Transcript An introduction to the physician assistant profession for

AN INTRODUCTION TO THE
PHYSICIAN ASSISTANT
PROFESSION FOR
UNDERGRADUATES
B y Rus s ell
Lo n g e ndor fer
B A C l a rk
Un i ver sity 2 010
M SPA B ay Pa t h
U n i ver sit y 2 017
WHAT IS A PHYSICIAN ASSISTANT?
Physician Assistants…
 Have a master’s degree in Physician Assistant Studies (MPAS)
or similar degree (MSPA, MMS, etc.)
 Are certified nationally by the National Commission for the
Certification of Physician Assistants (NCCPA)
 The Physician Assistant National Certification Exam (PANCE) is taken
after graduation to become certified
 The PANRE recertification exam is taken every 10 years to maintain
certification
 PA’s must complete 100 hours of Continuing Medical Education
(CME) every two years to maintain certification
 Are licensed by the state in which they work to practice
medicine under the supervision of a physician
 Typically, the physician is not actually present when the PA sees
patients, and PA “Scope of practice” is different in each state
WHAT DOES A PHYSICIAN ASSISTANT DO?
Physician Assistants…
 Diagnose and treat disease
 Order lab tests and imaging studies
 Prescribe medication
 Educate and promote wellness
 Perform minor surgical procedures (suturing wounds,
collecting biopsies, performing spinal taps, etc)
 Can perform major surgery up to the level of first assist
 In Massachusetts, can be full Primary Care Providers (PCP)
 Supervise and train medical residents
 Can participate in or conduct original research
 Can own a private practice
PHYSICIAN ASSISTANTS ARE VERY
SIMILAR TO NURSE PRACTITIONERS
 Physician Assistants and Nurse Practitioners can apply for
many of the same jobs
 They both practice medicine as part of a physician -led team
 Although NP’s can be “independent providers” in many states, the
majority practice in a setting which includes a Physician
 They both complete a bachelor’s degree, work in the medical
field, and then complete an advanced degree
 The majority of PA programs require medical experience, but not all
 The average salaries for Physician Assistants and Nurse
Practitioners are very similar
 In 2010, the difference was $100 in annual salary
 Physician Assistants and Nurse Practitioners often work side
by side in the same practice, and have the same duties and
skillset
WHAT IS THE DIFFERENCE BETWEEN A
PA AND A NURSE PRACTITIONER?
Physician Assistants
Nurse Practitioners
 Are trained in the
medical model
 Require a physician
supervisor in all states
 Has a master’s degree
in medicine
 Must have a bachelor’s
in any area before
starting program
 Have a generalist
degree
 Are trained in the Nursing
model
 Do not require a
physician supervisor in all
states
 May have a master’s or
doctorate in nursing
 Must have a bachelor’s in
nursing before starting
program
 May choose a degree
specialty
A BRIEF HISTORY OF PA’S
 1942: Eugene Stead, Jr. MD develops an
accelerated, 3-year medical curriculum at Emory
University to train physicians in WWII
 1957: Dr. Stead establishes a program for
“Advanced Nurse Clinicians” along with Thelma
Ingles, RN, at Duke University. The program
ultimately fails to become accredited by the
National League of Nursing (NLN)
 1965: Dr. Stead establishes the first “Physician’s
Assistant” program at Duke. The program aims to
train former Navy corpsmen to practice medicine
as part of a physician-led team. Four students are
enrolled in the first class
 1965: Medicare and Medicaid are established in
the U.S. The need for medical practitioners rises
sharply
Dr. Eugene Stead
Thelma Ingles, RN
A BRIEF HISTORY OF PA’S
 1968: The American Association of Physician
Assistants (AAPA) is established
 1970: California becomes the first state to
license Physician Assistants, though they are
employed broadly at this point
 1975: The NCCPA begins certifying Physician
Assistants who pass a certifying exam and
maintain re-certification standards
 1986: The Omnibus Budget Reconciliation Act
authorizes reimbursement of Physician Assistants
under Medicare
 1997: The Balanced Budget Act recognizes
Physician Assistants as covered providers in all
medical settings
 2000: Mississippi becomes the last state to
authorize PA practice
AN INCREASING NEED FOR PHYSICIAN
ASSISTANTS
 In 2010, President Obama passed the Patient
Protection and Af fordable Care Act (ACA)
 Patients can no longer be denied coverage due to a preexisting condition
 Patients can now purchase health insurance through staterun exchanges, and may qualify for subsidy depending on
income
 Significant expansion of Medicaid
 An estimated 30 Million new patients will now be covered
and will seek care
 Physician Assistant utilization is increasing rapidly to meet
the increased need for medical providers
PHYSICIAN ASSISTANTS TODAY
 There are currently 190 accredited Physician Assistant
training programs in the U.S (up from 146 in 2010)
 There were 95,000 certified Physician Assistants in the U.S at
the end of 2013 (up 219% from 43,000 at the end of 2003)
 Physician Assistant jobs are expected to grow another 30% in
the next 10 years (most industries are projected to grow 10%)
 While PA’s were mostly male in the early days of the
profession, two thirds of certified PA’s today are female
 Forbes Magazine rated Physician Assistant Studies the best
master’s degree for jobs in 2014
 U.S News and World Report has ranked the PA profession very
highly in terms of employment, salary, and job satisfaction
WHERE DO PHYSICIAN ASSISTANTS WORK?
