Physician Assistants are proven and integral members of the U.S. healthcare team. The boundaries of each PA’s scope of practice are essentially determined by four parameters; education, experience, state law, policies of employers and facilities, and the needs of the patients at the practice.
Education and Experience
A broad, generalist medical education prepares PAs to take medical histories, perform physical examinations, order and interpret laboratory tests, diagnose illness, develop and manage treatment plans for their patients, prescribe medications and assist in surgery. The intensive PA program curriculum is modeled on the medical school curriculum. The typical PA program extends over 27 continuous months and begins with classroom instruction in basic medical sciences. This is followed by rotations in medical and surgical disciplines including family medicine, internal medicine, general surgery, pediatrics, obstetrics and gynecology, emergency medicine and psychiatry.
PA students complete at least 2,000 hours of supervised clinical practice in various settings and locations by graduation.
Almost all PA programs now award
In order to practice, PAs must graduate from an accredited PA program, pass the Physician Assistant National Certifying Examination developed by the National Commission on Certification of Physician Assistants and be licensed by a state. To maintain their national certification, PAs must complete 100 hours of continuing medical education (CME) every two years and take a recertification exam every 10 years. Like other health professionals, after graduation PAs continue learning in the clinical work environment and through CME. PA scope of practice grows and shifts over time with advanced or specialized knowledge, with changes or advances in the medical profession overall or with changes in the PA’s practice setting or specialty.
STATE LAW Although there is still some variation in state law, the majority of states have abandoned the concept that a medical board or other regulatory agency should make decisions about scope of practice details for individual PAs. Most states now allow the details of each PA’s scope of practice to be decided at the practice level. Many of the first state laws for PAs, passed in the 1970s, were simple amendments to the medical practice act that allowed a physician to delegate to a PA patient care tasks that were within the physician’s scope of practice. These were followed by more stringent regulatory lists of tasks in some states. PAs function in a great variety of practice situations, in a wide range of specialties.
FACILITY POLICY Licensed healthcare facilities (hospitals, nursing homes, surgical centers and others) have a role in determining the scope of practice for PAs in their institutions. In order to provide patient care services within an institution, PAs request clinical privileges, which must be approved by the medical staff, and ultimately, the institution’s governing body. This process defines a scope of practice that each individual is qualified to provide within that organization. Institutions assess PA requests for privileges just as they do for physicians, including verification of professional credentials (graduation, licensure and certification) and documentation of additional relevant training.