PAs bridge the doctor-patient gap

[B]Capitol Weekly: Who exactly are physicians’ assistants?[/B]

Beth Grivett: A lot of people aren’t really aware that they’ve even seen a physician’s assistant sometimes, because they go into a doctor’s office and they’ve had to encounter someone who introduced himself as a PA, and they got their prescription that they needed, they got the referral that they needed and they left. So, a lot of people don’t even distinguish between what they see as their normal care, but the profession has only been around since 1967. We are a young profession in the scheme of medical professions.

[B]Was that when it was established as an academic discipline?[/B]

That’s when the first class graduated from Duke. It’s interesting to know we always go back to our roots, and our roots are that basically there was a physician who saw the physician shortage that was about at that time, and also saw this group of corpsmen coming out of the military with wonderful skills, and they couldn’t do anything with them because they weren’t established as a medical professional in the current system.

These were medically trained military people who came into civilian society without an outlet for their skills? So this was an outgrowth of the Medics?
At Duke University, they graduated the first class after training them and developing a certification saying, “Now, you’re a physician’s assistant.” Generally, our programs are somewhere between two and three years of medical school. Most people have a bachelor’s degree before going into the physicians’ assistant program. Depending on the program, between two and three years full time, with about a year in the classroom and a year acting as an intern in different disciplines.

[B]Within the profession, is there a natural progression from physicians’ assistant to doctor? Do some go on to become doctors?[/B]

Very, very few. We do hear some PAs have gone on to become MDS, but it is not a stepping stone. They have to apply back to medical school. The interesting part is, if you talk to most physician assistants, they don’t really have a desire to go on and become an MD. We fit in our little niche, and for a lot of people it’s very attractive to go to school for a shorter amount of time but also have flexibility as to where you can be in the profession. As a physician’s assistant, I’m in family practice, but I also could decide to do additional training and go work in a dermatology office, or cardiovascular surgery, or really whatever discipline I found attractive. There is flexibility within our practice, also.

[B]How many PAs are there in California?[/B]

There are almost 6,000 licensed. It’s kind of hard to track the numbers, because people might be maintaining a license but not really be practicing here.

[B]Licensed by the state, you mean?[/B]

We’re licensed by the Physician’s Assistant Committee, which is actually a subcommittee of the California Medical Board. There aren’t any freelance physicians’ assistants out there? You need to maintain your licensure through the state.

[B]Are there professional growth requirements you have to meet in order to get the committee’s licensing?[/B]

We have a national certification, that when you graduate from a PA program you have to sit for our national boards. That gives initial certification, and lets you put your designation as PA-C, with the “C” meaning certified. In California, to maintain your license it is not necessary to maintain your certificate, but if you are maintaining your certificate, which most PAs do, it does require 100 hours of CME [professional-growth education] every two years.

[B]Do physicians’ assistants perform medical procedures?[/B]

Yes.

[B]What kinds?[/B]

We are limited by the scope of practice of the physician we are working with, so when we go through our training, we are training in a lot of different procedures. But I can only do the types of procedures that are done in my office by doctors who are doing those on a daily basis. In my particular office, we do colposcopy, for instance. That could be something they could train me to do, and I’m allowed to do that because there are doctors in my office who do that routinely. I can do skin biopsies. I can do laceration repairs. I can do well-woman exams, pap smears, those kinds of things.

[B]When you went through your training as a physicians’ assistant, did you specialize or did you do that after you came out and you had someone to work with?[/B]

Most of the programs are family practice-based, but there are a couple of residency programs in which you could go on for additional training, but most of those residency programs are in the surgical subspecialty. There are people who will go an additional year, sort of like a fellowship and get additional experience to go into a surgical subspeciality.

[B]Is Duke the only university that has this program, or has it spread?[/B]

Nationally there are 137 programs, and we have 10 here in California.
[B]
Where do the PAs fit into the current health debate about the extent of universal health care and who should pay for it?[/B]

We have taken a stand on trying to increases access to care, but we have not decided on one particular approach.

[B]
Do you anticipate taking a visible role in this debate?[/B]

In response to Gov. Schwarzenegger’s plan, we are going up [to Sacramento] on March 12–we are having a legislative day–and we are lucky enough to have Karen Bass as a supporter, and she actually is a PA and a lot of people don’t know that.