 Physician Assistants can work in almost
any specialty
 No additional training or certification is
required to change specialty
 On average, a PA will change specialties
2-3 times throughout their career
 PA’s can work in hospitals, clinics,
skilled nursing facilities, home care,
and patient-centered medical homes
PHYSICIAN ASSISTANT SPECIALT Y
REPRESENTATION (DETAIL)
Credit: AAPA annual census 2012
PHYSICIAN ASSISTANT EMPLOYMENT FACTS
 Physician Assistant median
salary: $97,500 (Forbes
Magazine)
 Average hours worked per
week: 40.57 (NCCPA 2014
statistical report)
 Average patients seen per
week: 70
 Overall job satisfaction is
higher than physicians
 PA’s change specialty 2 -3
times during their career
 Only 1% of PA’s go to medical
school after certification
Credit: AAPA annual census 2012
PHYSICIAN ASSISTANT
TRAINING
PA SCHOOL QUICK FACTS
 On average, PA training programs last for 24 -27 months
 Nearly all programs are full -time, including summer
semesters and Saturday and evening obligations
 Most programs stipulate that you cannot work while at school,
or that you may only work at most 6 hours a week with special
permission
 The rigor of PA training will not leave you any free time to earn
income. You must live off of loans while you’re in school
 PA school consists of two main phases: one year of
classroom-based, didactic learning, and one year of clinical
rotations
 You will have 6-8 rotations of 6 weeks at different sites where you
will explore different specialties
 At the end you take a certification exam called the PANCE. If
you pass, you can begin practicing immediately!
HOW LONG WILL I BE IN SCHOOL?
Credit: PAEA annual report 2012
WHERE ARE THE PROGRAMS?
Credit: PAEA annual
report 2012
TOTAL ENROLLMENT AND AVERAGE
CLASS SIZE
Credit: PAEA annual report 2012
THE DIDACTIC YEAR
 Classes will start in January, May, June, August, or September,
depending on your program
 You will take an average of 20 credits worth of coursework per
semester, and complete three semesters within 12 -15 months
 This varies widely by program
 Most programs include Summer semesters
 You may have breaks between semesters or modules which
last from 1-4 weeks, depending on the semester and program
 You will study a variety of preclinical subjects including
Anatomy, Physiology, Pathophysiology, Pharmacology, Clinical
Medicine, and Diagnostic Skills
 Some programs include courses on professionalism, interview skills,
public health, ethics, or issues within the profession
THE CLINICAL YEAR
 At most schools, you will rotate to 6 -8 clinical sites
 Rotations last for 4 -8 weeks
 Each rotation will be in a dif ferent specialty. You will explore:
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Family or Internal Medicine
Pediatrics
Emergency Medicine
Women’s Health
Surgery
Psychiatry
Up to two elective rotations depending on your school
 Clincial sites are generally within an hour radius of your
school
 You will work under an MD, DO, NP, or PA who will act as your
preceptor
FINANCING PA SCHOOL
 Total tuition cost for PA school can be $70,000 - $100,000
depending on your program
 This does not include the cost of books, medical supplies, housing,
food, or transportation costs
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Apply for federal loans through FAFSA
Many students supplement federal loans with private loans
Many schools have small grants and scholarships available
Private grants and scholarships may also be available from
charitable organizations, your hometown, etc. Start looking
early!
