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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
(Source: 2009 A APA Annual Salary Report)
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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
(Source: 2009 A APA Annual Salary Report)
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
(Source: 2009 A APA Annual Salary Report)
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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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The PA StudentCareer Preparation
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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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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State Graduation fromPA Program
Passage of NCCPAExam (PANCE)
Current NCCPACertication
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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State Graduation fromPA Program
Passage of NCCPAExam (PANCE)
Current NCCPACertication
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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Jurisdiction Restrictions Controlled Substances
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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Jurisdiction Restrictions Controlled Substances
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.
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