the use of physician assistants in health care delivery
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The Use of Physician Assistants in Health Care Delivery. Trish Kelly, PhD, MMSc, PA-C UAMS Dept. of PA Studies AMDPA Conference 2013. What is a Physician Assistant?. Medical providers who are nationally certified and state- licensed to practice medicine - PowerPoint PPT PresentationTRANSCRIPT
The Use of Physician Assistants in Health Care Delivery
Trish Kelly, PhD, MMSc, PA-CUAMS Dept. of PA StudiesAMDPA Conference 2013
Medical providers who are nationally certified and state- licensed to practice medicine state- licensed to practice medicine
with the supervision of a physicianwith the supervision of a physician.
Trained in the medical modelTrained in the medical model at nationally accredited educational programs. Not independent clinicians. Work as a team with physician. PAs are trained and educated similarly to physicians
Share similar diagnostic and therapeutic reasoning.
What is a Physician Assistant?
What is a Physician Assistant?
PAs and Physicians work together as a teamPAs and Physicians work together as a team Supervision does not mean, that a supervising physician
must always be present with the PA or direct every aspect of PA-provided care.
Have the ability for autonomous decision making and patient management Can practice at site 60 miles from supervising
physician in Arkansas
This team model is an efficient way to provide high-quality medical care.
What is a Physician Assistant?
Must complete 100 hours of continuing medical education (CME) every two years.
Complete re-certification every 10 years
PAs can practice in any discipline of medicine and change disciplines without additional trainingMakes PAs more versatileDecreases attrition rate with
profession
Elicit medical historiesPerform physical examsOrder & interpret labs and diagnostic testsManage acute illness & chronic diseasesPrescribe medicationMake rounds in hospital & write patient ordersMake referralsPerform specific procedures Assist in surgeryPerform patient education
What Can PAs Do?
Venipuncture IV Access Arterial Puncture Intradermal, Subcutaneous,
Intramuscular injections Suturing & Stapling Shave & Punch Biopsy Incision & Drainage Lumbar Puncture Nasogastric Tube
Placement
Splinting Casting Urinalysis & Microscopy Wet Prep Analysis Urinary Catheter Placement Surgical Drain Placement &
Removal Bursal & Joint Injections
Central Line Placement Chest Tube Insertion Thoracentesis
Types of Procedures
2010 AAPA Annual PA Census Report:
86,500 PAs in US (5,964 new graduates)
Mean age: 38 years
Demographics of PAs
2010 AAPA Annual PA Census Report:
$93,105 – Total mean income
PA s completed 257 million patient visits
PAs wrote 332 million prescriptions
Demographics of PAs
Where PAs Work….
PA Distribution by Specialty
Family PracticeInternal MedicinePediatric MedicineWomen’s HealthEmergency MedicineOrthopedic MedicineBehavioral MedicineGeneral SurgeryCardiologyDermatologyEndocrinologyGastroenterology NeurologyHyperbaric Medicine OphthalmologyInfectious DiseasePulmonology
NephrologyHematology/ OncologyRheumatologyTransplant ServicesCT Surgery & VascularCritical CareNephrologyENTPathologyRadiologyUrologyPain ManagementSleep MedicineInterventional RadiologyAcademic MedicinePlastic SurgeryNeurosurgeryOccupational MedicineUrgent Care
Disciplines of Practice
Where PAs Practice……..
Physician Solo or Group Office Hospital Community Health Center Surgical Center Nursing Home Long Term Care Facility Home Health Agency Hospice Correctional Facility Research Education Medical Sales
Industrial Work Sites Armed Forces Dept of Veteran Affairs Indian Health Service Public Health Federal Government
CDC CIA
Management Medical Staffing Agency International Medicine
Areas of Practice
Arkansas 49th Out of 50 States
Health Care in Underserved Areas
Need for care in underserved areas is increasing with the physician shortage.
Only about 10 percent of physicians practice in rural areas Where approximately 20 percent of the U.S. population lives.
Access to care is a major concern in most rural areas.About 17 percent of PAs practice in underserved areas.
How are PAs reimbursed?
PA-provided services are covered by all
government-funded public payers Medicare, Medicaid and TRICARE
Nearly all private payers. Each payer has its own guidelines regarding service
coverage and payment.Medicare pays for medical and surgical services
provided by PAs at 85% of the physician fee schedule. Rate applies to all practice settings, including hospitals,
ERs, nursing facilities, homes, offices, clinics, and first-assisting in surgery.
How are PAs reimbursed? "Incident-to”
Medicare provision Allows for certain services provided by a PA in the office to be
billed under the physician’s provider number and reimbursed at 100 percent.
Shared visit billing Medicare provision that allows for services provided by both the PA
and the physician in a hospital to be billed under the physician’s provider number with reimbursement at 100 percent.
Nearly all private payers cover medical and surgical services provided by PAs. Some payers will separately credential or enroll PAs. Others require that PA services be billed under the supervising
physician’s name.
U.S. News & World ReportU.S. News & World Report: Identified the Physician Assistant Profession as
one of the “best careers” in the nation
CNN:CNN: Ranked Physician Assistant # 2 in its “Best Jobs
in America” listing
Interesting PA Facts
Physician Assistant Program
Graduate Professional Program 28 Month Program
13 months didactic (classroom) phase15 months clinical phase
Students enroll one time annually
Location – UAMS Campus, College of Health Professions Degree – Master of Physician Assistant Studies (MPAS)
Start Date: May Enrollment: 26 Students
Eventually grow to 40 students
UAMS Physician Assistant Program
The mission of the UAMS Physician Assistant Program is to educate students who will practice
patient-centered medicine while embracing cultural diversity, ethical integrity,
professionalism and collaboration with other members of the health care team. The program
fosters lifelong learning through emphasis on critical thinking, clinical application of knowledge and evidence-based medicine. Through innovative educational practices, the students will be prepared to enter into any discipline of medicine with the ability to serve any community and contribute to the profession
through leadership, education, and service.
