Career Companion

7/22/2019 Career Companion

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Copyright 2011 by the American Academy of Physician Assistants

All rights reserved

The electronic Career ComPAnion has the ability to quickly navigate to suggested external websites with a click of

a button. This glossary of web links allow you to take advantage of the suggested sites by simply typing the webaddress into your internet browser.

AAPA

www.aapa.org

Page 10 ResumeSample Resume

http://careers.dyc.edu/guide/sec3/resumes/pa_1.pdf

Suggested Resume Headings

http://www.thedoctorjob.com/careercorner/view_article.php?id_article=12&button=true

What to Showcase

http://college.monster.com/benefits-entry-level-resume/articles/210-entry-level-resume-dilemma-recent-college-graduate

Page 19 FinanceMoneydance

http://moneydance.com

Quicken

http://quicken.intuit.com

Mint

www.mint.com

Wesabe

www.wesabe.com

Thrive

www.justthrive.com

Page 53 Insurance/MalpracticeMedical Malpractice Terms

www.camedicalmalpractice.net/glossary.htm

Insurance Terms

www.medpro.com/web/medpro/glossary

NPI

https://nppes.cms.hhs.gov/

Career ComPAnion

Glossary of Web Links


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CHAPTER 1: THE PA STUDENTCAREER PREPARATION

Introduction ................................................................................................. 3

A. Creating Your Professional File ................................................................ 5

Records to Maintain .............................................................................. 5

Professional Development Portfolio ...................................................... 7

B. Rotations ................................................................................................ 8

What to Expect ..................................................................................... 8

Rotation Dos and Donts ....................................................................... 8

Specialties and Electives ...................................................................... 9

C. First PA Job Search ................................................................................ 10

Rsums and CVs ............................................................................... 10

Cover Letters ...................................................................................... 10

Employment Resources .......................................................................11

D. Interview Preparation ........................................................................... 12

Before the Interview ........................................................................... 12

During the Interview ........................................................................... 12

After the Interview .............................................................................. 13

E. Compensation ....................................................................................... 14 Before You Make Your Decision Checklist ............................................ 16

F. Financial Management .......................................................................... 18

Loans and Repayment ........................................................................ 18

Creating a Budget ............................................................................... 19

Analyzing Your Budget ........................................................................ 21

CHAPTER 2: BEGINNING YOUR PA CAREER

Introduction ............................................................................................... 25A. New PA Checklist .................................................................................. 27

B. Work Settings and Specialties ..............................................................28

Specialty Practice ............................................................................... 28

Hospital Practice ................................................................................ 29

C. Working with Physicians and Patients ................................................... 30

Ethical Conduct .................................................................................. 30

PA-Patient Relationships ..................................................................... 31

Table of Contents


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Table of Contents The Physician-PA Team ....................................................................... 32

D. NCCPA Certication ...............................................................................34

How to Get Certied ........................................................................... 34

Preparing for the PANCE...................................................................... 34

Maintaining Certication .................................................................... 34

E. State Practice Authorization/Licensure.................................................. 36

Obtaining Licensure, Registration or State Certication ....................... 36

Temporary or Graduate Licensure ................................................. 36

Federally Employed PAs ...................................................................... 36

Maintaining Your License, Registration or State Certication ............... 36

F. Continuing Medical Education ............................................................... 40

CME Opportunities ............................................................................. 40

Logging CME Credits ........................................................................... 41

G. PA Prescribing and Dispensing .............................................................. 42

State Regulation ................................................................................. 42

Types of Drugs .................................................................................... 42

DEA Registration ................................................................................ 42

Drug Dispensing ................................................................................. 43

Drug Samples ..................................................................................... 43

H. Contracts and Employment ...................................................................46

Written Contract Components ............................................................. 46

Contract Checklist .............................................................................. 49

Other Employment Options ................................................................. 50

I. Professional Liability Insurance ............................................................ 51

Policy Types.........................................................................................51

Sources of Coverage ........................................................................... 52

Insurance Carriers .............................................................................. 53 Where to Obtain Coverage .................................................................. 53

Liability Coverage Checklist ................................................................ 54

J. PA Reimbursement ................................................................................56

Coverage and Claims .......................................................................... 56

Claims Denials .................................................................................... 57

Conclusion ................................................................................................. 58


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Chapter 1:The PA Student

Career Preparation


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Career ComPAnion

The PA StudentCareer Preparation

Introduction

The time to begin planning your PA career is while you are still a

student. Preparing essential information, exercising professionalism

and educating yourself about what practice entails will help you

more easily transition into your first job as a PA.

In this section, you will find details about establishing a professional

file, why it is important and what it should include. You will also

learn about what to expect on rotations and how to make the most of

this important part of your training.

This section also includes practical information about searching

for your first PA jobwhat you will need to prepare, information

you should have ready and questions you should ask prospective

employers. Additionally, there are tips for managing student loan

debt and for creating a personal budget.


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RECORDS TO MAINTAIN

Since everyones path aftergraduation and certication varies,every le is different. However,there are standard records thatall students and practicing PAsshould collect and maintain:

Educational Information

Transcripts and diplomas:

Keep one copy for each

college degree. You can obtainthese from your college oruniversitys registrars ofce,usually for a small fee.

Clinical rotation information:

Note locations, dates, namesand positions of peoplewith whom you worked.

Keep contact informationfor your preceptors.

Include a list of duties/

procedures performed foreach of your rotations.

Credentialing

Rsum and curriculum vitae:

Always have these up todate and ready to submit foremployment or credentialing.

Edit your rsum to ensure thatit is relevant to any positionsfor which you are applying.

You can nd tips on rsumor CV preparation in the FirstPA Job Search section.

Licensing/registration/certication materials:

Keep a copy of your statelicense, registrationor certication.

You should start gathering information for your professional file as

early as possibleat least by the beginning of your second year of

PA school.

A professional file is a record of your education, career, professional

materials and achievements that you maintain throughout your

career. This reference is extremely helpful when you apply for

employment or licensure, enroll in postgraduate training, log your

continuing medical education hours or submit a manuscript for

publication.

Establishing your professional file while you are still a student

ensures that you will have complete records from your education and

the beginning of your PA career.

Creating Your Professional File

Paper Trails

Keep a notebook ofyour professional le,as well as electroniccopies. You cantake your notebookversion with youto interviews.

Becoming a PA-C

Begin planningfor your NCCPAcertication while stilla student. See page

34 for details andvisit www.nccpa.net.

Rsum Prep

You can nd tipson rsum or CVpreparation in the

First PA Job Searchsection on page 10.


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Record your NCCPAcerticate number and thedate of your certication.

Retain copies of yourcredentials from varioustrainings you may havecompleted (BLS, ACLS,PALS, ATLS, etc.).

Keep printed copies ofyour states PA laws,rules and regulations.

Hospital credentialing forms:

Keep copies of the forms you

complete for credentialingand privileging in all hospitalswhere you practice.

Keep all correspondencerelated to credentialingand privileging.

Procedure log:

Be sure to list the nameof the institution, type ofprocedure, date and name

of the physician from yourteam for each procedure.

Professional Education

Classes/Education:

Use a calendar to documentperiodic grand rounds,trainings you attended,preceptorships, classes, etc.

Document your education inpharmacology or other clinicaltopics that are required byyour state for licensure.

CME records:

Keep copies of the CMElogging forms and certicates

of completion from all CMEcourses you attend.

Supporting Documents

References:

Anticipate those that will bemost helpful and request thembefore a reference is needed.

If someone volunteers toprovide a reference in caseyou ever need one, accept thereference and keep it on le.

Personal correspondence:

Keep congratulatory lettersand endorsements frompatients or agencies youmay have assisted.

Collect articles or informationalbrochures featuring youor your practice.

Publications and presentations:

Keep copies of any articles

that you author or co-author,as well as any reviews orcorrespondence referencingthe article or paper.

Note presentations you havedelivered (CME presentations,lectures for PA programs,department in-services, etc.).

Keep copies of any patienteducational materialsyou helped develop.

