The PAWith the printing of this edition of The PA, we at CAPA can look back and see the progress that our profession has made over the years. All those who came before us should be recognized as it is because of their hard work we have matured to the great profession we are today. The PA booklet is an educational introduction for those who want to learn about PAs and the critical role we serve in healthcare. CAPA is here to fulfill our mission as stated below.

CAPA Mission StatementThe mission of the California Academy of PAs is to represent and serve

PAs statewide. As an advocate of its members for the provision of quality healthcare, in collaboration with all healthcare professionals, CAPA will

enhance, educate and empower PAs for the ultimate benefit of their patients.

CAPA Vision StatementFully integrate PAs into every aspect of California’s healthcare.

The PA History and Scope of PracticePAs are highly qualified professionals who are graduates of an accredited PA program and who are licensed to practice medicine. PA practice is conducted in collaboration with physicians as part of a healthcare team. PA practice includes most medical services and duties that are performed within the normal scope of the physician’s practice and which the PA is competent to perform.

In 1965, primary care physicians were in short supply, particularly in rural and inner city areas. In an effort to augment scarce medical supply, Dr. Eugene Stead of Duke University developed the PA concept and established its first education program. He believed that practicing with physicians, PAs could safely and effectively provide services previously provided solely by physicians. He was accurate in his vision.

Similar to physicians, PAs provide a broad, comprehensive range of diagnostic and therapeutic services. Such duties include, but are not limited to, performing comprehensive evaluations, consultations and physical examinations, diagnosing and treating illnesses, ordering and interpreting diagnostic tests, managing acute and chronic medical conditions, performing simple and complex surgical procedures under local anesthesia, assisting with surgical procedures performed under general anesthesia and providing care in the inpatient setting, such as rehabilitation facilities, skilled nursing facilities and hospitals. Additionally, PAs may hold important positions in healthcare administration, public elected office, academics, research settings, medical practice ownership, industries supporting healthcare, such as pharmaceutical and medical devices, as well as other innovative and entrepreneurial ventures.

As with physicians, there are PAs who practice in almost every field of medicine. California statute and regulation consider orders given, and the tasks performed, by a PA to be considered the same if they had been given and performed by the physician. PAs may perform all tasks or services agreed upon between the PA and physician, as long as it is consistent with the PA Practice Act and the physician’s scope practice, as well as is within the individual PA’s education, experience, and competence.

PAs may perform surgical procedures customarily performed under local anesthesia without the presence of the physician, as well as perform the duties of first or second assistant in surgical procedures performed under general anesthesia.

As reported in a recent article in Forbes, PAs, often considered primary care professionals, are increasingly providing specialty care services in fields such as surgery and emergency medicine. More than 70% of PAs now practice medicine in “non-primary care specialties,” according to the National Commission on Certification of Physician Assistants (NCCPA) in its annual profile of the PA profession.

The practice of medicine by PAs is done in collaboration with one or more physicians. This relationship is described in law and regulation. A PA may practice with multiple physicians and a physician may practice with more than one PA. The PA and physician teams have a number of options available to them to determine, in their practices, how to best collaborate. A key component involves a meaningful exchange of information to enhance the care provided to patients. PAs may provide medical care and surgical procedures performed under local anesthesia, of which they are competent to perform, without direct supervision of the physician, as long as the physician is accessible in person, by phone or by other electronic means.

The physician-PA team must establish, in writing, guidelines for collaboration. The guidelines may be

general or specific and may include standing orders, protocols, prescription drug order guidelines, individual patient orders, emergency consultation guidelines and medical care review mechanisms. The physician has the responsibility of following the patient’s progress and be participatory in the team-based care.

Very often, physicians serve as preceptors for students in a PA training program prior to employing a PA. As preceptors, they become involved in the teaching process and can assess firsthand the ability and potential of a PA. Many preceptors ultimately include, or expand, the PAs on the healthcare team. Physicians wishing to become preceptors, or to place an advertisement for qualified PAs for their practice, should contact the individual PA program or the California Academy of PAs.

The foundation of general medicine in PA education enables PAs to practice medicine in both primary care and specialty care. Some examples include: general and family practice; emergency medicine; pediatrics; obstetrics and gynecology; general surgery; orthopedic surgery; geriatrics; occupational medicine; psychiatry and mental health; cardiology and internal medicine; oncology and administrative and education. PAs may also change the area of medicine in which they practice. The flexibility of the PA license enables the PA to fluidly practice in both primary care and specialty care as the demands of various types of care within communities shift.

California PAs practice in a variety of rural and urban settings. PAs may provide services in any medical setting in which physicians provide services, including private offices, general acute care hospitals, acute psychiatric hospitals, special hospitals, nursing facilities, intermediate care facilities and private homes. The Medical Staff of hospitals may grant privileges to PAs for both medical and surgical services in the inpatient setting. A PA may practice at more than one location and with more than one physician at any time.

