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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.

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Presentation on theme: "The Use of Physician Assistants in Health Care Delivery Trish Kelly, PhD, MMSc, PA-C UAMS Dept. of PA Studies AMDPA Conference 2013."— Presentation transcript:

1 The Use of Physician Assistants in Health Care Delivery Trish Kelly, PhD, MMSc, PA-C UAMS Dept. of PA Studies AMDPA Conference 2013

2 state- licensed to practice medicine  Medical providers who are nationally certified and state- licensed to practice medicine with the supervision of a physician with the supervision of a physician.  Trained in the medical model  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?

3  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.

4 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

5 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 What Can PAs Do?

6  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

7 2010 AAPA Annual PA Census Report: 86,500 PAs in US (5,964 new graduates) Mean age: 38 years Demographics of PAs

8 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

9 Where PAs Work….

10 PA Distribution by Specialty

11 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 Disciplines of Practice

12 Where PAs Practice……..

13 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

14 Arkansas 49 th Out of 50 States

15 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.

16 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.

17 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.

18  U.S. News & World Report  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 Interesting PA Facts

19 Physician Assistant Program

20 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 UAMS Physician Assistant Program

21 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

22 Summer 2013 Fall 2013 PA Gross Anatomy4Principles of Medicine 18 Clinical Physiology3Diagnostic Assessment 13 Physical Assessment5Pharmacotherapy 12 Clinical Pharmacology 3Behavioral Medicine3 Patient Communication 1 1Patient Communication 21 Professional Issues 1 1Professional Issues 21 Clinical Reasoning 1 1Clinical Reasoning crClinical Nutrition1 20 cr Spring 2014Summer 2014 (6 wk module) Principles of Medicine 28Principles of Medicine 33 Diagnostic Assessment 23Surgical Medicine2 Pharmacotherapy 22Foundations of EBM2 Emergency Medicine3Medical Genetics1 Introduction to EBM2Medical Ethics2 Professional Issues 31Professional Issues 41 Clinical Reasoning 3111 cr 20 cr Didactic Curriculum

23  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 1 st year  Community Partnerships  Promise Neighborhood – early childhood reading  University District/ AARP – senior isolation  Safe Places – domestic violence survivor support groups Service Learning

24 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

25 Elective Rotations (3 wks)CardiologyDermatologyEndocrinologyGastroenterologyNeurologyNeurosurgery Hyperbaric Medicine Ophthalmology Infectious Disease Pain Management Sleep Medicine Interventional Radiology Plastic Surgery PulmonologyNephrology Hematology/ Oncology Rheumatology Transplant Services CT Surgery Critical Care NephrologyENTPathologyUrologyGeriatrics Clinical Curriculum

26 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

27 Prerequisite Courses Natural Science Requirements General Biology 1&2 with Labs 8 cr Microbiology with Lab 4 cr Human Anatomy with Lab4 cr Human Physiology with Lab4 cr General Chemistry 1& 2 with Labs8 cr Organic Chemistry with Lab 4 cr Medical Genetics/ Genetics3 cr Additional Course Requirements Intro or General Psychology3 cr Abnormal Psychology3 cr Statistics or Biostatistics3 cr

28 Clinical Experience Requirements Clinical Experience of 500 hours demonstrating direct patient care is required. The following are some accepted categories of experience: Paramedic/ EMTRegistered Nurse Licensed Practical NurseMedical Assistant Physical TherapistOccupational Therapist Athletic TrainerMedical Corpsman Respiratory TherapistPharmacist Hospice VolunteerRadiology Technician PhlebotomistSurgical Technician Nursing Assistant/AideEmergency Room Technician Peace Corp VolunteerPhysical Therapy Assistant Clinical Health EducatorDietician PsychologistPatient Care Technician Ophthalmic Technician

29 Gender  Female20  Male 6 Ave Age.25 yrs Ave. Cum GPA3.47 Ave NS GPA3.32 Ave GRE1123 Masters degree3 Race/ Ethnicity  White21  Black 2  Asian 1  Asian Indian 1  Persian 1 Patient Care Hrs2160  MA6  PCT1  CNA9  Rad Tech1  Health Corp1  EMT2  PT Asst2  Phlebotomist1 Instate24 Out of State 2 Current UAMS PA Cohort

30 Physician Assistant Program June 7 th, 2013 Inaugural White Coat Ceremony

31 Contact Information UAMS Physician Assistant Program Website  PA Program Contact Information:  

32 Questions??? “ Where Medicine Lives“


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