Organization records:

Record your professionalorganization membership(s)and positions of leadershipyou held, meetings youattended and activities in

Planning Ahead

Download the state

license applicationwell before yourescheduled tograduate. That wayyou have time tocomplete it and areaware of any uniquerequirements specicto your state.


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Own Your Career

AAPAs ProfessionalDevelopmentPortfolio iscustomizable andportable. At thetouch of a button onyour smartphoneor a few easy clickson your laptop,you can accessand update yourpersonal portfolio.

which you were involvedwith the organization(s).

Awards or honors:

Keep records of awards orhonors that you receivedin your professional role orin community activities.

Volunteer activities:

Document any medicallyrelated volunteer activitiesin which you participate,including training,mission trips, etc.

Sample write-ups:

Keep copies of sample write-ups that do not includepatient information.

Write-ups can encompass Opnotes, discharge summaries,history and physicalexams, SOAP notes, etc.

Financial Records

Employment contract:

Retain a copy of yourcontract or employmentagreement for every full-and part-time position.

Keep copies of your annualevaluation or review.

Malpractice (liability)insurance records:

Retain copies of all policiesyou currently hold and any you

held in the past. (If you are ona group policy, ask for a copyof the policy or the certicateof insurance. Either

document should includethe name of the insurancecompany, the insured entity,the policy number andthe dates of coverage.)

Expense records:

Save records of all professionaldues, expenses related toyour practice, equipmentyou bought for your practice,

CME expenses, etc.

Reimbursement information:

Keep copies ofreimbursement coveragepolicies for your state.

PROFESSIONALDEVELOPMENT PORTFOLIO

AAPA offers a convenient way

for members to manage theirprofessional les. You can accessour online tool, the physicianassistant Professional DevelopmentPortfolio, to record and manage allthe details of your professional le.

The PDP is free for all members andallows you to efciently track youreducation, work history, advancedtraining and other educationalactivities. To create your PDPaccount, please visit our website.

Payment for PAServices

AAPA researchesprivate insurancepayment policies forPA services. To learnmore and to readabout state-specicinformation, visit

AAPAs website.


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Clinical rotations give you the chance to put your classroom lessons

into practice. They also help you to learn more about working with

physicians and patients. Although all rotations are different, there

are similarities in how you should approach each rotation.

Rotations

WHAT TO EXPECT

Although most programs willprovide you with a clinical rotationshandbook, be prepared to alsolearn and follow each hospitalswritten and unwritten rules.

Organizations have differentmethods that are acceptable forwriting chart notes, dictating,writing prescriptions and makingreferrals. Additionally, you shouldbe sure to clarify your preceptorsexpectations, including your work

and on-call hours, your level ofresponsibility and how to dorounds. You also need to be awareof your legal limitations and theregulations for PAs in your state.

During all clinical rotations, youwill be expected to take an interestin your learning. Volunteer to doprocedures, ask for help and alwaysspeak up if you need clarication.

ROTATION DOS AND DONTS

Do:

Always come prepared to yourrotationbring a pen, notebook,stethoscope, etc.

Invest in professional andcomfortable shoes.

Turn your cell phone to vibrate orturn it off completely.

Spend as much time as you canwith your patients and learn theirpersonal histories and interests.

Ask you preceptor questions,especially if you are unsure.

Display your credentialsprominently.

Volunteer to take extra work orwork additional hours, but not atthe expense of your studies.

Have a good attitude about beingat every rotation; consider it aprivilege to be there.

Come to rotations well-groomedand appropriately dressed.

Share your resources witheveryone.

Remember you are on a perpetualinterview while on rotations. Younever know who is watching and

is interested in hiring you. Be condent and willing to

exercise your judgment.

Familiarize yourself withyour environment so whenemergencies happen, youll knowwhere to nd the proper supplies,medicine, equipment, etc.

Dont Forget

to update yourprofessional lewhenever you begina new rotation.


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Say yes when your preceptorasks you to do something.

Be courteous to your patientsfamilies and loved ones.

Befriend the nurses and learnnursing skills.

Follow HIPAA regulationscarefully and uphold patientcondentiality.

Carry trauma scissors: When allelse fails and you have no ideawhat is going on, you can alwayshelp by cutting off someonesclothing.

Dont:

Forget to study during rotations.

Complain.

Show up late.

Text.

Wait for preceptors to ask youto do something; be proactiveand motivated every day.

Treat the ofce or nursingstaff disrespectfully.

Act uninterested or as ifyou already know whatyou are being taught.

Say, I dont like (specialty).Instead say, Im not toofamiliar with (specialty).

Forget to smile.

Correct the preceptor, evenwhen you think he or she iswrong; ask a question instead.

Compare yourself to medicalstudentsyou are in twodifferent professions.

Ever do something you feeluncomfortable doing.

Ask to leave early; yourpreceptor will let you knowwhen you are nished.

Talk on your cell phone inthe room with patients, evenif the physician does.

Get discouraged if you dontunderstand a disciplineeveryone has his or her strengthsand weaknesses. Thats whymedicine is a team profession.

Think it will be easy, but alwaysremember it will be worth it!

SPECIALTIES AND ELECTIVES

For rotations, the majority ofspecialties you will study aredetermined by your PA programscurriculum. However, most clinicalportions of study offer one or twoelective rotations. For your electives,you can choose to spend more time

in a specialty with which you arefamiliar, or you can try somethingnew or clinically challenging for you.

Also, many students are hired byorganizations where they spenttime during their clinical rotations.So, the contacts you makeduring rotations can be valuablesources for future employment.Because of this, you should alsoconsider the geographic locationor organization type whenplanning your elective rotations.

Connect with OtherStudents

The Student Academyof the American

Academy of PhysicianAssistants has aFacebook page.There, you can joindiscussion boards,post to the wall andaccess informationspecically tailoredto the lifestyles of

busy PA students.Visit and like usat www.facebook.com/AAPAstudents.


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You may begin looking for your first job as a practicing PA during

your clinical rotations. At that time, you can begin to get a sense of

where you would like to practice and with whom. You should not only

prepare your rsum or CV for unexpected job opportunities, but also

prepare yourself for the interviews that will follow.

First PA Job Search

RSUMS AND CVS

The rsum or curriculum vitaeis typically the rst opportunityPAs have to make an impressionon potential employers. Whetheryou need a resume or CV dependsupon the positions for whichyou apply. It is more likely thatas a new PA graduate seekinga clinical position you will usea rsum. CVs are generallyused in scientic and academicsettings where it is necessaryto provide detailed informationabout teaching, research,publications and presentations.

Rsum

A rsum is a condensed list,usually one or two pages,highlighting and summarizingprevious and current jobs orother relevant experience.Rsums highlight informationthat specically relates to thejob for which you are applying.Rsums should include:

Contact information

Your objective

Employment history

Education information

Additional clinical training

License/certication information

Curriculum Vitae

A CV is a longer, more detaileddocument designed todemonstrate expertise andauthority. This compilation mightinclude information that is notspecically related to the job but

is important to your professionalcareer. CVs generally include:

Contact information

Employment history

Education information

Professional qualications

Awards

Publications

Presentations

Professional memberships

Interests

COVER LETTERS

A cover letter is a way to introduceyourself and your work toprospective employers. Coverletters should be direct, concise

Use Your Resources

To see cover letterexamples, go onlineor ask friends whohave had successfuljob searches.

Click on the linksbelow for tips onwhat to includein a rsum:

Sample Rsum

Suggested RsumHeadings

What to Showcase


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and tailored to each position forwhich you apply. Although eachcover letter will include differentspecic information, all cover

letters follow a general format:

Each letter should be aboutone page long, consisting ofabout three paragraphs

You should maintain anenthusiastic yet professionaltone throughout

The purpose of your letter shouldbe stated in the rst paragraph

In the body of the letter, explainhow your skills benet thepractice or organization

Mention areas of excellencethat are listed on your rsumor CV and explain them further

Close with proposed nextsteps, such as calling tofollow up within a week

EMPLOYMENT RESOURCES

PA Job Link

To help connect PAs and employers,AAPA developed the PA Job Linkafree, comprehensive employmentresource for PA students and

practicing PAs.The Job Link notonly includesjob postings,

but also hasprofessionaldevelopmenttools, salaryproles, interviewing tips andcontract templates to assist youin negotiating an employmentpackage. You can search for jobsby geographic location, specialtydiscipline and keywords.

