United States

Regulationedit

In the United States, the profession is represented by the American Academy of Physician Assistants, and all PAs must graduate from a nationally accredited ARC-PA program as well as passing the national certification exam. It was not until 1970 that the AMA passed a resolution to develop educational guidelines and certification procedures for PAs. The Duke University Medical Center Archives had established the Physician Assistant History Center, dedicated to the study, preservation, and presentation of the history of the profession. The PA History Center became its own institution in 2011, was renamed the PA History Society, and is now located in Johns Creek, Georgia.

Education and certificationedit

As of May 2019update, there were 243 accredited PA programs in the United States, and dozens more in development, represented by the Physician Assistant Education Association. Most educational programs are graduate programs leading to the award of master's degrees in either Physician Assistant Studies, Health Science (Master of Health Science), or Medical Science (MMSc), and require a bachelor's degree and Graduate Record Examination or Medical College Admission Test scores for entry. The majority of PA programs in the United States utilize the CASPA application for selecting students. Professional licensure is regulated by the medical boards of the individual states. Physician assistant students train at medical schools and academic medical centers across the country.

Physician assistant education is based on medical education although unlike medical school which lasts four years plus a specialty-specific residency, PA training is usually 2 to 3 years of full-time graduate study like most master's degrees. The training of PA education consists of classroom and laboratory instruction in medical and behavioral sciences, such as anatomy, microbiology, immunology, pharmacology, pathophysiology, hematology, pathology, genetics, clinical medicine, and physical diagnosis, followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine, as well as elective rotations. Unlike physicians, who must complete a minimum of three years of residency after completion of medical school, PAs are not required to complete such residencies after they complete their schooling. There are residency programs in certain specialties for PAs who choose to continue formal education in such a format.

PA clinical postgraduate programs are clinical training programs which differ from training on the job in their inclusion of education and supervised clinical experience to meet learning objectives which are clearly defined. The Montefiore Medical Center Postgraduate Surgical Physician Assistant Program was established in 1971 as the first clinical postgraduate PA program to be recognized. Currently, there are known to be 49 programs in various specialties such as Neurology, Trauma/Critical Care and Oncology. The Association of Postgraduate Physician Assistant Programs was formed in 1988 as an instrument in the establishment of educational standards for postgraduate PA programs and currently includes 50 member programs.

A physician assistant may use the post-nominal initials "PA", "PA-C", "APA-C", "RPA" or "RPA-C", where the "-C" indicates "Certified" and the "R" indicates "Registered". The "R" designation is unique to a few states, mainly in the Northeast. APA stands for aeromedical physician assistant and indicates that a physician assistant successfully completed the US Army Flight Surgeon Primary Course. During training, PA students are designated PA-S. The use of "PA-C" is limited only to those PAs currently certified and in compliance with the regulations of the national certifying organization, the National Commission on Certification of Physician Assistants and who have passed the PANCE.

In the United States, a graduate from an accredited PA program must pass the NCCPA-administered Physician Assistant National Certifying Exam (PANCE) before becoming a PA-C; this certification is required for licensure in all states. The content of the exam is covered in the PANCE BLUEPRINT. In addition, a PA must log 100 Continuing Medical Education hours and reregister his or her certificate with the NCCPA every two years. Every ten years (formerly six years), a PA must also recertify by successfully completing the Physician Assistant National Recertifying Exam (PANRE) There is a growing number of doctoral programs for certified PAs leading to a Doctor of Medical Science (DMSc) but there is no requirement for one to have a doctorate in order to practice. "National Physician Assistant Week" is celebrated annually in the US from October 6 through October 12. This week was chosen to commemorate the anniversary of the first graduating physician assistant class at Duke University on October 6, 1967. October 6 is also the birthday of the profession's founder, Eugene A. Stead, Jr., MD.

Scope of practiceedit

Physician assistants have their own licenses with distinct scope of practice. Each of the 50 states has different laws regarding the prescription of medications by PAs and the licensing authority granted to each category within that particular state through the Drug Enforcement Administration (DEA). PAs although trained to prescribe, in Kentucky, Puerto Rico and the US Virgin Islands are not allowed to prescribe any controlled substances. Several other states place a limit on the type of controlled substance or the quantity that can be prescribed, dispensed, or administered by a PA. Depending upon the specific laws of any given state board of medicine, the PA must have a formal relationship on file with a collaborative physician. The collaborating physician must also be licensed in the state in which the PA is working, although he or she may physically be located elsewhere. Physician collaboration can be in person, by telecommunication systems or by other reliable means (for example, availability for consultation). In emergency departments the laws governing PA practice differ by state, generally allowing a broad scope of practice and limited direct supervision.

