Physician assistant
A Physician Assistant or Physician Associate (PA) is a type of healthcare professional. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes between smaller jurisdictions such as states or provinces. Depending on location, PAs practice semi-autonomously under the supervision of a physician, or autonomously perform a subset of medical services classically provided by physicians.[1]
Not to be confused with Assistant physician.The educational model was initially based upon the accelerated training of physicians in the United States during the shortage of qualified medical providers during World War II. Since then, the use of PAs has spread to at least 16 countries around the world.[1][2] In the US, PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and serve as a principal healthcare provider. In many states PAs are required to have a direct agreement with a physician.[3] In the UK, PAs were introduced in 2003. They support the work of the healthcare team, but are dependent clinicians requiring supervision from a physician.[4] They cannot prescribe medications nor request ionising radiation investigations (e.g., x-ray) in the UK.[5] PAs are widely used in Canada. The model began during the Korean War and transitioned to the present concept in 2002. Skills and scope of privileges are similar to those in the US.[1]
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History[edit]
In 1961, Charles Hudson recommended that the American Medical Association create new medical provider certifications. Eugene A. Stead of the Duke University Medical Center assembled the first class of physician assistants in 1965, composed of four former US Navy Hospital Corpsmen.[16][17] He based the curriculum of the PA program on his first-hand knowledge of the fast-track training of medical doctors during World War II.[18] Two other physicians, Richard Smith at the University of Washington, and Hu Myers at Alderson-Broaddus College launched their own programs in the mid-late 1960s. J. Willis Hurst started the Emory University Physician Assistant Program in 1967.
The Liberian model of PAs was a curriculum intended for graduates to work in areas absent of physicians as physician substitutes. Advisors for this program included UNICEF, American physicians, and Agnes N. Dagbe, MS, RN, a Liberian nurse educated in the US. Additional training was done in the USSR. The Liberian government inaugurated the program in 1965 with Dagbe as PA program.[19]
Beginning in January 1971,[20] the US Army produced eight classes of physician assistants, at 30 students per class, through the Academy of Health Sciences, Brooke Medical Center (academically accredited by Baylor University).
In 2017, approximately 68% of physician assistants in the United States were women and approximately 32% were men.[21]
The profession expanded globally. It can now be found in Afghanistan, Australia, Canada, Germany, Ghana, India, Israel, Liberia, the Netherlands, New Zealand, Saudi Arabia, and the United Kingdom. As a profession, physician assistants have greatly influenced the theory and conceptualization of socially accountable health professional education.[22]
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Physician assistants or associates may:
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Workplaces[edit]
Physician assistants or associates train to work in settings such as hospitals, clinics and other types of health facilities, or virtually via telemedicine. PAs are commonly found working in teaching and research as well as hospital administration and other clinical environments. PAs may practice in primary care or medical specialties, including emergency medicine, surgery and cardiology.[15]
Training[edit]
Physician assistant (or associate) education is shorter than a medical degree required to become a physician. It also typically does not involve residency training, although this is increasingly offered in a variety of specialties.
Renewal of certification is usually required every few years, varying by jurisdiction.
Jurisdictions[edit]
Australia[edit]
In 2011, Health Workforce Australia began developing the role of physician assistant throughout the country culminating with registration and a PA Program based out of James Cook University.[23] The Australian Society of Physician Assistants in 2011 published a code of practice.[24] Despite all initial indicators showing that the new profession would be successfully integrated into the health care system, in 2013 it was reported that the progress had floundered resulting in the majority of PAs in Australia being unemployed.[25]
Canada[edit]
As of October 2018, there are approximately 800 physician assistants working in healthcare settings in Canada.[26] The first formally trained physician assistants graduated in 1984 from the Canadian Forces Medical Services School at Borden, Ontario.[27] The Canadian Medical Association (CMA) recognized physician assistants as a health professional in 2003.[27] Physician assistants are able to perform medical functions such as ordering tests, diagnosing diseases, prescribing medications, treating patients, educating patients and performing various medical and surgical procedures. Physician assistants are labeled under the federal government national occupational classification code 3124: allied primary health practitioners.[28]