, behavioral/mental health, Internal medicine, Family medicine, Surgery
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About how many hours does Daemen's supervised clinical Experiences consist of?
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about 2,000
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What is the normal semester set up for a PA program?
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Summer, Fall, Spring, Summer
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AMA stands for: American Medical Association
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1. The physician is responsible for managing the health care of patients in all practice settings. 2. Health care services delivered by physicians and Physician Assistants must be within the scope of each practitioner's authorized practice as defined by state law. (scope of practice is determined by the physician's specialty) 3. The physician is ultimately responsible for coordinating and managing the care of patients and, with the appropriate input of the Physician Assistant, ensuring the quality of health care provided to patients. 4. The physician is responsible for the supervision of the Physician Assistant in all settings. (Physician can review charts made by PAs, Physician can physically see every patient, Physician and PA can discuss cases together, or during surgery they can delegate together) 5. The role of the Physician Assistant(s) in the delivery of care should be defined through mutually agreed upon guidelines that are developed by the physician and the Physician Assistant and based on the physician's delegatory style. (Don't make lists-guidelines should be generic- because there is always going to be a new drug that won't be added to list in consequence) 6. The physician must be available for consultation with the Physician Assistant at all times either in person or through telecommunication systems or other means. 7. The extent of the involvement by the Physician Assistant in the assessment and implementation of treatment will depend on the complexity and acuity of the patient's condition and the training and experience and preparation of the Physician Assistant as adjudged by the physician. (The Physician judges experience, steep learning curve) 8. Patients should be made clearly aware at all times whether they are being cared for by a physician or a Physician Assistant. (Always need to know title; Nurses can't say \"Doc will be in soon\") 9. The physician and Physician Assistant together should review all delegated patient services on a regular basis, as well as the mutually agreed upon guidelines for practice. 10. The physician is responsible for clarifying and familiarizing the Physician Assistant with his supervising methods and style of delegating patient care. (Most physicians don't know their supervising roles)
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A PA's scope of practice is defined by:
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1. STATE LAW- each state has their enabling legislation and limitations. NY is a \"great\" state. 2. FACILITY POLICY- every hospital has medical staff, which PA's are part of. This medical staff can make the rules for the PA's. The facility's policies can be more restrictive than the state. 3. PHYSICIAN DELEGATION *Also- PA's EDUCATION & EXPERIENCE*
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NY State Law 6542
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The PA may perform medical services only when under the supervision of a physician and only when the acts and duties are within the scope of the supervising physician's practice (Vague-general law)
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NY State Law 3704 after about 10+ years
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A physician assistant may perform any function in conjunction with a medical service lawfully performed by the physician assistant, in any health care setting, that a statute authorizes or directs a physician to perform and that is appropriate to the education, training and experience of the registered physician assistant and within the ordinary practice of the supervising physician. (Anything a physician can do, we can do it but if we have proper training and experience)
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State Regulation of PAs: History
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Early Laws- (1970's) brief amendments to the medical practice act (doesn't apply to physician assistants practicing with physician supervision) Next set of laws- tried to delineate lists of tasks PAs could perform (PA may sign, authorize, prescribe, etc) Modern laws- allow PAs to delegate tasks with physician's scope of practice for which PA is trained
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Regulations are supposed to establish a legal framework which:
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1. Public is protected from dangerous practices 2. Physician-PA teams are able to provide care to patients in the most efficient way possible
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Best practices for PA regulation under American Academy of physician assistants
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-Adopting 6 key elements of a modern PA law -Adding PAs to other relevant laws -Make licensure and supervision agreements meet access goals
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1. Licensure as a regulatory term
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-Early on, PA's used to not be licensed, which was a problem. Then they were identified as \"RPAC,\" (Registered PA Certified) now they are PAC's (Certified PAs). -Licensure is important because it is easily recognized by consumers and requires PAs to comply with laws governing \"licensed health professionals,\" ex: child abuse reporting mandates.
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2. Physician may delegate prescriptive authority to include all schedules of drugs
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-There are 5 schedules (categories) of drugs which are controlled substances. 1. Heroin, Cocaine, LSD, Marijuana (No one can prescribe) 2. OxyContin, Morphine, Ritalin, Adderall (high potential for dependence drugs) 3., 4., 5., (The abuse potential gets less) *PA's can now write for #2 categories, NY-State PAs can do #2-5. Why is this important? Long term treatment of pain, follow up care of children with ADHD, acute pain symptoms (e.g. kidney stones) and other aspects of health care require the physician to be able to delegate prescriptive authority for all Schedules of medications to PAs. The physician should determine what PA prescriptive authority best meets the needs of the practice.
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Scope of Practice is determined by the supervising physician, the PA, and any relevant facility
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➢ PAs have differing levels of experience ➢ Supervising physician is in the best position to evaluate the PA's competence ➢ Supervising physician should be able to customize patient care by delegating those aspects of care that the PA is competent to provide ➢ NOT BY LAWS OR REGULATIONS
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Adaptable supervision requirements
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➢ PAs work as members of physician-directed teams in a wide variety of settings ➢ Physician workforce is stretched (Need more providers, some counties only have 1 physician and 2 PA's) ➢ Appropriate supervision in a trauma center is not the same as appropriate supervision in a well child clinic, physicians must have flexibility ➢ Technology allows real time remote evaluation of patients and patient data by physicians *You don't want anything rigid such as the \"Dr. must be within 10 mile radius of PA,\" because 10 miles could be different in minutes depending on where you are, or even climate can affect this.
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Chart co-signature requirements determined by the practice
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➢ Important to use physician's time well ➢ Different types of practices require different methods of supervision ➢ PAs have varying levels of experience ➢ Each physician-PA team should be able to customize methods of oversight and review *We should not have a state law to mandate this Chart co-signature requirement
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No Ratio Limitation
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➢ The number of PAs a physician can safely supervise should be determined at the practice site ➢ Each setting and group of patients and providers is unique ➢ Physicians should be authorized to customize their health care team *We should not have a law to determine how many PA's work for Doctor
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SIX KEY ELEMENTS BY STATE
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All 6 elements= Vermont, Rhode Island, North-Dakota (Because they are rural and small) 5 Key elements= New York 1-2 Key elements= Mississippi (LAST STATE TO ALLOW PA'S), Louisiana (Has issues with laws), Georgia, South Carolina, Indiana, Ohio, Pennsylvania (conservative state), New Jersey
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PA's per 100,000
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States with the LEAST PAs= California (Has 10 PA programs, stricter laws for PA's, PA's are more hospital based, more NP's), Missouri, Arizona, Louisiana, Mississippi, Alabama, Indiana, Ohio (has community colleges) States with the MOST PA's= Montana, South Dakota, Alaska *(New York has such a big population that it dilutes the amount of PA's working)
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International PA's
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-Saudi Arabia -Great Britain -Canada (in process) -Australia -Netherlands