You can access the PA Job Linkat www.aapa.org/joblink.

Networking

Consider visiting state chapterwebsites or attending state chapterevents and conferences. You willhave the opportunity to meet withPAs who work in your area andwho may be able to connect youto employers who are hiring PAs.

You also can become involvedwith your PA programs alumnigroup as a networking resource.

Did You Know?

Many employers

nd value in theirPA(s) belongingto professionalassociations and willoften reimburse youfor your AAPA fellowmembership. You canaddress this issuewhen discussing youremployment contractwith a new employer.


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BEFORE THE INTERVIEW:

Prepare a list of referencesto provide as well as copiesof your relevant certicates(PA program, NCCPA).

Update and organize yourprofessional le (yournotebook version) to bringwith you to the interview.

Familiarize yourself with thelaws and regulations governingPA practice in your state,particularly concerning yourphysician-PA team. You can ndlinks to all state PA practiceacts on the AAPA website.

Consider bringing a copy ofAAPAs state law summaryto rst-time PA employers.

Review the licensureapplication to know whetherthe physician from your teamneeds to submit paperwork.

Gather information about thepractice and the physicians that

will be on your team. You can

look for news articles, search the

Internet, check the state licensing

board for any disciplinary

actions against individuals

and even check the Medicare

fraud listings (ExclusionsProgram) at http://oig.hhs.gov.

If the practice or facility is in

your community, talk to friends

and neighbors to learn about

the organizations reputation.

Research the health prole

and the demographics of the

community in which you will

work. This will give you a better

idea of the types of health

problems the area may face.

DURING THE INTERVIEW:

Questions an interviewer

may ask you:

What are some of your strengths?

Weaknesses? Career goals?

The job interview is your chance to market yourself to an employer. It

is also your chance to gain a better understanding of the practice or

organization.

As you interview for positions, be sure to consider the balance of

quality of life, quality of practice (autonomy, philosophy of patient

care), familiarity with team practice and level of compensation each

position offers. Also, before you can begin working you will need

a license (or, depending on the state, registration or certification),

malpractice coverage and possibly hospital privileges.

Interview Preparation

Know Your Worth

AAPAs AnnualSalary Report isa comprehensivereport that includessalary informationfor all specialtiesin all states. Salary

information is listedby practice setting,organization type andyears of experience.It is available onthe AAPA website;keyword search:Salary Survey.


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Employer Education

AAPA offers many

types of informationaldocuments to helppotential employersunderstand PApractice and thebenets associatedwith physician-PApractice:

Partners inMedicinebrochure

Physician-PATeam issue brief

What is a PA?PowerPointpresentation

Guide for NewPA Employersbooklet

To learn more, visitwww.aapa.org.

Why do you feel you are a goodmatch for this position? How wouldwe benet from hiring you?

Why did you decide to

become a PA?

What did you do before youbecame a PA (especially regardingmedically related jobs)?

What have you been doing duringthe time that you have not beenworking as a PA (if there is a gapin your employment history)?

How do you envision your role inthis position? What type of duties

do you enjoy most? What do youhope to gain from this position?

How would you describeyourself? What are yourprofessional interests?

Where do you see yourselfin ve years?

As the physician on theteam, what is my liability?

Does the physician-PA team

agreement require the presenceof a physician at all times?

Do I need to add you to mymalpractice insurance, or willyou have your own policy?

Can we bill for your services? Willthe income you generate coveryour costs to the practice?

How soon could you start working?

Questions you should

ask the employer:

Have you worked with PAs before?What is your vision of what PAs do?

What do you know aboutthe PA profession?

How will the team be arranged? Willwe establish a practice agreement?

What hours will I beexpected to work?

What roles will I be expectedto play? What will myprimary duties be?

In which practice settings

will I be working?

What is your perspective onprecepting students? Will I beallowed to work as a preceptor?

How do you envision my role orresponsibilities changing over time?

Who is in charge of scheduling?How will patients be assigned?Who will decide and how? Will Ihave my own panel of patients?

How does the telephonetriage system work?

How is the staff structured? Whoare the other employees andpartners? What are their roles? Whowould be available to assist me?

Has your staff worked with PAsbefore? If not, how will they beeducated about the role of a PA?Is there anything I can do to help?

How many PAs have been in thisposition in the past few years?

Is the practice for sale? Is a salepossible in the next year? Is itmerging with a health system?

Will you be offering awritten contract?

AFTER THE INTERVIEW:

If you are interested in the

position, send a thankyou letter reafrming yourinterest and restating thecontributions you can make tothe organization or practice.

If you are no longer interested,send a letter to thank theinterviewer for his or hertime and to notify him orher of your intentions.


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This compensation information is taken from AAPAs 2009 Salary

Report, which includes data compiled from the Bureau of Labor

Statistics and the 2009 AAPA Annual Census. The data presented

here represent the national sample of PAs working at least 32 hours

per week and who are not self-employed.

For more detailed information, order a complete 2009 Salary Report

on our website. The report is a comprehensive document that presents

salary information by region, division and state. Salaries are further

broken down by years of experience, practice setting and specialty.

Compensation

2009 National Survey

The average yearlysalary for PAswith less than oneyear of experienceis $78,201.

TABLE 1. Salary by primary care specialty for PAswith less than one year of experience

Primary Care Specialty Average Salary

Family Medicine $73,188

Family Medicine withUrgent Care

$76,666

General Internal Medicine $75,243

General Pediatrics $74,821

Obstetrics/Gynecology $72,065

(Source: 2009 A APA Annual Salary Report)

TABLE 2. Salary by specialty for PAs with lessthan one year of experience

Specialty Average Salary

Dermatology $75,909

Emergency Medicine $87,129

Hospital Medicine $79,318

Occupational Medicine $74,833

Pain Management $76,818

Psychiatry $75,441

Other $82,241



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TABLE 3. Salary by subspecialty for PAswith less than one year of experience

Subspecialty Average Salary

Surgical $79,678

Pediatric $77,016

Internal Medicine $75,707

(Source: 2009 AAPA Annual Salary Report)

TABLE 4. Salary by surgical subspecialty for PAswith less than one year of experience

Surgical Subspecialty Average Salary

General Surgery $75,681

Surg: Cardiovascular/Cardiothoracic

$82,214

Surg: Neurology $81,861

Surg: Orthopedic $79,290

Surg: Otorhinolaryngology $75,576

Surg: Plastic $78,750

Surg: Urology $81,029

Surg: Spine $79,833


TABLE 5. Salary by internal medicine sub-specialty for PAs with less thanone year of experience

Internal MedicineSubspecialty

Average Salary

IM: Cardiology $75,694

IM: Gastroenterology $74,615

IM: Neurology $76,500

IM: Oncology $76,730

(Source: 2009 AAPA Annual Salary Report)

TABLE 6. Fringe benets for PAs who work atleast 32 hours a week for their primaryemployer and are not self-employed

Fringe Benets Average Days

per Year

Vacation(1 year in current position)

15

Paid Sick Leave 8

Paid CME Leave 6



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Use this checklist to help you consider your employment options:

Practice Hours and Location

How many ofce locations are there? In how many of these will you be expectedto work?

What are the hours of operation for each location?

How many hours are you expected to work per week?

Is there an on-call schedule? Is it exible?

How will holidays be covered?

What time do weekends begin and end?

Responsibilities

Is this the type of work you want to do?

What are the physicians expectations of what you will do?

How will you interact as part of the physician-PA team? What level of autonomywill you have?

What is the availability of the physician on your team?

What is your relationship to your co-workers? Will you have supervisoryresponsibilities?

In how many hospitals is the physician privileged? Will you be privileged, too?

What are your hospital responsibilities (rounds, ER, evaluations, deliveries,surgical assisting)?

Will you have hospital committee work?

In how many nursing homes does the physician follow patients?

What will be your responsibilities in the nursing home(s)?

Will you be allowed to precept students?