AVERAGE TUITION COST OF PA SCHOOL
Credit: PAEA annual report 2012
NATIONAL HEALTH SERVICE CORPS
 The National Health Service Corps (NHSC) is a government
program which provides financial incentives to candidates
who are interested in working in primary care specialties in
health care shortage areas
 NHSC will fund your tuition and provide you with a stipend
while you are in school
 In exchange, you agree to work in a health care shortage area
for one year per year you were funded
 Maximum of four years, minimum of two
 There are several qualifying sites in Boston, Worcester, and
Western Massachusetts
 Learn more at NHSC.HRSA.gov
APPLYING TO PA
SCHOOL
PA SCHOOL APPLICATION CHECKLIST
 Research your programs
 Take prerequisite courses
 Maintain a strong GPA
 Begin asking for letters of
recommendation
 Job shadow a Physician Assistant
 Take the GRE
 Obtain good Patient Care
Experience
 Write your personal statement
essay
 Apply through CASPA
THE CENTRALIZED APPLICATION
The Centralized Application Service for Physician Assistant
programs (CASPA) is a common application accepted by the
majority of U.S. PA programs. It is administered by the
Physician Assistant Education Association (PAEA)
 CASPA will report your coursework, grades,
recommendations, test scores, and personal statement to all
participating programs that you apply to
 Many programs require a supplemental application in
addition to your CASPA application
RESEARCH YOUR PROGRAMS
 There are currently 190 programs accredited by ARC -PA
 A full list of these programs is available at:
http://www.arc-pa.org/acc_programs/
 There are 25 programs which do not participate in CASPA
 A list of these schools is available here:
http://www.mypatraining.com/non-caspa-pa-schools
 If you choose to apply to any of these schools, you will have to
research the program website for application instructions
 Many programs have unique requirements for your
application. Research some programs now so that you won’t
be caught of f-guard when you apply
COURSES, GRADES, AND
GPA CALCULATIONS
Academic
Performance is
a Top Priority
WHICH COURSES ARE REQUIRED?
Required Courses
 Intro Biology 1&2 with
lab
 Intro Chemistry 1&2 with
lab
 Anatomy & Physiology
1&2 with lab
 Biochemistry
 Statistics
 Microbiology
 Psychology or Behavioral
Science Course
 English with Composition
Recommended Courses
 Organic Chemistry
 Genetics
 Nutrition
 Cell Biology
 Immunology
 Medical Ethics
 Medical Terminology
 Physics
 Pathophysiology
PROGRAM-SPECIFIC COURSE
REQUIREMENTS
 Some schools have additional course requirements
 Boston University requires three 300-level Biology courses of your
choosing
 Bay Path requires a course in Ethics
 Franklin Pierce recommends Anthropology rather than Psychology
 Many schools require that all prerequisite courses be taken
within 10 years of applying
 In many cases, a “refresher” course or taking an advanced course in
the same subject can substitute for retaking these courses
 Research the programs you might be interested in, and plan
your coursework accordingly
 You can’t take every course recommended by every school in
the country. Choose programs and course lists which are a
good fit for you and your interests!
