Transcript The Use of Physician Assistants in Health Care Delivery

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
with the supervision of a physician.
 Trained 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?
 PAs 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
training
Makes PAs more versatile
Decreases attrition rate with
profession
What Can PAs Do?
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Elicit medical histories
Perform physical exams
Order & interpret labs and diagnostic tests
Manage acute illness & chronic diseases
Prescribe medication
Make rounds in hospital & write patient orders
Make referrals
Perform specific procedures
Assist in surgery
Perform patient education
Types of Procedures
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Venipuncture
IV Access
Arterial Puncture
Intradermal, Subcutaneous,
Intramuscular injections
Suturing & Stapling
Shave & Punch Biopsy
Incision & Drainage
Lumbar Puncture
Nasogastric Tube
Placement
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Splinting
Casting
Urinalysis & Microscopy
Wet Prep Analysis
Urinary Catheter Placement
Surgical Drain Placement &
Removal
 Bursal & Joint Injections
 Central Line Placement
 Chest Tube Insertion
 Thoracentesis
Demographics of PAs
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
Where PAs Work….
PA Distribution by Specialty
Disciplines of Practice
Family Practice
Internal Medicine
Pediatric Medicine
Women’s Health
Emergency Medicine
Orthopedic Medicine
Behavioral Medicine
General Surgery
Cardiology
Dermatology
Endocrinology
Gastroenterology
Neurology
Hyperbaric Medicine
Ophthalmology
Infectious Disease
Pulmonology
Nephrology
Hematology/ Oncology
Rheumatology
Transplant Services
CT Surgery & Vascular
Critical Care
Nephrology
ENT
Pathology
Radiology
Urology
Pain Management
Sleep Medicine
Interventional Radiology
Academic Medicine
Plastic Surgery
Neurosurgery
Occupational Medicine
Urgent Care
Where PAs Practice……..
Areas of Practice
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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
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Industrial Work Sites
Armed Forces
Dept of Veteran Affairs
Indian Health Service
Public Health
Federal Government
 CDC
 CIA
 Management
 Medical Staffing Agency
 International Medicine
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 firstassisting 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.
Interesting PA Facts
 U.S. News & World Report:
 Identified the Physician Assistant Profession as one of
the “best careers” in the nation
 CNN:
 Ranked Physician Assistant # 2 in its “Best Jobs in
America” listing
Physician Assistant
Program
UAMS Physician Assistant Program
 Graduate Professional Program
 28 Month Program
 13 months didactic (classroom) phase
 15 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
Mission of UAMS PA 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.
Didactic Curriculum
Summer 2013
PA Gross Anatomy
Clinical Physiology
Physical Assessment
Clinical Pharmacology
Patient Communication 1
Professional Issues 1
Clinical Reasoning 1
Spring 2014
Principles of Medicine 2
Diagnostic Assessment 2
Pharmacotherapy 2
Emergency Medicine
Introduction to EBM
Professional Issues 3
Clinical Reasoning 3
4
3
5
3
1
1
1
18 cr
8
3
2
3
2
1
1
20 cr
Fall 2013
Principles of Medicine 1
Diagnostic Assessment 1
Pharmacotherapy 1
Behavioral Medicine
Patient Communication 2
Professional Issues 2
Clinical Reasoning 2
Clinical Nutrition
Summer 2014 (6 wk module)
Principles of Medicine 3
Surgical Medicine
Foundations of EBM
Medical Genetics
Medical Ethics
Professional Issues 4
8
3
2
3
1
1
1
1
20 cr
3
2
2
1
2
1
11 cr
Service Learning
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Students engage in community service
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Non-medical experience across the life-span
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Specific learning objectives assigned
Student reflection on experience
Debriefing weekly with faculty
Seniors, children, domestic violence
Students will rotate to a different experience every semester
10 hrs required each semester during 1st year
Community Partnerships
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Promise Neighborhood – early childhood reading
University District/ AARP – senior isolation
Safe Places – domestic violence survivor support groups
Clinical Curriculum
 Clinical Phase (15 months)
Core Clinical Rotations (5 weeks each)
 Family Practice
 Internal Medicine – Inpatient
 Internal Medicine – Outpatient
 Pediatric Medicine
 Women’s Health
 Emergency Medicine
 General Surgery
 Orthopedic Medicine
 Behavioral Medicine
 Geriatric Medicine
Elective Rotations
Clinical Curriculum
 Elective Rotations (3 wks)
Cardiology
Dermatology
Endocrinology
Gastroenterology
Neurology
Neurosurgery
Hyperbaric Medicine
Ophthalmology
Infectious Disease
Pain Management
Sleep Medicine
Interventional Radiology
Plastic Surgery
Pulmonology
Nephrology
Hematology/ Oncology
Rheumatology
Transplant Services
CT Surgery
Critical Care
Nephrology
ENT
Pathology
Urology
Geriatrics
Admissions 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 Courses
Natural Science Requirements
General Biology 1&2 with Labs
Microbiology with Lab
Human Anatomy with Lab
Human Physiology with Lab
General Chemistry 1& 2 with Labs
Organic Chemistry with Lab
Medical Genetics/ Genetics
8 cr
4 cr
4 cr
4 cr
8 cr
4 cr
3 cr
Additional Course Requirements
Intro or General Psychology
Abnormal Psychology
Statistics or Biostatistics
3 cr
3 cr
3 cr
Clinical Experience Requirements
 Clinical Experience of 500 hours demonstrating direct patient
care is required. The following are some accepted categories
of experience:
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Paramedic/ EMT
Licensed Practical Nurse
Physical Therapist
Athletic Trainer
Respiratory Therapist
Hospice Volunteer
Phlebotomist
Nursing Assistant/Aide
Peace Corp Volunteer
Clinical Health Educator
Psychologist
Ophthalmic Technician
Registered Nurse
Medical Assistant
Occupational Therapist
Medical Corpsman
Pharmacist
Radiology Technician
Surgical Technician
Emergency Room Technician
Physical Therapy Assistant
Dietician
Patient Care Technician
Current UAMS PA Cohort
 Gender
 Female
 Male
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Ave Age.
Ave. Cum GPA
Ave NS GPA
Ave GRE
Masters degree
Race/ Ethnicity
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White
Black
Asian
Asian Indian
Persian
 Patient Care Hrs
20
6
25 yrs
3.47
3.32
1123
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21
2
1
1
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MA
PCT
CNA
Rad Tech
Health Corp
EMT
PT Asst
Phlebotomist
 Instate
 Out of State
2160
6
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9
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Inaugural White Coat Ceremony
Physician Assistant Program
June 7th, 2013
Contact Information
UAMS Physician Assistant Program
Website
www.uams.edu/chrp/pa/
PA Program Contact Information:
[email protected]
501-686-7211
Questions???
“ Where Medicine Lives“