Legal Issues

Is the necessary paperwork led with the state licensing board or department?Did you review state statutes and regulations with the physician?

Have you discussed rules/regulations and gray areas with your employer?

Did you review the nursing home regulations?

Is there a probationary period with the employer?

Does the employer provide a written contract?

Did you review and discuss the physicians malpractice policy type andcoverage?

Before You MakeYour Decision Checklist

notes


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Did you discuss the malpractice policy type and coverage you will need?

Does the employer provide tail coverage (if needed)?

Is there a non-compete clause? Is it enforced if you are terminated

without cause?

Insurance

What malpractice coverage does the employer have (personal occurrencepolicy, personal claims-made policy with paid tail coverage or rider onphysicians policy)?

Is health and dental insurance provided? For dependents?

Is life and disability insurance provided?

Leave

What is the annual leave policy?

What are the paid holidays?

What is the sick leave policy?

What is the family/maternity leave policy?

What is the unpaid leave policy?

How many days are given for paid jury duty?

How many days are given for CME?

Professional Expenses

Is the PANCE expense covered?

Is the PANRE expense covered?Are AAPAs Annual Conference expenses covered?

Are state chapter CME conference expenses covered?

What amount is available for CME?

Are AAPA annual membership dues covered?

Are the state chapter annual membership dues covered?

Is professional activity in local, state and national PA organizations permitted?

Is malpractice insurance paid/provided?

Income

What is the base salary? Does this match your research?

Is a partnership available?

How often will you be paid?

How often will you receive a performance review?

Is there a bonus plan available?

Is there a prot-sharing plan available?

Is a pension/retirement plan provided?

PANCE stands forPhysician AssistantNational Certifying

Exam and is theinitial certifyingexamination forpracticing PAs.Once you pass theexam, you can thenuse the credentialsPA-C for physicianassistant-certied.

PANRE standsfor Physician

Assistant NationalRecertifying Examand is the exam thatPAs take every sixyears to maintaintheir nationalcertication.


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Once you land your dream job and prepare for work, you will need

to reassess your personal budget. Your financial profile will change

somewhat; you will have a new monthly income and will likely also

begin repaying student loans.

Money from loans generally form the foundation of student financial

aid. Some financial aid packages also include scholarships and grants

that you do not need to repay. For more information on funding your

education or details about your specific financial aid package, contactyour financial aid department. Also, visit AAPAs Student Academy

resource page to review available scholarships and traineeships.

Financial Management

LOANS AND REPAYMENT

Most student loans are reportedon all three credit bureaus:Equifax, Experian and TransUnion.Therefore, it is important that

you manage your loans and takesteps to ensure you follow youlenders repayment processes.

As you get closer to graduation,you should collect and review allnancial aid information for yourPA education. It is best to reviewthe guidelines for loan repaymentwell before you graduate. Usually,most student loan providers

allow a grace period beforeyou need to begin repayment.Nonpayment during this time willnot adversely affect your credit.

You may have subsidized loans,unsubsidized loans or both. If youhave a subsidized loan, then the

government will pay the interest onthe loan during the grace period.If you have an unsubsidized loan,however, the interest will continueto accrue on the loaneven in

deferment. Therefore, dependingon your employment status, youmay choose to make interestpayments on unsubsidized loanswhile they are still in deferment.

Many student loan companies offervarious repayment options to meetborrowers needs. You should checkwith your nancial aid company fora list of their repayment options and

the qualications necessary for eachoption. Student loan companiesalso often provide defermentoptions based on certain borrowerqualications. There are manyreasons to qualify for a deferment,including being unemployed,being a full-time student orexperiencing a nancial hardship.

Borrowed Time

A grace period is anamount of time

usually six monthswhen no loanpayment is due tothe lender and theloan is considereddeferred.


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CREATING A BUDGET

After your grace period has expired, you will need tools to managerepaying your loans. A fundamental tool is a budget that thoroughlyaccounts for all income and expenses. It is best to prepare your

budget during your grace period so you have time to secure aloan repayment plan that will t your nancial needs.

1. Income:

For employment, use net incomewhat you are paid after payingfederal and state taxes, social security, any deductions for 401Kor health insurance, etc.

Employment income _______

Income from trusts/investments _______

TOTAL NET INCOME _______

2. Fixed expenses:

Rent or mortgage payment _______

Association dues _______

Car payment(s) _______

Car insurance _______

Telephone/cell phone _______

Cable TV/satellite TV _______ Internet service _______

Water, sewage and garbage _______

Gas and electric _______

Health insurance (if you pay your own) _______

Life insurance _______

Child care _______

Student loan payment(s) _______

T O T AL F I XE D E XP E NS E S _______

FinancialManagement Tools

There are manysoftware packagesand online resources

available forpersonal nancialmanagement:

Moneydance

Quicken

Mint

Wesabe

Thrive


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3. Fluctuating expenses:

Best estimates of monthly costs

Groceries _______

Meals out _______

Clothing _______

Laundry/dry cleaning _______

Gas/parking _______

Public transit _______

Home repairs _______

Prescriptions/glasses _______

Credit card payment(s) _______

Beauty care _______ Entertainment _______

Pets _______

Gifts/charity _______

Newspapers/magazines _______

CME expenses _______

Membership dues _______

Vacation _______

T O T AL F LUCT UAT I NG E XP E NS E S _______

4. Savings expenses:

Determine how much you pay monthly for investments andretirement. For your emergency fund, you should ideally havethree months of your total expenses in a savings account.

Investments _______

Retirement _______

Emergency fund _______

TOTAL SAVINGS EXPENSES _______

TOTAL EXPENSES (FROM 2, 3 AND 4) _______

Career Costs

Be sure to budget for:

NCCPACertication(approximately$500 to takethe PANCE)

State Licensing(rangescan costup to $300)


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Did You Know?

The U.S. Department

of Education hastools to help youmanage your studentloans and calculatepayments based ondifferent repaymentplans. To accessthese tools, visitthe federal studentaid website.

ANALYZING YOUR BUDGET

After you have lled in all applicableinformation, compare your totalexpenses to your total income.

If they are fairly close, then youhave developed a good workingbudget. If you have substantiallymore income left over every month,then you can opt to pay moretoward savings, student loans orcredit card debt. If your expenses

are greater than your income, youwill need to determine where youcan cut back on expensesforexample, not having cable TV

or where you can realisticallyobtain more monthly income.

Remember, many student loancompanies offer exible repaymentmethods. Be sure to research allavailable payment options.


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Beginning Your PA Career

Chapter 2:


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Introduction

When you find the perfect job you will want to jump right in. But

there are a number of things you will need to address before you don

your white coat and see your first patients.

This section covers all the essential steps you must take to begin

practicing as a new PA. You will need to become nationally certified,

obtain state authorization to practice (via state license, registration or

certification) and begin logging continuing medical education hours.

You will need to understand how to navigate new relationships with

both your physician-PA team and your patients. This section also

covers what you should know about prescribing and how to negotiate

an employment contract. There are details about professional liability

insurance and how to obtain it before you begin practicing. In

addition, the last section provides an overview of PA reimbursement

and what you will need to know about claims processing.


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Before you treat any patients as a PA you will need to make sure you:

Take and pass the PANCE (to become NCCPA-certied)

Have state authorization to practice (license, registration or statecertication)

Have a National Provider Identier number

Have a Drug Enforcement Administration registration number(to prescribe controlled medications)

Obtain hospital privileges and a credential number (if you will be working

in a hospital setting)

Have liability (malpractice) insurance coverage

New PAChecklist

notes


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SPECIALTY PRACTICE

AAPAs Specialty Practice IssueBriefs illuminate PA practice in manyspecialties and are useful resourcesfor new PAs considering specialtypractice career paths. The collectionis available on AAPAs website.

