INTRODUCTION with certified authority to medically screen

INTRODUCTION

            What is a Physician Assistant? A Physician Assistant is a
medical provider with certified authority to medically screen and treat
patients. They are also empowered to prescribe medications and perform medical
procedures as needed. A Physician Assistant can be found in medical hospitals,
specialty clinics and doctor’s offices around the nation. The caveat being that
they work under collaboration with a Physician to ensure effective medical care
is provided. They are 1 of 3 medical providers with this authority, the other 2
being Nurse Practitioners and Medical Doctors. Unlike the aforementioned
medical providers, a Physician Assistant is educated and trained in General
Medicine. However, this does not limit them to practicing General Medicine
only. Physician Assistant are widely known for the lateral mobility available
to them in choosing their career path. They can interchange between specialties
without the requirement of additional education. In fact, a Physician Assistant
frequently works in more than 1 specialty in their life time.

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            The path to becoming a Physician Assistant has always
been the career that I’ve wanted to pursue. Providing medical attention to
those in need is commonly on the top of everyone’s list and it is no different
for me. However, one might ask why a Physician Assistant over a Medical Doctor?
The answer is simple for me. I have never wanted to be tied down to one
specialty. I have always been intrigued by multiple systems in the body from
the heart, to the lungs, to the skin and so on. What makes the Physician
Assistant career shine is their ability to work in multiple specialties over
their employment. My brother works in the ER of a hospital as a Physician
Assistant while also working in an urgent care clinic just down the road from his
home. If he wakes up tomorrow morning wanting to work in a Cardiologist’s
office then he can! No additional education required. The ability of a
Physician Assistant to interchange between specialties like this in invaluable
and is the main reason why I have been attracted to this career path.

EDUCATION
AND PROFESSIONAL ASSOCIATION

            A Physician Assistant is typically required to obtain a
Bachelor’s Degree of the student’s choosing (typically one that is science
related.) Many Physician Assistant programs require pre-requisites, such as
Anatomy and Physiology, Organic Chemistry, etc.. However, no 2 schools are
alike in their elective requirements. A Physician Assistant program is
typically 27 months long but some are as long as 36 months. This program includes
education both in the classroom and within a clinic or hospital. The first year
of education is strictly in the classroom where students are required to “hit
the books.” The curriculum is heavily based off of the program used for medical
students and consists of anatomy, physiology, pathology, genetics and
pharmacology.  The second year consists
of 10 clinical rotations in 10 different specialties, ranging from Cardiology
to ER to Pediatrics. 7 of these specialty rotations are required of the
student, however, the last 3 are to be chosen by the student based off of their
personal interests. Once the required 2,000 hours of clinical practice has been
reached, the student is prepared to take the certification exam. The Physician
Assistant National Certifying Exam, or PANCE, is a computer based multiple
choice exam that is separated into 5 different sections, taking 1 hour each.
The exam is scored from 200 – 800. Once the student has passed, they are
allowed to put their training into action and work as a Physician Assistant.

            There are numerous amounts of organizations directed
towards bettering the Physician Assistant community. The American Academy of
Physician Assistants, or AAPA, is arguably the largest organization in the
Nation. In their own words, the organization “works to ensure the professional
growth, personal excellence and recognition of PAs. We also enhance their
ability to improve the quality, accessibility and cost-effectiveness of
patient-centered healthcare.” The Physician Assistant career began in 1968 and
has been watched over by the AAPA organization since. Not only are they working
to better the community now, but they are working hard to establish
improvements within the field. For example, Physician Assistants are seeking
the credibility to work independently of doctors and eventually open their own
clinics. This would be a monumental step for the community moving forward.

INFORMATION
NEEDS

            Sadly, it is not infrequent to experience a situation
where a doctor questions a Physician Assistant’s authority. The following is a
typical scenario representing this case:

An 18
year old boy presents to the ED with sudden onset right lower quadrant
abdominal pain that is sharp in nature. Upon examination, the Physician
Assistant finds that the patient has tenderness to palpation in the right lower
quadrant with a positive McBurney’s Point Sign. The Physician Assistant
suspects acute appendicitis. CT of the abdomen confirms his suspicion. The
patient is to be admitted for emergent surgery in the morning. The Physician Assistant
consults a Gastroenterologist about the patient. After hearing the findings,
the GI doctor believes that the patient can be sent home and the surgery can be
done as an out-patient. The 2 medical providers disagree and the GI doctor
questions the Physician Assistant’s credibility.