GRADES AND GPA CONSIDERATIONS
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Many schools require a B - or better in all required courses
Some schools require a minimum overall GPA of 2.8, 3.0, or 3.2
Competitive applicants will have overall GPAs above 3.4
CASPA will report three separate GPA values to your programs:
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Cumulative undergraduate GPA
Science GPA
Non-science GPA
Additionally, some schools will calculate a “Prerequisite GPA”
 Every undergraduate level course you’ve ever taken will be
included in these calculations
 GPA from Masters-level classes will be considered separately
PATIENT CARE
EXPERIENCE
To be a
Practitioner,
First you Must
Practice
PATIENT CARE EXPERIENCE
 Besides grades, this is the most important part of your
application
 Paid, full-time work experience is preferred
 Three important criteria are evaluated in determining the
quality of patient care experience:
1. History taking
2. Treatment delivery
3. Physical contact
 Most schools require at least 500 - 2,000 hours of patient
care experience (2,000 hours = ~one year of full -time work)
 More experience is better
 Competitive applicants will have experience in both inpatient
and outpatient settings
 Competitive applicants will have more complex roles with
higher levels of training and responsibility
AVERAGE HEALTH CARE EXPERIENCE OF
ADMITTED STUDENTS
PATIENT CARE EXPERIENCE
STRONG patient care
experience jobs
 Nurse
 EMT / Paramedic
 Ultrasonographer
 Respiratory Therapist
 Physical Therapist
 Medical Assistant
 Radiology Tech
 Nursing Aide
 Phlebotomist
MODERATE patient care
experience jobs
 Roles with a limited
scope of skills or
responsibility
 Clinical research or any
roles where patient
care is secondary
 Roles which have some
but not all of the
criteria: assessment,
treatment, hands-on
contact
PATIENT CARE EXPERIENCE
Roles without direct patient contact are not competitive. Some
examples of WEAK patient experience include:
 Medical Scribe
 Insurance Counselor
 Medical Laboratory Technician
 Medical Of fice Manager
 Medical Technologist
 Medical Record Manager
 Medical software industry
 Medical devices / sales industry
 Non-allopathic medical techniques such as acupuncture, reiki,
etc.
PHYSICIAN ASSISTANT
JOB SHADOWING
Know the
Profession
Before You
Apply
PA JOB SHADOWING
Physician Assistant programs want to see that you understand
what a PA is and what the job entails on a day -to-day basis.
 Many programs require a specific number of shadowing hours
before applying
 Requirements range from 0 (recommended but not required) to 40+
hours, depending on the program
 Competitive applicants will shadow for at least several days,
and may shadow a second or third PA in another setting or
specialty
 Working alongside a PA while working or volunteering is good
exposure to the profession, but does not count as job
shadowing
PA JOB SHADOWING
Securing a job shadow can be ver y difficult. Many clinics don’t
allow shadowing at all for safety or patient protection reasons, and
PA’s are often busy with their duties. However, most PA’s recognize
that shadowing is an essential contribution to the profession, and
will try to help if they can. To secure a job shadow opportunity:
 If you know a PA, reach out to them. Unfortunately, it is not
acceptable to job shadow a parent, but family friends are OK.
 If your PCP is a PA or has a PA that works in the office, reach out
to them.
 Use PAShadowOnline.com to find a registry of PA’s who are
willing to shadow. Reach out to them by email.
 Reach out to a program you’re interested in, and ask if any
alumni of that program are willing to let you shadow them
 Cold call clinics or hospitals in your area and ask if they allow
job shadowing of providers for prospective students.
 Small, office-based clinics are more likely to allow job shadowing than
major hospitals because of liability concerns
LETTERS OF REFERENCE
Get Someone
to Vouch for
You
WHO TO ASK FOR A RECOMMENDATION
 Schools vary on letter requirements, but in general you should
have three letters of reference
 At least one from a science professor
 At least one from someone who has supervised your healthcare work
experience
 Your letters should be from someone who can speak to your
work ethic, personality, knowledge of the profession, and
whether you are a good fit for the role of PA
 When asking a professor for a letter of recommendation,
make sure that you will have worked with them for at least
two semesters
 The better the professor knows you, the better the letter will be
 Approach the professor about writing a letter for you while you are
still working with them
 Give the professor ample time (several months) to write the letter
before it is due to CASPA
WHO TO ASK FOR A RECOMMENDATION
 Whoever directly supervises you at your healthcare job should be
your first choice to ask for a recommendation
 This person should be able to comment on your professionalism, work
ethic, bedside manner, ethics, and personality
 Your third letter should come from someone who supervises you,
either at work or in school, who knows you well enough to
comment on why you’re a good fit for the PA profession
 Have a few backup letter writers in mind. Not everyone is
comfortable writing recommendations, and you don’t want to
have to badger someone to write one for you. If you don’t get
anywhere with an author after a few weeks, choose another
writer and move on
 Do not write your letters yourself or have a friend or family
member write one for you
 CASPA does not accept committee letters from the pre -med
committee. All letters must be submitted directly to CASPA by
the author
STANDARDIZED TESTS
GRE, MCAT,
and TOEFL