PAs practice in six generalspecialty practice areas:

Primary care

Family medicine

General internal medicine

General pediatrics

Geriatrics

Obstetrics/gynecology

Surgical practice

General surgery Cardiovascular surgery

Neurosurgery

Orthopedic surgery

Otolaryngology

Plastic surgery

Emergency medicine

Pediatric subspecialties

Neonatal intensive care

Pediatric intensive care

Pediatric orthopedics

Internal medicine subspecialties

Allergy and immunology

Cardiology

Endocrinology

Gastroenterology and hepatology

Nephrology

Rheumatology

Urology

Others

Addiction medicine

Anesthesiology

Dermatology

Hospital medicine

Occupational medicine

Oncology

Psychiatry

Radiology

PAs practice in a range of settings in almost all medical and surgical

specialties and subspecialties. As of 2009, nearly half of PAs (44

percent) worked in group practices or solo physician offices; 38

percent worked in hospitals. Yet, the work spectrum is broad and

also includes rural clinics, community health centers, freestanding

surgical facilities, nursing homes, school- or college-based facilities,

industrial settings and correctional systems.

Work Settings and Specialties


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HOSPITAL PRACTICE

PAs who practice in hospitals workin virtually every department andpractice with physicians of every

medical and surgical specialty.These PAs may be employed bythe hospital, a medical practiceor hospital medicine group.

If you are going to work in ahospital, you must obtain hospitalprivileges rst. Also, the physicianon your physician-PA team mustbe a member of the medical staffbefore you can apply for privileges.

Hospitals have some optionsabout the process for privilegingPAs, but most likely, you will applythrough the medical staff ofce(within the human resourcesdepartment or other stafng ofce).

Credentialing is the rst stepin obtaining privileges. Thecredentialing staff at the hospitalwill check your basic professional

credentials: PA program graduation,state license/registration/certication (federal employeesmay have different requirements)and NCCPA certication. Theywill also require proof of medicalliability insurance coverage, eitheryour own policy or through youremployer. If your state licensingboard requires other documentsfor example, DEA registration,

narcotics registration or a practiceagreementthe credentialingstaff will need copies.

Once the credentialing process iscomplete, the medical staff will

consider the specic privilegesyou have requested. They will wantassurance from the physician onyour physician-PA team through

recommendations and supportingdocumentation that you arequalied to perform the privilegesrequested. They will ask for proof ofyour relevant training or experienceand proof of your ability to performthe privileges requested. In thecase of a new graduate PA, theymay accept procedure logs fromPA student rotations, letters fromthe physician-PA team you worked

with during rotations or lettersfrom your PA program faculty.

Like physicians, the credentialingand privileging standards forPAs are guided by the same sixgeneral competencies identiedfor physicians by the AccreditationCouncil for Graduate MedicalEducation and the AmericanBoard of Medical Specialties.

These competencies are:

patient care

medical/clinical knowledge

practice-based learningand improvement

interpersonal andcommunication skills

professionalism

systems-based practice

For more information aboutcredentialing, privileging andmedical staff membership, visitwww.aapa.organd keywordsearch hospital practice.

The Credentialingand PrivilegingProcess

The process forobtaining hospitalprivileges can belengthy. To see a listof all the informationyou may needto provide, visitwww.aapa.organdkeyword searchhospital practice.


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ETHICAL CONDUCT

(Excerpt from AAPAs Guidelinesfor Ethical Conduct for thePhysician Assistant Profession)

The PA profession has revised itscode of ethics several times sincethe profession began. Although thefundamental principles underlyingthe ethical care of patients have notchanged, the societal framework inwhich those principles are appliedhas. Economic pressures of thehealth care system, social pressuresof church and state, technologicaladvances and changing patientdemographics continually transformthe landscape in which PAs practice.

Individual PAs must use their bestjudgment in a given situation whileconsidering the preferences of

the patient and your physician-PAteam, clinical information, ethicalconcepts and legal obligations.

Four main bioethical principlesbroadly guided the developmentof these guidelines: 1) autonomy,

2) benecence, 3) nonmalecenceand 4) justice.

AutonomyStrictly speaking, autonomymeans self-rule. Patients havethe right to make autonomousdecisions and choices, andPAs should respect thesedecisions and choices.

BenecencePAs should act in the patientsbest interest. In certain cases,respecting the patients autonomyand acting in their best interestsmay be difcult to balance.

NonmalecenceDo no harm and do not imposeunnecessary or unacceptableburden upon the patient.

JusticePatients in similar circumstancesshould receive similar care.Justice also applies to normsfor the fair distribution ofresources, risks and costs.

When you first begin working with physicians and patients, you may

be unsure how to navigate these new relationships. To help guide

you, AAPA has developed ethical guidelines for the PA profession

that offer a framework for your decision-making. We also have tools

available to help PAs work efficiently and effectively with their

physician-PA team.

Working with Physicians and Patients

Core Competencies

You shouldalso review theCompetencies for thePA Professionbeforeyou begin practicing.Developed by theNational Commissionon Certication of

Physician Assistants,the CerticationReview Commissionon Education for thePhysician Assistant,the Physician

Assistant EducationAssociation and theAmerican Academyof Physician

Assistants, thecompetencies helpguide you throughyour career as a PA.


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PA-PATIENT RELATIONSHIPS

The principle value of the PAprofession is to respect the health,safety, welfare and dignity of

all people. This concept is thefoundation of the patient-PArelationship. You have an ethicalobligation to see that each patientreceives appropriate care. Youshould also be sensitive to patientbeliefs and expectations and shouldrecognize that each patient has anethical right to self-determination.

While PAs are not expected to

ignore their own values, scienticprinciples, ethical standards or thelaw, they should not allow theirpersonal beliefs to restrict patientaccess to care. You have an ethicalduty to offer each patient the fullrange of information on relevantoptions for his or her health care. Ifpersonal moral, religious or ethicalbeliefs prevent you from offering thefull range of treatments available or

care the patient desires, you havean ethical duty to refer the patientto another qualied provider.

Points from AAPAs Guidelinesfor Ethical Conduct for thePhysician Assistant Profession:

Cost ContainmentYou should inform patientsof nancial incentives to limitcare, use resources in a fairand efcient way and avoidarrangements or nancialincentives that conict withthe patients best interests.

DiversityYou should respect theculture, values, beliefs andexpectations of the patient.

Non-discriminationYou should not discriminateagainst patients based ongender, color, creed, race,

religion, age, ethnic or nationalorigin, political beliefs, nature ofillness, disability, socioeconomicstatus, physical stature, bodysize, gender identity, maritalstatus or sexual orientation.

Initiation andDiscontinuation of CareIn the absence of a pre-existingpatient-PA relationship, you are

under no ethical obligation tocare for a person unless no otherprovider is available. However,you are morally bound to providecare in emergency situations. Youand your physician-PA team maydiscontinue the relationship withan established patient as long asproper procedures are followed.

Informed ConsentThe doctrine of informed consentmeans that you will provideadequate information that iscomprehensible to a competentpatient or patient surrogate.

CondentialityYou should maintaincondentiality. You should alsochoose methods of informationstorage and transmissionthat minimize the likelihood

that patient data can becomeavailable to unauthorizedpersons or organizations.

Patient Medical RecordsYou must keep information inthe patients medical recordcondential. This informationis the property of the patient,


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and both ethically and legally,a patient has rights to knowthe information contained inhis or her medical chart.

Care of Family Membersor Co-WorkersTreating oneself, co-workers,close friends, family membersor students whom you superviseor teach may be unethical orcreate conicts of interest.

Genetic TestingYou should be sure that patients

understand the potentialconsequences of undergoinggenetic testsfrom impact onpatients themselves, possibleimplications for other familymembers, and potential use ofthe information by insurancecompanies or others who mighthave access to the information.

Reproductive Decision-Making

Patients have a right to access thefull range of reproductive healthcare services, including fertilitytreatments, contraception,sterilization and abortion.

End of LifeDying is a personal experienceand part of the life cycle. Youshould provide patients withthe opportunity to plan for

end-of-life care and shouldinvolve the physician in allnear-death planning.

CONFIDENTIALITY INTHE INTERNET AGE

The ubiquity of online socialnetworking makes upholding

patient condentiality even moreimportant. Once information isposted online, you are no longerable to control who sees it and for

how long. You should not discussyour patients online and you shouldnever post pictures of patients(even if they are inadvertentlyincluded in a picture with you).Ensuring that your patientsprivacy is protected is a guidingprinciple of the PA profession,and patient condentiality ismandated under federal law.

