What Does A Physician Assistant Do – When trying to explain what a Physician Assistant does, there’s always a pitch I like to use:
A Physician Assistant (PA) is a professional healthcare provider. A PA takes histories, physicals, orders and interprets tests, diagnoses, and develops treatment plans. They also perform diagnostic and treatment procedures, reduce fractures, cast and fuse, perform biopsies, and assist in surgery. They educate and counsel patients about preventive health. They work under the supervision of a doctor.
What Does A Physician Assistant Do
Many Canadian PAs have come across PA jobs on real.ca, and based on the listed salary and job description it is clear that the employer is not posting a real “PA” position.
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PAs can perform 12 Trusted Professional Activities (EPAs). Canadian EPA-PAs describe the duties or responsibilities that may be assigned to a Medical Assistant once they are qualified (AFMC 2016).
In other words, the Canadian EPA-PA answers the question: “What can a PA do when they see a patient?”
Physician assistants are physicians who work to extend the services performed by a physician. PAs may be assigned tasks that fall within the scope of practice of the physician they supervise.
PAs perform patient assessments – order and interpret tests, interpret diagnoses, develop treatment plans, manage patients, coordinate referrals, administer medications* and treatments.
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PAs also perform procedures – These procedures can be medical or therapeutic. For example, in family medicine, PAs can perform joint injections/aspirations, soft tissue injections, ear irrigation, vaccinations, skin biopsies, etc. In the ER, PAs can perform skin pressure tests, nasal packing for nosebleeds, injections, cuts and fractures and/or dislocations.
Learn more about specific programs and knowledge of PAs in specific specialties: Q&A with an Emergency Physician Assistant and a Day in the Life of an Internal Medicine and Critical Care PA.
Physician assistants help increase patient productivity. Two physicians (PA and physician) see patients at the same time. To review cases, or if the PA has questions or concerns, the doctor comes to discuss and advise – not something that doctors previously did with medical students as fellows, residents and medical students.
As the PA develops experience – the knowledge and understanding of the PA grows and expands. A highly experienced PA practices automation, requiring very little direct supervision. A doctor is always available to provide guidance and deal with difficult issues.
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At the larger health care system level, PAs can help save the health care system money while simultaneously improving patient access to health care services. This can free up health care dollars to be spent on other important services.
In a family practice for example, a PA can see their patient list, while a physician can see their patient list. A family system that adds PA to its practice can increase the number of patients seen, increasing the number of options available while simultaneously reducing wait times to see a primary care provider.
In a specialized practice, a PA can help a medical professional increase the number of patients he sees, reduce wait times to be seen by a specialist, while increasing the cost-per-service available in the practice**
** In Canada, a physician must have “meaningful participation” in order to be paid for a patient encounter at 100% physician code (Source: OHIP Schedule of Benefits). An example of how this might work:
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This fee-for-service system allows the physician to be paid 100%, with the PA doing 85% of the work on the patient encounter. PAs in Canada cannot independently rate home health insurance plans. The above example allowed my attending physician to triple the number of patients seen, while reducing the duration of the hospital stay (6 hours instead of 8), and the doctor did not write a medical order in the hospital afterwards as the PAs completed the documents within the next patient.
In the United States, PAs are billed and do not require physician participation to pay for third-party insurance. They charge 85% of the doctor’s fee. “Incident” billing is when a physician enters and participates in a patient encounter, an action that may cost 100% of the physician’s fee. The steps described above can be used for PAs in a new school, but as the PA builds skills, it can change to an indirect form of supervision (the MD is contacted in writing or by phone if the PA wants to consult).
There are four Physician Assistant schools in Canada. This includes 3 civilian programs, and one military program. University of Manitoba Master of PA Studies, McMaster University PA Program, University of Toronto (PA Consortium) and Canadian Forces Program
Each PA program has its own admission requirements (eg undergraduate education, healthcare experience, letters of reference, etc.) and curriculum. Each program follows a common structure: the 1st year is a practical training in which the fundamentals of medicine and clinical skills are established, and the 2nd year is a clinical rotation in different disciplines, core rotations (ie family medicine, internal medicine, surgery, emergency, psychiatry, paediatrics, OB/GYN) and elective rotations (cardiac surgery, etc.
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Currently every 3rd citizenship program in Canada uses the MMI as the interview method of choice.
Programs in the United States rely on three different school-based methods: traditional interviewing, group interviewing, or MMI.
The question I often ask patients after introducing myself as a Physician Assistant is, “So when did you complete your training?” I took this as an opportunity to do PA advocacy and explain that I am a PA who has worked for 6 years, and completed my training. I quickly went into my PA palette, and defined my limit.
It may be confusing to some because the role seems to be almost identical to what doctors do—patient examination, diagnosis, diagnosis, treatment plans, and even treatment methods. However we also work with the attending physician, this is where our confusion comes from thinking that we are somewhere along the path of medical education to become a Doctor.
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Unlike a medical student who will become a doctor, we will not open our clinics independently. Nursing staff can do this. However, there is an effect as the PA is tied to the PA/MD relationship.
PAs are trained under the medical model, nurses are trained under the nursing model. Nurses can choose to attend PA school or Nursing (NP) school. There are some of my PA colleagues who were registered nurses before they became Physician Assistants.
PAs do not compete for nursing jobs, as PAs do not perform the same clinical duties as nurses. The scope of practice for PAs is more similar to Nurse Practitioners than it is to Registered Nurses. In the United States, there are other practices that advertise a PA or NP in the same position.
Physician Assistants (PA) and Nurse Practitioners (NPs) will perform detailed patient assessments (histories and physicals) and initiate orders as an extension of the physician. Nurses may often consult with PAs and NPs for a patient being seen by a physician (as they would with residents, colleagues or hospital clerks). These primary service providers (APPs – PAs and NPs) have medical guidelines and/or documents approved by authorized authorities (for example, hospital or company staff, physician in charge, director of the department) that governs the scope of the APP’s work.
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When a physician or PA needs to record an encounter with a patient, this can happen in one of several ways:
Medical scribes allow the doctor to focus solely on the patient without much work or spending a lot of time after the meeting recording a dictionary or writing/typing a clinical note. Patients are satisfied, and clinical notes are often made.
Using PAs as scribes is a waste of clinical training, knowledge and expertise. PAs can complete and record their own patient assessments. In fact, in our practice the PAs are very knowledgeable about the EMR, so we complete the medical record for the doctor, which saves time and makes the patients satisfied.
The unfortunate thing about the term “Assistant” is that it does not capture the knowledge, skills and abilities of a PA. There has been an attempt in the United States to change the name to “Physician Agent”.
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Employers unfamiliar with the PA role mistakenly list “Administrative Assistant” or “Medical Secretary” as a Physician Assistant.
Administrative Assistants (Medical Secretaries) work in the administrative and organizational functions of the office and clinic. They book patient appointments, document surgeries, fax documents, document tests and schedules such as CT scans or MRIs, submit bills, appointment reminders, .
Education for administrative assistants with a college diploma or degree in medical office administration. In these courses they learn about medicine and anatomy, because this is important when working with a doctor.
Medical assistants perform basic tasks such as greeting patients and escorting them to exam rooms, maintaining medical office equipment, storing vaccines and office supplies, and keeping the office clean and organized. They often share administrative work with administrative assistants (eg medical secretaries).
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Some job postings for medical assistants may or may not include specific clinical duties such as taking medical histories, recording vital signs, taking height and weight, performing simple laboratory tests, and explaining procedures to patients. Explanation
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