THE GRE
 The GRE is a standardized, computer -based test which
measures your ability to perform at the graduate level
academically, and your ability to do well on other
standardized tests
 Many schools require you to take the GRE, but there are also
many that don’t require it
 You must self-report your scores to CASPA, and send
individual test reports from ETS to each program requesting
scores
 Take the GRE within 5 years of your planned application date
THE GRE
 Several GRE prep courses are available through Kaplan, Exam
Krackers, and Princeton Review
 Allow three months to study for the GRE
 Take several practice exams through ETS. Understanding how to pace
yourself through the test will dramatically increase your scores
 Review high school level math. The GRE is not knowledge -based, but
it uses algebra as a method for testing your problem solving skills
 Take an English course and read books for pleasure. Your reading
comprehension and writing skills will be tested on the exam
 Scores above the 50 th percentile are considered competitive
THE MCAT
 Take the MCAT as planned if you are still considering
medical school
 A very small number of schools recommend taking the
MCAT or reporting your scores to them
 Some schools will accept the MCAT as a substitute for the
GRE
 If you choose to report your MCAT scores to CASPA, you
cannot reverse this choice once your application has been
submitted
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If you reapply the following year, they will still be there
If you scores are good, this could be a good thing
If your scores are bad, this can hurt your application
Either way, be prepared to talk about why you are choosing to
apply to PA school and not medical school
THE TOEFL
 The Test of English as a Foreign Language (TOEFL) evaluates
your English speaking skills
 If you are a native English speaker, you do not have to take
the TOEFL
 If you have graduated from a U.S. or Canadian university, you
may be exempt from taking the TOEFL
 Schools have specific requirements for required TOEFL scores
 Generally, scores above 120 are required for consideration
THE PERSONAL
STATEMENT
The
Centerpiece of
Your
Application
YOUR PERSONAL STATEMENT
 After grades and experience, your Personal Statement is the
next important part of your application
 A strong Personal Statement can mean the difference between
getting an interview or not
 A weak Personal Statement can prevent you from getting an
interview – even if your grades and experience are strong
 CASPA requests a 5,000 character Personal Narrative (roughly
one page, single-spaced) which describes your motivation or
desire to become a Physician Assistant
 The CASPA statement is sent to all of your programs – keep it broad
 Many schools require additional personal statements or
essays
 Generally, they’d like to know why their program is right for you, and
vice versa
WHAT TO WRITE ABOUT
 Start thinking about why you want to practice medicine right
now
 Do not settle for “I like science and want to help people.” You need to
find a source of motivation that is deeply personal and unique to you
 The CASPA personal statement has no specific prompt, but it
may be helpful to brainstorm using some common themes:
 Have you had a difficult experience in your life where a medical
professional made an impact on you?
 Have you overcome some form of adversity, and has that motivated
you to achieve?
 Do you feel a sense of responsibility for the well -being of others?
Why?
 You should address the question of why you want to be a PA
and not a doctor, NP, etc. Researching the profession and
finding what makes it unique will make this easier
WHEN AND HOW TO WRITE
 Start early. The more time you give yourself, the more you can
develop your ideas and the better your Personal Statement
will be
 At least 3 months to write is ideal. It’s never too early to start
working on your ideas
 After you’ve written a draft, do at least one major re -write
 This will give you the chance to explore different thematic
approaches and structures
 Save all of your scrapped drafts and ideas
 You will be writing many more essays for your supplemental
applications. Previous drafts of your PS can be helpful during this
process
 Choose an editor or two, but not too many
 Dr. T can help make sure your major thematic elements are good
 Choose a friend who will be honest with you, but not overly critical, to
help iron out the stylistic elements of your essay
THE APPLICATION
TIMELINE
What to do,
and When
BEFORE YOU BEGIN
The application process takes about one year. Before planning your
application date, you should:
 Have all of your prerequisite classes done
 Some schools will allow you to have up to 2 in progress will applying
 Have at least six months of solid patient care experience
 Have a list of programs you’d like to apply to, and information
about them
 Request an info packet from schools you’re interested in. Most will send
you a brochure and subscribe you to a newsletter
 Attend some open houses if possible, these can be very valuable
experiences
 You don’t have to be done with the GRE yet, but if you take it
ahead of time you will be happy you did
 Be mentally and emotionally ready for a very tough two years of
school if you get in
 If you need to take a year off, use that time to gain work experience and
take some extra classes at night
THE TIMELINE - SPRING
 January: Enroll in Spring classes. This is the last round of
courses that will appear on your CASPA application
 Some schools will not count classes taken after this semester
 February: Begin working on your personal statement. Take the
GRE if needed
 March: Approach your letter writers about recommendations.