Patient acceptance of PAs is excellent. Surveys repeatedly indicate patients are highly satisfied with the performance, competence and professional manner of PAs. The utilization of PAs has resulted in improved quality and access to healthcare as well as enhanced patient satisfaction. Results of studies comparing the primary care services of PAs with those of general or family physicians and general internists have consistently shown no discernible difference in the quality of their diagnostic or therapeutic care. Most findings indicate that PAs are able to spend more time per patient visit, provide more thorough medical record documentation and devote more time to patient education. PAs contribute positively and significantly to healthcare delivery, particularly in rural and underserved areas. Depending on the setting, PAs may provide the majority of the services routinely performed by physicians in general or family practice, with a comparable level of competence to that of physicians. All PAs practice medicine in team practice with physicians.

The Physician’s Role in PA Practice

Practice Settings Acceptance and Quality of Care

There are 13 accredited PA programs in California and 218 accredited programs throughout the country, most of which require 21-33 months to complete, graduating students with a master’s degree. Programs are accredited by the Accreditation Review Commission on Education for the PA (ARC-PA) based on quality standards deemed essential for PA education. Many physician organizations contribute to the educational standards adopted by the ARC-PA. Most PAs nationwide are educated in broad-based curriculum based on general medicine that is well-suited for primary care and specialty care.

The education of PA students is similar to that of medical students in that a didactic phase of intense academic course work is followed by supervised clinical experiences or rotations.

In the first year, PA students usually complete rigorous courses in such topics as anatomy and physiology, microbiology, physical diagnosis, pharmacology, laboratory and screening techniques, medical and surgical procedures, medical ethics and a course in clinical medicine, among others.

In the clinical phase, students further develop their professional competency by applying the knowledge obtained during the didactic phase of their education through rotations in both primary care and specialty settings. The combination of both didactic and clinical education is a proven method of educating healthcare professionals.

Every new PA in California must be certified by the National Commission on Certification of Physician Assistants (NCCPA). National certification can only be achieved by graduating from an ARC-PA accredited PA education program and successfully passing the Physician Assistant National Certifying Examination (PANCE). The PANCE is comprehensive in content scope and assesses academic and patient management knowledge. To maintain certification with the NCCPA, PAs must complete at least 100 hours of continuing medical education every two years and every 10 years successfully pass an NCCPA-developed recertifying examination.

PAs are issued licenses to practice medicine in California by the California Physician Assistant Board. Licensure requires submitting proof of graduation from an ARC-PA approved program and successful completion of the PANCE. California regulations require ongoing completion of continuing medical education (CME) every two years when renewing their California medical license.PAs have been found to be high value contributors to the healthcare system when appropriately utilized. Team-based care is an effective model at reducing overall costs, increasing productivity as well as improving the quality of life for the members of the team.

PA Education and Certification

There is no fixed income for PAs. For clinically practicing PAs, salaries vary widely and often reflect the type of practice, the practice location, the experience of the PA and the benefit of the PA to the practice. Other PAs have profit-sharing incentives as well as entrepreneurial PAs who own practices or utilize their license in innovative ways to generate income. Professional benefits are expected to accompany salaried positions. The American Academy of PAs (AAPA) maintains information on practice profiles, salaries and benefits which are updated annually.

Liability insurance is essential for PAs providing medical care. The expense is often absorbed by the medical practice or hospital. For some PAs, it is advantageous to obtain a liability coverage policy directly in their own name. Other PAs choose to be added to an umbrella policy or “rider” of the physician or hospital policy. Many carriers do not

Economic Factors & Valueincrease the premium when a PA is employed; some increase it only slightly, while others may increase it significantly. Physicians or hospitals should consult their carrier about their particular policy. As part of team-based care, PAs have proven to be an asset in reducing malpractice exposure in private practice settings. The reduction in malpractice has been attributed to the extra time PAs devote to patient education and counseling, improved patient compliance and the close teamwork between the physician and PA.

PAs receive payment for their services in a variety of ways. When receiving reimbursement from third-party insurance payors, often the reimbursement is issued to the medical practice, hospital or physician. The PA is either issued salary or paid as an independent contractor. Other models of directly reimbursing PA services exist as well.

Medicare currently reimburses for physician services provided by PAs, including surgical assists, under Parts A and B at a rate of 85% of the physician fee schedule. In certain outpatient situations, reimbursement may be at 100%.

In California, the Medi-Cal program reimburses for services provided by PAs at 100% of the physician’s reimbursement rate. Medi-Cal has some specific requirements for physicians utilizing PAs.

Private insurers reimburse at varying agreed upon rates which may be up to 100% of that of the physician.

Reimbursement

Up-to-date Information on California PAs, California PA Programs and Employment Information:

California Academy of PAs2318 S. Fairview St.Santa Ana, CA 92704-4839(714) 427-0321 FAX: (714) 427-0324capa@capanet.orgwww.capanet.org

California Laws, Regulations and Information for Physicians and PAs:

Physician Assistant Board2005 Evergreen St, Ste 1100Sacramento, CA 95815-3831(916) 561-8780 FAX: (916) 263-2671www.pac.ca.gov

For More Information About PAs

2318 S. Fairview St. Santa Ana, California 92704-4938

16TH EDITION 2017