The COVID-19 Pandemic forced local, state & federal governments to relax regulations around scope of practice, in an effort to maximize the healthcare workforce and allow PAs & NPs to better assist in the crisis. New bills are being passed as a result, which pave the way for physician assistant independence:

• On May 21, 2020, the law S.B. 1915 was signed by Oklahoma Governor Kevin Stitt. This law allows Physician Assistants to become primary care providers and receive direct pay from insurers. The reference of “supervision” was changed to “delegating” in regards to physician responsibility. This law also allows PAs to legally volunteer in the case of disaster or emergency.
• On May 27, 2020, Governor Tim Walz signed into Minnesota law the Omnibus Healthcare Bill S.F. 13. This law removes references to physician responsibility of supervision and delegation of care provided by PAs. The law also removes delegated prescriptive authority.

Employmentedit

The first employer of PAs was the then-Veterans Administration, known today as the Department of Veterans Affairs. Today it is the largest single employer of PAs, employing nearly 2,000.

According to the AAPA, there are more than 108,500 certified PAs in the United States as of 2016.

In the 2008 AAPA census, 56 percent of responding PAs worked in physicians' offices or clinics and 24 percent were employed by hospitals. The remainder were employed in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs Fifteen percent of responding PAs work in counties classified as non-metropolitan by Economic Research Service of the United States Department of Agriculture; approximately 17% of the US population resides in these counties.

The US Department of Labor Bureau of Labor Statistics report on PAs states, "... Employment of physician assistants is projected to grow 37 percent from 2016 to 2026, much faster than the average for all occupations ..." This is due to several factors, including an expanding health care industry, an aging baby-boomer population, concerns for cost containment, and newly implemented restrictions to shorten physician resident work hours.

For PAs in primary care practice, malpractice insurance policies with $100,000–300,000 in coverage can cost less than $600 per year; premiums are higher for PAs in higher-risk specialties.

Money magazine, in conjunction with Salary.com, listed the PA profession as the "fifth best job in America" in May 2006, based both on salary and job prospects, and on an anticipated 10-year job growth of 49.65%. In 2010, CNN Money rated the physician assistant career as the number two best job in America. In 2012, Forbes rated the physician assistant degree as the number one master's degree for jobs. In 2015, Glassdoor rated physician assistant as the number one best job in America. According to Bureau of Labor Statistics, the median pay for physician assistants working full-time was $108,610 per year or $52.22 per hour, and the highest 10 percent earned more than $151,850. Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn up to $200,000 per year.

Federal government, uniformed services, and US armed forcesedit

PAs are employed by the United States Department of State as foreign service health practitioners. PAs working in this capacity may be deployed anywhere in the world where there is a State Department facility. They provide primary care to US government employees and their families in American embassies and consulates around the world. An important part of their jobs is to get to know what resources are available locally that they can count on in an emergency. They have some other important roles, such as advising their ambassadors on the health situation in the country and provide health education to the diplomatic community. In order to be considered for the position these PAs must be licensed and have at least two years of recent experience in primary care.

Military PAs serve in the White House Medical Unit, where they provide care to the president and vice president and their families as well as White House staff.

They are employed by several organizations with the intelligence community, specifically the Central Intelligence Agency. While much of the job description is classified, they work under the Directorate of Support and are deployed to "austere environments" where they provide medical care, including trauma stabilization, and teach in the fields of survival, field medicine, and tactical combat casualty care.

United States Army PAs serve as Medical Specialist Corps officers, typically within Army combat or combat support battalions located in the continental United States, Alaska, Hawaii, and overseas. These include infantry, armor, cavalry, airborne, artillery, and (if the PA qualifies) special forces units. They serve as the "front line" of Army medicine and along with combat medics are responsible for the total health care of soldiers assigned to their unit, as well as of their family members.citation needed

PAs also serve in the Air Force and Navy as clinical practitioners and aviation medicine specialists, as well as in the Coast Guard and Public Health Service. The skills required for these PAs are similar to that of their civilian colleagues, but additional training is provided in advanced casualty care, medical management of chemical injuries, aviation medicine, and military medicine.citation needed In addition, military PAs are also required to meet the officer commissioning requirements, and maintain the professional and physical readiness standards of their respective services.

The marine physician assistant is a US Merchant Marine staff officer. A certificate of registry is granted through The United States Coast Guard National Maritime Center located in Martinsburg, West Virginia. Formal training programs for marine physician assistants began in September, 1966 at the Public Service Health Hospital located in Staten Island, N.Y.