Retake the GRE if needed. Order of ficial transcripts for your
own use
 April: Focus on your personal statement and make sure you
are approaching a final version.
THE TIMELINE - SPRING
April 16 th CASPA opens! Create an account. You can
now:
 Send CASPA transcript requests to your undergraduate
school(s)
 Send CASPA requests for letters of recommendation to your
letter writers
 Manually enter your coursework and grades using your copy of
your transcripts
 Manually enter your test scores for the GRE
 Send your MCAT scores to CASPA
 Only do this if you did well AND you can explain why you’d rather be a
PA than a doctor
 Upload your personal statement to CASPA
 Designate your programs
THE TIMELINE - SUMMER
 When you have finished all the steps in your CASPA application,
you can e-submit the application
 At this point, your statement and self-reported grades and test scores
are final
 You do not need to have all letters and transcripts in to CASPA yet.
However, they will not report your application until all of your transcripts
are in
 After your schools have received your CASPA, many will send you
a secondary application
 You should prioritize the order in which you complete these secondaries
 Begin with schools with early deadlines and rolling admissions
 Make sure that your top choice schools are done well ahead of time
 Be prepared to interview at schools with a Winter or Spring start
date
 Register for Fall classes. Many schools will accept coursework
done in the Fall, some will not
THE TIMELINE - FALL
 Interview season generally starts in the early fall and goes
well into the winter
 Make sure you are able to take time of f work during this
season. Interview invitations usually come a few weeks ahead
of time, but they may come on very short notice
 Buy a suit, have it tailored
 Be prepared to answer common interview questions
 Tell us about yourself
 What are you strengths and weaknesses?
 Have a clear idea of your reasons for wanting to join the
profession and be able to present them succinctly
 Admissions decisions may arrive from schools with Winter or
Spring start dates
 Finish your fall coursework
THE TIMELINE - WINTER
 Admissions decisions should arrive from schools with a
summer or spring start date
 If you took courses during the fall semester, you must send
final transcripts to schools that have accepted you. You may
self-report grades to schools that still have you under
consideration, but have not of fered an acceptance
WHAT IF I DON’T GET IN?
Don’t
Panic
WHAT IF I DON’T GET IN?
You’re in good company!
 Eugene Stead didn’t succeed in founding
the profession on his first attempt
 PA school admission is very competitive
 Highly rated programs may receive more than
20 applications per seat
 The GPAs of accepted PA students are
comparable to those of accepted medical
students
Dr. Eugene Stead
SOME GOOD NEWS
 You can improve your chances of getting in the second time by
planning ahead
 On average, most people don’t get in until their late 20’s:
 The number of accredited programs is increasing rapidly (next
slide)
 You now have a significant life challenge to write about in
your personal statement!
THE NUMBER OF PROGRAMS IS
GROWING
Credit: PAEA annual report 2012
WHAT TO DO NEXT
 Solicit feedback from your programs
 Many programs will at least give you a form letter about how to improve
your application. Some schools might be willing to comment on your
application and how to improve it for next year. Send a friendly email or
phone call and be patient
 Take more classes
 Go down the list of recommended courses and take as many as possible.
A few extra credits can make a big difference
 Get more patient care experience
 If possible, begin training for a job that will give you higher -quality
clinical experience
 If you’ve just started working, keep at it. Seek opportunities to work in
new settings or with new populations
 Double down on your “Soft skills”
 If your application is marginal, your essay needs to be a slam dunk.
Spend some extra time revising and really go for it
 Interview skills can be learned, and a good interview performance can
make the difference. Read up, and practice with mock interviews
PA NOT QUITE WHAT YOU’RE LOOKING FOR?
Other Masters-level allied health professions:
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Nurse Practitioner
Anesthesiologist Assistant
Radiology Assistant
Pathology Assistant
Physical Therapist
Nurse Anaesthetist
Nursing Administration
Perfusionist
Radiation Dosimetry
THANK YOU FOR
LISTENING!
For a copy of
these slides,
email me at:
Rlongendorfer
@gmail.com