THE PHYSICIAN-PA TEAM

Team practice is fundamental tothe PA profession. This concepthowever, does not mean that thephysician must always be presentwith you or direct every aspectof care you provide. You and thephysician should dene yourroles in the practice. You shouldseek input from the physician

when you have questions thatexceed your clinical expertiseor when physician involvementis necessary for care.

The most effective physician-PAteams provide optimum patientcare by designing a practicemodel where the skills andabilities of each team memberare used most efciently.

Successful team practice dependson all parties having a clearunderstanding of individualroles and responsibilities.

Here are some things to considerwhen beginning practice withyour physician-PA team:


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Practice agreementA practice agreement, sometimescalled a delegation agreement,outlines in a general way the

patient problems and proceduresthat the physician authorizes thePA to address or perform. Theagreement should be reviewedand updated periodically asthe physician-PA team evolvesin the way it delivers care.

Like any partnership, thephysician-PA team requires opencommunication and ongoing

evaluation between you andthe physician on your teamto remain effective. For moreguidance on practice agreements,please visit AAPAs website.

State law supervisionrequirementsAll PAs practice medicine withphysician supervision. However,not all states dene supervision

the same way. All states have

different requirements regardingphysician co-signatures,physicians supervising multiplePAs and appropriate methods

of supervision. Go to AAPAswebsite to access a summary ofyour states laws and regulations.

PA scope of practicedened in state lawTo a large extent, PA scope ofpractice is determined by thedelegatory decisions made bythe supervising physician, butstate laws and regulations play

a signicant role as well. Formore information about yourstates PA practice act, visit theAAPA website or contact yourstates PA regulatory authority.

PhysicianSupervision

does not mean thatyour supervisingphysician mustbe with you at alltimes. Depending onyour state laws andpractice policies, youand your supervisingphysician may noteven need to be atthe same location at

the same time. SeeAAPAs website formore informationabout supervision.

Sample PracticeAgreement

Visit the AAPAwebsite to view asample practiceagreement. You cantailor it to your needsor you can simplyuse it as a referencewhen dening yourduties with yourphysician-PA team.


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HOW TO GET CERTIFIED

You must pass PANCE, amultiple-choice test thatassesses entry-level medicaland surgical knowledge. Onlygraduates of accredited PAprograms may take the exam,which is available at Pearson VUEtesting centers throughout thecountry. Test dates are availablecontinually during the year.

Contact NCCPA for details onwhen and how to register for the

exam at www.nccpa.netor at678-417-8100.

Visit www.pearsonvue.com/nccpato nd testing locations inyour area.

PREPARING FOR THE PANCE

AAPA has collected informationabout many differentpreparation resources:

CoursesThere are a number ofexamination review coursesavailable throughout theU.S. Please visit the AAPAwebsite for an updated listwith dates and locations.

MaterialsThere are also a number ofprint resources available for

examination preparation.Please see the most updatedlist on AAPAs website.

MAINTAINING CERTIFICATION

National recertication for PAs isvoluntary, except as required bycertain states for licensure or by youremployer. To maintain your NCCPAcertication, you must complete

an ongoing 6-year process thatinvolves: 1) completing continuingmedical education and 2) passinga recertication examination.

Recertication ExaminationFor recertication you must passthe Physician Assistant NationalRecertifying Examination,a computer-based examadministered by Pearson

VUE throughout the U.S. andinternationally. You can takethe PANRE as early as year ve,and can have as many as fouropportunities (two per year)to take and pass the exam.

Before you can obtain state authorization to practice, you must

first pass the Physician Assistant National Certifying Examination

administered by the National Commission on Certification of

Physician Assistants.

NCCPA Certication

Did You Know?

You must log 100hours of continuingmedical educationevery two years tomaintain a validNCCPA certication.PAs may earn CMEcredit as soonas their NCCPAcerticate is issued.


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Continuing Medical EducationEvery two years, PAs must earnat least 100 hours of CME credit,including at least 50 hours of

Category I CME credit. CategoryI activities are reviewed andpreapproved by one of thefollowing organizations: AAPA,American Academy of FamilyPhysicians, American OsteopathicAssociation and organizationsaccredited by the Accreditation

Council on Continuing MedicalEducation (which includes theAmerican Medical Association).

For more information aboutCME, please see the ContinuingMedical Education section onpage 40 or visit AAPAs website.

If you are submittingCME hours for therst time, contact the

NCCPA for deadlines,which may varydepending on whenyour certicatewas issued.


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Before you can begin practicing, you must be authorized to practice

by the state in which you plan to work. State laws and regulations

dictate who may practice as a PA, the medical services a PA may

perform and the requirements for the physician-PA team.

Most states grant licenses to PAs; however, a few states use the terms

registration or certification for PAs who are authorized to practice

in those states.

State Practice Authorization/Licensure

OBTAINING LICENSURE,REGISTRATION OR STATECERTIFICATION

To obtain an application for stateauthorization to practice, or formore specic information, contactthe PA licensing agency in thestate where you are planning

to practice. A list of state andterritorial regulatory authoritiesis available on AAPAs website.

TEMPORARY ORGRADUATE LICENSURE

The majority of states allownew graduates to practice withtemporary or graduate licensesso new PA graduates can practicebetween graduation and NCCPA

certication. You must apply for atemporary or graduate license justas you do for full licensure, andyou may not work as a PA until itis issued. For more information,visit the AAPA website.

FEDERALLY EMPLOYED PAS

Each federal employer of PAs

such as the Department of

Veterans Affairs, Indian Health

Service, Federal Bureau of Prisons

and the Armed Serviceshas

its own requirements for PA

practice. If you plan to work for

the federal government, you must

ensure you are appropriately

credentialed by your federalemployer before you begin work.

MAINTAINING YOURLICENSE, REGISTRATION ORSTATE CERTIFICATION

Although all 50 states require PAs

to pass the PANCE to obtain initial

state authorization to practice,

renewal requirements vary by

state. Some states require thatyou maintain NCCPA certication

for renewal while others require

that you earn CME only. All PAs

should obtain a copy of the statute

and administrative rules that

govern their state authorization

to practice. Contact the PA

licensing agency in your state.

Keep in Mind

All states havedifferent PA practiceacts and differentlicensing boards. Itis important that youcheck your statesspecic requirementsfor PA licensing.


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Table 7 lists state licensure and renewal requirements. You can also view an updated chart on AAPAswebsite.

TABLE 7.State statutory and regulatory requirements for licensure

State Graduation fromPA Program

Passage of NCCPAExam (PANCE)

Current NCCPACertication

RenewalRequirements

Alabama CME

Alaska NCCPA

Arizona CME

Arkansas and baccalaureate degree

CME

California

Colorado

Connecticut and baccalaureate degree

NCCPA

Delaware CME

District of Columbia CME

FloridaOsteopathic

CMECME

Georgia CME

Hawaii NCCPA

Idaho and baccalaureate degree

NCCPA

Illinois and/or NCCPA certication NCCPA

Indiana NCCPA

Iowa CME

Kansas CME

Kentucky NCCPA

Louisiana NCCPA

MaineOsteopathic

CMECME

Maryland and baccalaureate degree

CME


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RenewalRequirements

Massachusetts and baccalaureate degree

CME

MichiganOsteopathic

Minnesota CME(NCCPA for Rx)

Mississippi and masters degree

CME

Missouri **and masters degree for those

graduating af ter 1/1/08

NCCPA

Montana NCCPA

Nebraska CME

NevadaOsteopathic

CME

CME

New Hampshire NCCPA

New Jersey CME

New MexicoOsteopathic

NCCPANCCPA

New York

North Carolina CME

North Dakota NCCPA

Ohio**** masters degree NCCPA

Oklahoma For graduates after 7/07

program must meet

specic requirements

CME

Oregon NCCPA for Sch. IIprescribing

Pennsylvania

Osteopathic

and baccalaureate degree

and baccalaureate degree

NCCPA

NCCPA

Rhode Island CME

South Carolina NCCPA

South Dakota CME

Tennessee CME

Texas CME


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RenewalRequirements

Utah CME

Vermont CME

Virginia NCCPA

Washington

Osteopathic

CME

CME (NCCPA Sch. IIfor Rx)

West Virginia

Osteopathic

CME (NCCPA for Rx)

CME (NCCPA for Rx)

Wisconsin

Wyoming NCCPA

** Program requirement waived for those employed as PAs prior to 1986.

Board may issue temporary license to PAs enrolled in a masters program.