            To evaluate the situation, we will answer a few questions
about the medical care given. First, how did the Physician Assistant come to
the conclusion that the patient has appendicitis? Typically, the Physician
Assistant would know that the patient’s symptoms are text book for
appendicitis. However, there are resources available for any new providers who
are not accustomed to the ER setting, such as the doctor that is overseeing the
care or resources available on the internet. The National Institutes of Health
is a good resource for medical questions that need answering on the fly. Databases
are updated frequently and contain the newest information regarding patient
treatment available. This allows up-to-date patient care to ensure the most
effective treatment. So, using the education they’ve obtained, consulting
medical providers around them and researching health databases on the internet
will ultimately provide an answer to the medical question. Second, how should
the patient be treated in this scenario? Typically a Physician Assistant will
consult with the doctor who is overseeing them in the ER. They both agree that
the patient is to be admitted for pain treatment and emergent surgery in the
morning. The Hospitalist is to be consulted to admit the patient, who agrees to
do so. They require a GI consult in the morning. However, the
Gastroenterologist refuses as they believe that an admission is not required.
That brings us to the third question, How does a Physician Assistant handle a
situation where their credibility is questioned? If this is ever the case, the
doctor overseeing the Physician Assistant should be notified of the push back
from the GI doctor. Ultimately, it is the ER doctor’s decision whether to admit
or have the patient follow up as out-patient. Hopefully, the doctors can
resolve the issue and can agree on the treatment that is best for the patient.

INFORMATION
RESOURCES

            Important journals used
by Physician Assistants include, but are not limited to, the following:

·     
The
Journal of the American Academy of Physician Assistants – A
peer reviewed journal specifically for Physician Assistants that includes
articles regarding case studies, clinical trials, developing research and professional
interests.

·     
The
Journal of the American Medical Association – A peer reviewed
journal available to medical providers that contains published research,
editorials, and articles focused on the sciences.

·     
The
British Medical Journal – A UK based, peer reviewed medical journal
containing podcasts, videos, blogs and articles covering numerous subjects,
such as: clinical trials, medical news, continuing education, and political
campaigns.

Important
databases used by Physician Assistants include:

·     
PubMed
Health – A free database available to the public and health care
providers alike, containing informational resources geared towards the life
sciences and medicine.

·     
Medline
Plus
– Another free database available to the public, Medline provides health and
medicinal information ranging over 1,000 different topics.

Important
websites used by Physician Assistants include:

·     
National
Commission on Certification of Physician Assistants – A
non-profit organization established to provide certification programs for
Physician Assistants and provide continuing education post certification.

·     
National
Institute of Health – An agency collaborating with the US
Department of Health with purposes to advance research and education in
healthcare and medicinal practices.

·     
American
Medical Association – The largest association of medical providers
in the world that publishes the Journal of the American Medical Association
(explained above).

·     
American
Academy of Physician Assistants – A society of Physician
Assistants represented across the nation. This organization prides itself in
its ability to “ensure the professional growth, personal excellence and
recognition of Physician Assistants.”

·     
The PA
Life
– A collection of resources for aspiring Physician Assistants, Physician
Assistant students and current Physician Assistants. Some resources include:
Pance exam practice, advice on applications, and continuing education.

The
following is a research article that may be typical for a Physician Assistant
to encounter:

TITLE: Diagnosis
of Right Lower Quadrant Pain and Suspected Acute Appendicitis

CITATION:
Dahabreh IJ, Adam GP, Halladay CW, Steele DW, Daiello LA, Weiland LS, Zgodic A,
Smith BT, Herliczek TW, Shah N, Trikalinos TA. Diagnosis of Right Lower
Quadrant Pain and Suspected Acute Appendicitis. Comparative Effectiveness
Review No. 157. (Prepared by the Brown Evidence-based Practice Center under
Contract No. 290-2012-00012-I.) AHRQ Publication No. 15(16)-EHC025-EF.
Rockville, MD: Agency for Healthcare Research and Quality; December 2015. 

