Q: What is a physician assistant? What can a P.A. do?
A: A physician assistant (P.A.) is a licensed health professional who practices medicine under the supervision of a physician. A physician assistant provides a broad range of health care services that were traditionally performed by a doctor. As part of the physician/P.A. team, a physician assistant exercises considerable autonomy in diagnosing and treating illnesses.

What a physician assistant does varies with training, experience, and state laws. In general, P.A.'s can provide approximately 80 percent of the services typically provided by a family physician. They perform physical exams, diagnose illnesses, develop and carry out treatment plans, order and interpret lab tests, suture wounds, assist in surgery, provide preventive health care counseling, and in 39 states, including Maine, can write prescriptions. A P.A. can do whatever is delegated to him/her by the supervising physician and allowed by law. In most states, a P.A. can treat patients when the physician is away from the practice.

The scope of the P.A.'s practice corresponds to the supervising physician's practice. For example, the P.A. working with a surgeon would be skilled in surgical techniques in the operating room, perform pre- and post-operative care, and be able to perform special tests and procedures.

Q: What is the difference between a P.A. and a physician?
A: Physician assistants are trained in the medical model. In some schools they attend many of the same classes as medical students. One of the main differences between P.A. education and physician education is not the core content of the curriculum but the amount of time spent in school. The length of a P.A. program is about two thirds that of medical school. Physicians also are required to do an internship, and the majority also complete a residency in a specialty; P.A.'s do not have to undertake an internship or residency. A doctor has complete responsibility for the care of the patient; P.A.'s share that responsibility with the doctors. Doctors are independent practitioners; P.A.'s practice medicine under the supervision of a physician.

Q: How did the physician assistant profession begin?
A: In the mid-1960s, physicians and educators recognized a shortage and an uneven distribution of primary care physicians. To expand the delivery of quality medical care, Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of P.A.'s in 1965. He selected Navy corpsmen who had received considerable medical training during their military service and during the war in Vietnam but who had no comparable civilian employment. He based the curriculum of the P.A. program in part on his knowledge of the fast-track training of doctors during World War II.

Q: What areas of medicine can P.A.'s work in? Do P.A.'s specialize?
A: Physician assistants are found in all areas of medicine. Today, approximately 50 percent of all physician assistants practice what is known as primary care medicine, that is, family medicine, internal medicine, and pediatrics. About 23 percent are in surgery or the surgical subspecialties. Physician assistants receive a broad education in primary care medicine. Their education is ongoing after graduation through continuing medical education programs that are required and through continual interaction with physicians and other health care providers.

Q: Where do P.A.'s draw the line in what they can treat and what a physician can treat?
A: What a physician assistant does varies with training, experience, and state law. In addition, the scope of the P.A.'s practice corresponds to the supervising physician's practice. In general, a physician assistant will see many of the same types of patients as the physician. The cases handled by physicians are generally the more complicated medical cases or those cases requiring care that is not a routine part of the P.A.'s scope of work. Referral to the physician, or close consultation between the patient, P.A., and physician, is done in unusual or hard to manage cases. Physician assistants are taught to know their limits and refer to or consult with physicians appropriately. It is an important part of P.A. training.

Q: Can P.A.'s prescribe medications?
A: Thirty-nine states and the District of Columbia and Guam allow P.A.'s to write and sign prescriptions without a physician cosignature. These prescriptions will be filled by pharmacists.

Q: How much education and training does a P.A. receive?
A: Most P.A. education programs require applicants to have previous health care experience and some college education. The typical applicant already has a bachelor's degree and more than four years of health care experience. Nurses, EMTs, and paramedics often apply to P.A. programs. P.A. programs look for students who have a desire to study, work hard, and be of service. On average, an accredited P.A. program lasts 25 months. P.A. programs are accredited by an independent organization sponsored in part by the American Medical Association. All PA programs must meet the same standard curriculum essentials.

P.A. students typically study anatomy and physiology, pharmacology, microbiology, internal medicine, pediatrics, emergency medicine, obstetrics and gynecology, geriatrics, surgery, and psychology. These classes are taught as both lectures and lab sessions. P.A. students also spend at least one year in clinical rotations. During this period, they treat patients in each of the major disciplines of medicine and perform additional course work on campus.

A P.A.'s education doesn't stop after graduation. P.A.'s are required to take ongoing continuing medical education classes and to be retested on their clinical skills on a regular basis.

Q: What does P.A.-C. stand for? What does the C mean?
A: Physician assistant-certified. It means that the person who holds the title has met the defined course of study and has undergone testing by the National Commission on Certification of Physician Assistants (NCCPA). The NCCPA is an independent organization, and the commissioners represent a number of different medical professions. It is not a part of the P.A. professional organization, the American Academy of Physician Assistants (AAPA). To maintain the C after P.A., a physician assistant must log 100 hours of continuing medical education every two years and take the recertification exam every six years.

Q: When are you going to be a doctor?
A: P.A. training is demanding in its own right. This route to a medical career is neither a short cut, nor an easy way out. P.A.'s are not people who didn't get into or who flunked out of medical school. They decided to become a P.A. for a number of personal reasons. They enjoy what they are doing and get great satisfaction from providing quality, affordable, and accessible health care.

Q: What do doctors think about P.A.'s?
A: Most physicians who have worked with physician assistants like having P.A.'s on staff. The American Medical Association, the American College of Surgeons, the American Academy of Family Physicians, the American College of Physicians, and other medical groups support the physician assistant profession by actively supporting the P.A. certifying commission and the P.A. program accrediting agency. Studies done by the federal government show that P.A.'s provide care that is comparable to physician care. The Eighth Report to the President and Congress on the Status of Health Personnel in the United States (released in 1992) states that physician assistants have demonstrated their clinical effectiveness both in terms of quality of care and patient acceptance.

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