Mission of UAMS PA Program
Summer 2013 Fall 2013
PA Gross Anatomy 4 Principles of Medicine 1 8
Clinical Physiology 3 Diagnostic Assessment 1 3
Physical Assessment 5 Pharmacotherapy 1 2
Clinical Pharmacology 3 Behavioral Medicine 3
Patient Communication 1 1 Patient Communication 2 1
Professional Issues 1 1 Professional Issues 2 1
Clinical Reasoning 1 1 Clinical Reasoning 2 118 cr Clinical Nutrition
1
20 cr
Spring 2014 Summer 2014 (6 wk module)
Principles of Medicine 2 8 Principles of Medicine 3 3
Diagnostic Assessment 2 3 Surgical Medicine 2
Pharmacotherapy 2 2 Foundations of EBM 2
Emergency Medicine 3 Medical Genetics 1
Introduction to EBM 2 Medical Ethics 2
Professional Issues 3 1 Professional Issues 4 1
Clinical Reasoning 3 1 11 cr
20 cr
Didactic Curriculum
Students engage in community service Specific learning objectives assigned Student reflection on experience Debriefing weekly with faculty
Non-medical experience across the life-span Seniors, children, domestic violence Students will rotate to a different experience every semester
10 hrs required each semester during 1st year Community Partnerships
Promise Neighborhood – early childhood reading University District/ AARP – senior isolation Safe Places – domestic violence survivor support groups
Service Learning
Clinical Phase (15 months)Core Clinical Rotations (5 weeks each)
Family PracticeInternal Medicine – InpatientInternal Medicine – OutpatientPediatric MedicineWomen’s HealthEmergency MedicineGeneral SurgeryOrthopedic MedicineBehavioral MedicineGeriatric Medicine
Elective Rotations
Clinical Curriculum
Elective Rotations (3 wks)
CardiologyCardiology
DermatologyDermatology
EndocrinologyEndocrinology
Gastroenterology Gastroenterology
Neurology Neurology
NeurosurgeryNeurosurgery
Hyperbaric Medicine Hyperbaric Medicine
OphthalmologyOphthalmology
Infectious DiseaseInfectious Disease
Pain ManagementPain Management
Sleep MedicineSleep Medicine
Interventional RadiologyInterventional Radiology
Plastic SurgeryPlastic Surgery
PulmonologyPulmonology
NephrologyNephrology
Hematology/ OncologyHematology/ Oncology
RheumatologyRheumatology
Transplant ServicesTransplant Services
CT SurgeryCT Surgery
Critical CareCritical Care
NephrologyNephrology
ENTENT
PathologyPathology
UrologyUrology
GeriatricsGeriatrics
Clinical Curriculum
Admissions RequirementsAdmissions Requirements• Cumulative undergraduate GPA 3.0 on a 4.0 scale strongly
recommended.
• Natural Science GPA of 3.0 on a 4.0 scale strongly recommended.
• Bachelor’s of Science/ Arts degree required
• Graduate Record Examination (GRE)
• Pre-requisite courses
• 500 hours of direct patient care
• Application with narratives, letters of recommendation
• On-Campus Interview
Prerequisite CoursesPrerequisite CoursesNatural Science Requirements
General Biology 1&2 with Labs 8 cr
Microbiology with Lab 4 cr
Human Anatomy with Lab 4 cr
Human Physiology with Lab 4 cr
General Chemistry 1& 2 with Labs 8 cr
Organic Chemistry with Lab 4 cr
Medical Genetics/ Genetics 3 cr
Additional Course RequirementsIntro or General Psychology 3
crAbnormal Psychology 3 crStatistics or Biostatistics 3
cr
Clinical Experience RequirementsClinical Experience Requirements Clinical Experience of 500 hours demonstrating direct patient
care is required. The following are some accepted categories of experience:
Paramedic/ EMT Registered Nurse Licensed Practical Nurse Medical Assistant Physical Therapist Occupational Therapist Athletic Trainer Medical Corpsman Respiratory Therapist Pharmacist Hospice Volunteer Radiology Technician Phlebotomist Surgical Technician Nursing Assistant/Aide Emergency Room Technician Peace Corp Volunteer Physical Therapy Assistant Clinical Health Educator Dietician Psychologist Patient Care Technician Ophthalmic Technician
Gender Female 20 Male 6
Ave Age. 25 yrs Ave. Cum GPA 3.47 Ave NS GPA 3.32 Ave GRE 1123 Masters degree 3 Race/ Ethnicity
White 21 Black 2 Asian 1 Asian Indian 1 Persian 1
Patient Care Hrs 2160 MA 6 PCT 1 CNA 9 Rad Tech 1 Health Corp 1 EMT 2 PT Asst 2 Phlebotomist 1
Instate 24 Out of State 2
Current UAMS PA Cohort
Physician Assistant Program
June 7th, 2013
Inaugural White Coat Ceremony
Contact Information
UAMS Physician Assistant Program Websitewww.uams.edu/chrp/pa/
PA Program Contact Information:[email protected]
Questions???
“ Where Medicine Lives“