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The Physician Assistant: What Should “PA” Stand For?

In its current model, a Physician Assistant (PA) is a licensed medical practitioner who is authorized to practice under the supervision of a physician. All licensed PAs must be graduates of an accredited institution and pass a national qualifying examination. PAs are trained in the medical model, like physicians, and in some programs, they may share classes with medical students during their education. Practicing PAs must complete 100 hours of continuing education every two years, plus pass a recertification examination every six years. At this time, there is a move among the Physician Assistant profession to change the name from “Physician Assistant” to “Physician Associate” (Belcher, NEJM Journal Watch Neurology for November 10, 2015).

To learn more about this professional group for LMS physicians, I spent time with the Interim Director of UK’s Physician Assistant Program, Emery Wilson, M.D (formerly dean of the UK College of Medicine). and Sam Powdrill, PA-C, an Associate Professor within the Physician Assistant Program. Dr. Wilson advised me that there were about 100,000 Physician Assistants nationally, which contrasts with approximately 190,000 Nurse Practitioners, as noted in the accompanying article regarding the nursing profession. There are approximately 200 Physician Assistant training programs currently in the United States.

In November 2015, Dr. Wilson submitted a Periodic Review of the Physician Studies Master’s Program at UK for the years 2009 to 2015. This study found significant success in the UK PA Program in educating PA students to provide care to patients in Kentucky and beyond. The Program now serves 40 students each year at the Lexington campus, and 16 students in the Rural Curriculum track at Morehead State University. There has been recent initiation for a clinical campus in Louisville at Norton Healthcare. The UK PA Program also has one residency program in neonatology, and a joint PA-C/Pharm D degree program with the UK College of Pharmacy.

Currently, the UK PA curriculum consists of conventional didactic and clinical components, and the Curriculum Committee is in the process of transitioning to a more biologic systems-based approach for the education of students. It now takes about 28 months to complete the UK PA Program, and the recommendation by the Committee is this should be reduced to 24 months and should coincide with the academic calendar. More residency programs should be considered, including Psychiatry, Internal Medicine/Hospitalist, Surgery/Trauma, and Orthopedics/Sports Medicine. Discussions have occurred with Eastern State Hospital to establish a residency in Psychiatry. Other joint degree programs under consideration consist of Public Health, Healthcare Administration, and Sports Medicine.

In contrast to the Nursing curriculum noted in the accompanying article within this KentuckyDoc edition, the curriculum of the UK PA Program appears to be more like a condensed medical school curriculum. The first year of the UK PA Program focuses upon physiology, anatomy, pathology, pharmacology, clinical laboratory procedures, and patient management and evaluation. The second year has discreet rotational programs, much like medical school, in Family Medicine, Internal Medicine, Pediatrics, Psychiatry, Women’s Health, Emergency Medicine, Geriatrics, and Surgery, with time for some electives.

In the profession’s current structure, Physician Assistants have no means to engage in independent practice, unlike Nurse Practitioners and nurses with the DNP degree. The Physician Assistant must work under a supervising physician, whereas the Nurse Practitioner or DNP currently operates within a physician-nurse collaborative agreement. In general, Nurse Practitioners and DNPs are trained in their profession by nurses, while Physician Assistants are trained in their profession by physicians.

After completing the current UK PA Program evaluation, Dr. Wilson and his committee recommended a number of strategic changes:

  • Recruit a dynamic leader as Program Director, recruit faculty members with strong academic credentials, and assure program reaccreditation in 2016.
    Reduce the curriculum from 28 months to 24 months.
    Maintain the Rural Curriculum track with development of additional tracks in Healthcare Administration, Sports Medicine, Public Health, Geriatrics, and Basic Science/Clinical/Translational Research.
    Develop additional residency programs in Psychiatry, Surgery/Trauma, Orthopedic/Sports Medicine, and Internal Medicine/Hospitalist.
    Continue the PA-Pharm D joint degree program.
    Consider other joint degree programs in Healthcare Administration, Public Health, and Sports Medicine.
    Develop a research focus.
    Increase the number of faculty members engaged in clinical service.
    Develop a reputation among PA programs nationally as the “PA Program of the Future.”

It is clear that the thrust and vision of the UK PA Program, like the DNP program within the UK College of Nursing, is to increase the professionalism and clinical skills-sets of both PAs and Nurse Practitioners/DNPs. Moreover, there is an increased focus to improve diversity in both professions, while broadening the availability of specialty tracks within each professional program. Whether “physician assistant” will morph into “physician associate” remains to be seen. However, physicians are on notice that both PAs and Nurse Practitioners/DNPs are distancing from physicians and increasing specialty niches while voicing allegiance to the “team” concept of medical practice.

By Robert P. Granacher Jr., M.D., M.B.A.

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