**** The masters degree requirement is waived for PAs licensed by any state prior to 01/01/2008.


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CME plays an important role in every medical professionals life. It

not only fulfills the essential requirement of retaining licensure, but

also encourages lifelong learning.

Continuing Medical Education

For NCCPA recertication, youwill need to complete 100 hoursof CME credit every two years;

at least 50 hours of CME mustinclude Category I CME.

Category IActivities that are preapproved.All Category I activities mustbe documented by certicatesof completion, attendanceor ofcial verication fromthe programs provider.

Category IIActivities that are elective; theyhave not been reviewed foreducational content. CategoryII activities should be chosenaccording to the followingguidelines and submitted onan hour-per-hour basis:

Any practice-related programthat is not eligible for Category

I CME credit. This includesmany educational programsprovided by pharmaceuticalcompanies and medicaldevice manufacturers.

Any practice-related, voluntary,self-learning activity (journalreading, medical textreading, precepting, etc.).

Any practice-relatedpostgraduate course,excluding courses taken

in actual PA programs.

CME OPPORTUNITIES

For information on the widevariety of CME opportunitiesavailable, please visit AAPAswebsite. A few are listed below:

AAPAs Annual Conference

On site

There is a comprehensiveschedule of CMEs offered ateach years conference. Theofferings consist of a range oftopics, often with more than300 sessions available.

Off site

Select presentations from themost recent conference areavailable for purchase. For more

information and to access thesesessions, see IMPACT On-Demandon the AAPA website. IMPACTOn-Demand has been approvedfor AAPA Category I CME credit,and a certicate of completionwill be accessible after viewinga presentation and completingthe corresponding evaluation.


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Home Study Programs(Enduring Materials)More than 50 hours of Category ICME credit can be earned through

home study programs listed onAAPAs website. Some programsuse only online tools, while othersrequire purchasing materialsbefore completing a post-test.

Additional CME servicesAAPA provides:

Online Post-TestTo verify completion of a home

study program, AAPA givesfellow members the option ofsubmitting post-tests onlineand obtaining the certicateof completion immediately.

Conference CerticateElectronic certicatesdocumenting participation inAAPAs Annual Conferences areavailable online for two yearsafter the conference closes.If you need a certicate for aworkshop you attended, pleaseemail [email protected] and indicatewhich conference you attendedand the title of the workshop.

AAPAs CME CalendarA calendar of CME programsoffered by constituentorganizations can be foundon our website. The calendar

includes dates, provider, location,contact name and CME creditinformation for each program.

CME ApprovalCategory I CME approval isavailable for programs presentedin a variety of formats: live

programs; postgraduateprograms; journal articles; andenduring material programs(including online activities,CD-ROMs and DVDs). Approvalfees vary according to theprovider type and numberof CME hours requested. Formore information, email CMEServices at [email protected].

LOGGING CME CREDITSFor national certicationmaintenance, you must logyour CME credit hours withNCCPA at www.nccpa.net.

Before contacting the NCCPA,be sure to have the followinginformation available:

Title of the program

Provider (the organizationadministering the program)

Number of credits

Sponsor (the organizationthat designates theprogram for CME credit)

If you are logging CME credit foryour state license only, pleasecontact your state licensing board

for instructions. For a list oflicensing boards and their contactinformation, visit the AAPA website.


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All states, the District of Columbia, the Commonwealth of the

Northern Mariana Islands and Guam permit delegated prescribing

by PAs, and nearly all states include controlled substances in that

authority.

PA Prescribing and Dispensing

STATE REGULATION

The laws and regulations for PA

prescribing vary by state. Theregulations are administered bymedical or PA licensing boards andrarelyby pharmacy boards.

In general, PAs are authorizedto sign prescriptions with theirnames; prescription blanks arerequired to bear the PAs name

and, in some states, the nameof the physician from your team.

For state summaries of theinformation that must be includedon PA-written prescriptions,

please see AAPAs website.

TYPES OF DRUGS

When PAs have prescriptive

privileges, it means that, atminimum, they can sign forlegend drugs without obtaining a

physicians signature. Forty-eightstates, the District of Columbiaand Guam permit PAs to prescribecontrolled medications. The list ofcontrolled medications PAs mayprescribe and the conditions under

which PAs may prescribe themvary with state law (see Table 8).

To review summaries of state lawsregarding controlled medication

prescribing, visit the AAPA website.

A few states have also developedformularies (lists of drugcategories) to guide prescribing.For information on which statesrequire formularies, see therestrictions category in Table 8.

DEA REGISTRATION

The federal governments DrugEnforcement Administrationenforces the controlled medicationslaws of the United States. Aspart of its effort to limit illegaldiversion of controlled drugs,the DEA keeps detailed recordsof these prescriptions.

Therefore, you must register withthe DEA in order to prescribecontrolled medications (provided

that state law authorizes PAs thisprescriptive authority). You mayuse the same DEA registrationnumber when practicing indifferent locations within the samestate. However, you will need aseparate DEA registration for eachstate in which you practice.

Legend Drug

Any medicationthat requires aprescription.

Controlled

Medications

Controlledmedications havea high potentialfor abuse, and aretherefore regulatedby the DEA.

These medicationsare categorizedby SchedulesIthrough V. Theschedules rankmedications by thepossible level ofphysical or emotionaldependency.

Schedule I drugs,which include heroinand LSD, have noaccepted medical

use in the U.S.


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You can apply for DEAregistration through the Ofceof Diversion Controls websiteor by calling 800-882-9539.

For more detailed informationon DEA registration for PAs,please see AAPAs website.

DRUG DISPENSING

Approximately 28 jurisdictions allowphysicians to delegate dispensingprivileges to PAs. Dependingon the state, dispensing maybe restricted to certain kinds of

health care facilities or geographiclocations; the quantity of drugsdispensed may also be limited. Youcan check your states dispensing

privileges by reviewing its PApractice act or by referencing AAPAssummaries of PA practice acts.

DRUG SAMPLESIn 1987, Congress enacted thePrescription Drug Marketing Act,which sets storage, handling andaccounting requirements for drugsamples; bans the re-importationof prescription drugs; and prohibitscertain wholesale drug distributionpractices. The law containslanguage allowing individuals

licensed or otherwise authorizedby the state to prescribe to requestand sign for drug samples. OnlyPAs with prescriptive privilegesmay request and sign for samples.

TABLE 8.Where PAs are authorized to prescribe

Jurisdiction Restrictions Controlled Substances

Alabama Sch. III-V

Alaska Sch. II-V

Arizona Sch. II-III limited to 14-day supply with boardprescribing certication (72-hours without); Sch. IV-Vnot more than 5 times in 6-month period per patient

Arkansas Sch. III-V

California Sch. II-V1

Colorado Sch. II-V

Connecticut Sch. II-VDelaware Sch. II-V

District of Columbia Sch. II-V


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Florida Formulary ofprohibited drugs

Georgia Formulary Sch. III-V

Guam Sch. III-V

Hawaii Sch. III-V

Idaho Sch. II-V

Illinois Sch. II-V2

Indiana Sch. III-V

Iowa Sch. II-V; Sch. II (except depressants)

Kansas Sch. II-V

Kentucky

Louisiana Sch. III-V

Maine Sch. III-V (Medical board may approve Sch. II forindividual PAs practicing within a physician-PAteam. No such provision for osteopathic board.)