PRACTICE
SECTION

            According to the US
Bureau of Labor Statistics, a typical Physician Assistant is expected to make
$97,420 annually full time. It is important to note that full time is between
12 – 14 shifts per month. That is approximately 3 shifts per week. Typically, a
Physician Assistant will work 15 – 20 shifts per month which accumulates to
more than $150,000 annually.

            A real life job search shows the following information:

SUMMARY 
The Physician Assistant for MD Anderson The Woodlands will be supervise the
daily treatments in the ATC in the absence of a supervising physician. 
SALARY RANGE 
Minimum: $87,200 – Midpoint: $109,000 – Maximum: $130,800 
ESSENTIAL JOB FUNCTIONS 
Provides assessment, triage and therapeutic management of patient/family needs
throughout the disease process as an integral part of an interdisciplinary
team. Acts under the authority and supervision of the attending physician and
in accordance with regulations, hospital policy, protocols and clinical
pathways. Obtains medical histories, performs physical examinations,
reviews/orders diagnostic tests and radiographic results, formulates and
manages patient treatment plans and outcomes. Performs as first or second
assist on operative cases, using fine motor skills and manual dexterity.
Performs procedures, prescribes treatment and signs prescriptions in accordance
with institution and state requirements. Screens physician calls to educate
patient/family on care and resources. Makes rounds with interdisciplinary team.
Collaborates in research projects, formulates protocols and applies research to
practice. 
EDUCATION 
Required: Graduate of a Physician Assistant training program approved by the
Council of Medical Education of the American Medical Association. 
EXPERIENCE 
Required: None 
Preferred: Experienced PA preferred. Medical Oncology experience
preferred. 
LICENSE/CERTIFICATION 
Required: PA certification by the National Commission of Certification of
Physician Assistants. Licensed by the Texas State Board of Physician Assistant
Examiners. 

SUMMARY

            Physician Assistants are an integral part of healthcare
utilized in clinics, hospitals and offices around the world. The demand for
these providers in increasing astronomically due to their ability to work in
multiple specialties. Receiving education and certification takes as little as
6 years with PA programs littered around the country. Thanks to the growing popularity,
there is an abundance of resources available to aspiring or current Physician
Assistants in the form of: health databases, peer reviewed journals and varying
websites. Becoming a Physician Assistant has been on my radar for as long as I
can remember and I look forward to pursue this promising career.

CONCLUSION

            There are many things that I have learned in this class
that can be applied to my career pursuit. Namely, the ability to utilize
databases online to enhance my education. A Physician Assistant is taught
medical information as we know it. However, information is being updated
constantly. Medical care and pharmacology is no different. With the resources
utilized in class, such as PubMed, I am confident in knowing that I have
up-to-date information at the tips of my fingers. That being said, some
databases can be overwhelming with the amount of information given. Over the
time of the course, we have effectively learned how to navigate and filter our
searches to find the most pertinent answers to our questions. Continuing your
education is important for an ever changing world of information, especially
for a Physician Assistant.

 

 

 

 

CITATION

Search of “Dermatology PA jobs
in Texas” – https://www.indeed.com/q-Physician-Assistant-Dermatology-l-Texas-jobs.html?vjk=777bea8537250f0a

American Academy of Physician
Assistants – https://www.aapa.org/

US Bureau of Labor Statistics –
https://www.bls.gov/oes/current/oes291071.html

The Journal of the American
Academy of Physician Assistants – https://www.aapa.org/about/business-opportunities/jaapa-advertising/

The Journal of the American
Medical Association – https://jamanetwork.com/journals/jama

The British Medical Journal – http://journals.bmj.com/

PubMed Health – https://www.ncbi.nlm.nih.gov/pubmed/

MedLine Plus – https://medlineplus.gov/

National Commission on
Certification of Physician Assistants – http://www.nccpa.net/

National Institute of Health – https://www.nih.gov/

American Medical Association – https://www.ama-assn.org/

 

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