Maryland Sch. II-V

Massachusetts Sch. II-V

Michigan Sch. III-V; Sch. II (7-day supply) as discharge meds

Minnesota Formulary Sch. II-V

Mississippi Sch. II-V

Missouri Sch. III-V3

Montana Sch. II-V (Sch. II limited to 34-day supply)

Nebraska Sch. II-V

Nevada Sch. II-V

New Hampshire Sch. II-V

New Jersey Sch. II-V (certain conditions apply)

New Mexico Formulary Sch. II-V

New York Sch. II-VNorth Carolina Sch. II-V (Sch. II-III limited to 30-day supply)

North Dakota Sch. II-V

Ohio Formulary Sch. III-V

Oklahoma Formulary Sch. III-V (limited to 30-day supply)

Oregon Sch. II-V


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Pennsylvania Sch. II-V. (Sch. II limited to 72-hours for initialtherapy; 30 days for ongoing therapy)

Rhode Island Sch. II-V

South Carolina Sch. III-V

South Dakota Sch. II-V (Sch. II limited to 30-day supply)

Tennessee Sch. II-V

Texas Sch. III-V (limited to 30-day supply)

Utah Sch. II-V

Vermont Sch. II-V

Virginia Sch. II-V

Washington Sch. II-V

West Virginia Formulary Sch. III-V (Sch. III limited to 72-hour supply)

Wisconsin Sch. II-V

Wyoming Sch. II-V

1 In California, PAs may write drug orders, which, for the purposes of the DEA registration, meet the federal denition

of a prescription. Controlled medications require a patient-specic order from the physician-PA team unless the PA has

completed a board-approved course on controlled substances.

2 Illinois law to authorize physicians to delegate prescriptive authority for Sch. II controlled substances to PAs was passed

in May 2009. Regulations necessary to implement the law have not yet been adopted.

3 Missouri law to authorize physicians to delegate prescriptive authority for Sch. III-V controlled substances to PAs was

passed in July 2009. Regulations necessary to implement the law have not yet been adopted.


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Contracts and Employment

PA compensation plans vary aswidely as the multitude of specialtiesand settings in which PAs practice.Putting all agreements into awritten contract protects you ifdisagreements arise later. Thecontract should not be written untilyou and your employer have agreedon the essential components.

It is advisable to hire an attorneyto review any contract you intendto sign. Retain an attorney who hasknowledge of contracts, particularlyhealth care contracts, and whocan help you understand theresponsibilities and expectationsoutlined in the contract. A localattorney is best; he or she is more

likely to be familiar with yourstate laws. It is also importantto know if the attorney hasexperience with PA contracts andhow many years of experience heor she has had in contract law.

WRITTEN CONTRACTCOMPONENTS

Terms and TerminationThe term, or length, of thecontract must be stated, includingyour starting date and theduration of the initial contract.

The contract should also statewhether it can be terminatedearly if notice is given. If so, theamount of notice and reasonsfor justifying early terminationshould be carefully described.Termination provisions are eitherwith causewhere legitimatecauses for dismissal should beclearly denedor withoutcausemeaning the contract

can be ended by either partyat any time without reason.

Your contract should addressbonuses, severance payand vacation or sick timereimbursement. The contractshould also clarify who paysmalpractice insurance premiums.

Your first contract lays a critical foundation for your career. Temper

your enthusiasm to accept the first position you are offered and

protect yourself with well-researched contract negotiation points.

Before you commit to taking a position, it is important to review all

the essential components of your employment with your potential

employer. Delineating all these components in a contract helps to

ensure mutual understanding of what each partys responsibilities

and expectations are.

Dont Sign Yet

Remembera writtencontract is a legallybinding agreement.Do not sign it until

you are absolutelysure of your decision.If you back out aftersigning a contract,legal action may betaken against you.


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Performance ReviewsThe contract should state howoften a formal job performancereview will be conducted. For a

new position, this is typicallyat one-month, three-monthand six-month intervals.

Contract RenewalEvery contract should includean option to renew or aprovision to renegotiate basedon a performance evaluation.Performance criteria shouldbe included in the contract.

Employee vs. IndependentContractorIt is important to specifywhether you are an employee orindependent contractor becauseyour employers liability regardingemployment taxes and pensionbenets will be affected. The IRShas guidelines that you and yourtax advisor should examine.

Services to be Provided

The contract should clearlydene the area of medicine inwhich you practice and yourduties and obligations, includingwork days and hours, sites,practice duties, requirementsfor rounds and on-call duties.If the contract includes clausesthat prohibit you from holdinga second job (moonlighting),verify whether these restrictions

apply to volunteer health careor non-medical employment.

Credentials and PrivilegesThe contract should specifythe professional credentials(e.g., NCCPA certication) thatyou must possess or obtainwithin a specied time. Italso should specify whether

you must apply for or obtainprivileges at certain hospitals.

CompensationYour contract must includewhether you will be paid a salary,an hourly rate, a percentage offees billed or collected, or salaryplus bonus based on productivity.If your compensation will bebased on a percentage of feesbilled, specify which fees willbe included in the calculation. Ifyou will be paid an hourly rate,include a minimum number ofhours per week or per month

you must work. Your contractshould also specify the frequencyof calculation or payment.

Liability (Malpractice) InsuranceThe contract should list who willpay for liability coverage. If you arepaying for it, then your contractshould state how much it will cost.The contract should also indicatewhether you will be listed on the

policy of the physician from yourteam or have your own policy.

You should also understand thedifferent between occurrenceand claims-made policies.

Occurrence policy coversalleged negligence thatoccurs during the policyperiod, regardless of whenclaims are reported

Claims-made policy coversincidents that happen andare reported while the policyis in force; for an extrapremium, tail coverage willprotect you against claimsled after the policy ends

Your malpractice policy should coverliability for services rendered (or


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not rendered) and all legal costs,regardless of the suits outcome orwhether the suit was fraudulent.Try to obtain an ultimate net-loss

policy, which will cover all legal fees.

See page 51, Professional LiabilityInsurance, for more informationabout malpractice coverage.

Fringe BenetsThe contract should describeboth included and excludedfringe benets. Typical benetsinclude vacation and educationleave, travel expenses related

to education leave, professionaldues, CME expenses, conferencefees, licensure fees, hospitalmedical staff fees, booksand professional journals,NCCPA fees, Drug EnforcementAdministration registration fees,health insurance, disability, lifeinsurance and retirement plans.

Sick Leave and DisabilityThe contract should specify ifyou will continue to be paid ifyou become sick or disabled,and, if so, for how long. Oftenpractices have different disabilitypolicies for physicians andother employees; it is importantto understand which one willcover you. If you purchase thepolicy yourself, the federalgovernment does not tax it.

Purchasing Into the PracticeIf you plan to buy into the practiceeventually, the conditions ofthe buy-in and basic terms ofpurchase should be listed, usuallyin a separate letter of intent. Thisletter should include methods forvaluing the practice assets andthe physical site, and it shouldoutline your participation in

business decisions, the length oftime it will take before you becomea full partner, and the amountand terms of the purchase.

Restrictive CovenantsA restrictive covenant, sometimescalled a non-compete clause,is a provision in the contract thatprohibits you from practicingin a given geographic area orgiven medical specialty after youleave a practice. This is usuallyfor a dened period of time,often a few years after leavingthe practice. These clauses areenforceable in most states if theterms are considered reasonable.

Some red ags regardingrestrictive covenants:

Exclusions from practicingin entire counties or states

A prohibition from practicingat a particular hospital

An employer that wants

you to sign against yourbetter judgment and claimsthat he or she would neverenforce the clause(s)

DisputesBe sure that the contract specieswhether disputes between youand your employer will be settledby mandatory arbitration or incourt and whether the prevailing

party will receive lawyers fees andcosts. The contract also shouldinclude a clause that allows youand your lawyer access to patientmedical records if a lawsuit isbrought against you after youleave the practice. (Otherwise,your attorney may have tosubpoena the records, which is

a costly, protracted process.)

A Word on

Moonlighting

Some PAs wish tohold a second job(moonlighting) whileworking for theirprimary employer.If you want to holda moonlightingposition, verifythat your contract

allows that kind ofemployment. Also,you will need to besure you have yourown malpracticeinsurance to coveryour work whilemoonlighting.

Did You Know?

AAPA sponsors a

professional liabilityinsurance programfor its members. Formore information andan application form,call 877-356-2272.