Hire a PA
What Can a PA Add to My Practice?
A PA practices medicine within the scope of the supervising physician, taking into account any specific restrictions in state law or institutional policy. PAs provide a broad range of diagnostic and therapeutic services, from primary care to surgical procedures. In their work with physicians, PAs routinely:
- Take patient histories and perform physical examinations
- Order and interpret diagnostic studies
- Manage illnesses
- Treat injuries such as lacerations and fractures
- Assist in surgery and provide pre-op and post-op care
- Write prescriptions
- Provide health education and patient counseling
All states allow PAs to provide patient services in sites where the supervising physician is not physically present, although the physician must be available by telecommunication. Within these guidelines, flexibility marks the physician-PA relationship.
The idea of a physician-PA team and supervision is not that the supervising physician should have to accompany the PA’s every step. In an effective team relationship, the physician trusts that the PA will consult him or her regularly. Likewise, the PA feels confident that the physician will be available when needed, provide learned advice, and accept the care of patients that are beyond the PA’s expertise. The physician also regularly reviews records of the care provided by the PA, providing advice and guidance as needed.
Physicians can be confident that a PA who has completed a training program and passed the national certifying exam is competent to practice. PA education was developed by physicians and is based upon the medical model. Much like a medical student, a PA receives didactic instruction in anatomy, physiology, physical diagnosis, pharmacology and pathophysiology. PA students are also required to complete clinical rotations in all of the major medical specialties, usually alongside medical students. Physicians can be comfortable working with PAs because PAs are trained to think like physicians.
EASING PHYSICIAN WORKLOADS
PAs improve patient flow by freeing up physicians to manage more complex or demanding cases. An American Medical Association survey found that PAs enhance practice efficiency, and solo physicians who employ PAs experience expanded practice, greater efficiency, and greater access to care for their patients. The survey determined that physicians who employ mid-level practitioners such as PAs were able to work one week less per year on average while supplying more hours in office visits and increasing net income.
According to the Medical Group Management Association, PAs generate revenues greater than what their compensation costs employers. Their recent report shows that for every dollar of charges a PA generates for a practice, the employer pays on average 30 cents to employ the PA.
BOOSTING PATIENT SATISFACTION
Hiring a PA enhances patient satisfaction in several respects. Studies by the Kaiser Permanente Center for Health Research report high patient satisfaction levels for services provided by PAs. Aspects of patient satisfaction examined included interpersonal care, confidence in provider, and understanding of patient problems. With a PA on staff, patient waiting times are decreased, improving patient satisfaction through increased access to health care.
WHAT CAN I EXPECT WHEN I HIRE A PA?
Flexibility is an important attribute of PAs – PAs are trained to adapt to fit your needs. Due to a broad primary care curriculum, PAs are prepared to serve in a variety of health care settings. After hiring a PA there will typically be an adjustment period of several weeks while the PA learns the day-to-day routine of your practice. The PA will quickly become accustomed to your style of practice and your office protocols. In addition, the PA will gradually learn to perform any procedures you wish to delegate. As your comfort level with the PA gradually increases, you will find that the level of supervision you need to provide will decrease. Even so, you may remain comfortable in the knowledge that the PA will always act in the best interest of your patients and will consult with you frequently regarding their care.
The above information was provided by the American Academy of Physician Assistants.
For more information about PA practices or hiring a PA, please visit the AAPA website at: www.aapa.org
FAQs by Physicians
Physicians who have not worked with PAs before often have many questions about PAs. We try to address some of the most common questions we receive below. If you need further information, please do not hesitate to contact us via email at:
Q. What will a PA Add to my practice?
A. Hiring a physician assistant will decrease your workload. PAs are well trained to manage essentially all of the routine tasks you do every day – perform examinations and make diagnoses, process insurance claims, return patient phone calls, etc. Wouldn’t you like to have more time free to work with your patients who have complex healthcare issues?
Hiring a PA will increase patient satisfaction. Another practitioner will ensure that your patient can be seen in a more timely fashion. Their phone calls are returned more quickly. Patients have expressed a high degree of satisfaction in the care rendered by PAs – in most cases, equivalent with that provided by a physician. And if you aren’t rushed all day, won’t you have more quality time with the patients that you see?
Hiring a PA will increase your revenue. A PA is not just another salaried employee for your office – the services provided by a PA should be submitted to your insurance carriers for reimbursement. In general, services provided by a PA are reimbursed at a slightly lower level that those provided by a physician, but the revenue more than covers the overhead costs associated with hiring a PA.
Q. Won’t it be a nuisance to supervise a PA? If I have to see all their patients anyway, it’s faster for me to do everything myself.
A. Many physicians have a misconception of what “direct supervision” means, as defined by NJ law. A physician does not have to be physically present when a PA is providing medical care. In fact, some PAs work in satellite clinics where the physician is very rarely present.
“Direct supervision” requires that your PA is able to immediately contact you if the need arises. Pagers and cell phones make this very convenient. And if you still want to see all of your patients to at least say hello, won’t it be nice to have the H&P recorded, instructions finished, and the prescriptions already written?
Q. What kinds of things can a PA do?
A. For the most part, that is up to your PA and you to decide. You and your PA need to have a conversation to decide what you wish to delegate to them. In general, you can delegate any task to your PA that it within your scope of practice.
Common tasks PAs perform include:
- Performing and recording a history and physical examination
- Ordering and interpreting diagnostic studies
- Ordering medications and writing prescriptions
- Suturing and other wound management
- Casting and splinting
- Other procedures such as lumbar puncture and thoracentesis
- Assisting in surgery
PAs provide a wide variety of other services, depending on their specialty – for example, cardiology PAs assist with stress testing. You ability to delegate is limited only by your comfort level, and the comfort level of your PA.
Q. Where do PAs “draw the line” as far as what they can treat and what a physician can treat?
A. What a physician assistant does varies with training, experience, and state law. In addition, the scope of the PA’s practice corresponds to the supervising physician’s practice. In general, a physician assistant will see many of the same types of patients as the physician. The cases handled by physicians are generally the more complicated medical cases or those cases which require care that is not a routine part of the PA’s scope of work. Referral to the physician, or close consultation between the patient-PA-physician, is done for unusual or hard to manage cases. Physician assistants are taught to “know our limits” and refer to physicians appropriately. It is an important part of PA training.
Q. Can PAs prescribe medications?
A. In New Jersey, PAs may write inpatient medication orders and outpatient prescriptions. PAs may apply for a DEA number to prescribe controlled substances (just like physicians do.)
Q. What environments can a PA work in?
A. Basically anyplace a physician can work – and maybe places a physician would not want to work. Imagine having a clinician in your office able to make house calls…
PAs work in all medical settings including outpatient offices, inpatient facilities, critical care units and surgery. PAs provide some of the most advanced trauma care in the world in our forward military units and work on staff in the White House.
Q. Who can supervise a Physician Assistant?
A. In New Jersey, you must be a plenary licensed physician – a Medical Doctor (MD) or Doctor of Osteopathy (DO) – to supervise a PA. A PA may not be supervised by a chiropractor, a dentist or a podiatrist.
Q. Isn’t PA education somewhat spotty?
A. The educational curriculum used by the PA profession should seem familiar to you – anatomy, pharmacology, physiology, etc. Our curriculum was designed by a physician and based upon a medical school curriculum.
Following intensive classroom training, PA rotate through clinical experiences that should also be familiar to you – medicine, surgery, pediatrics, emergency medicine, etc. PAs generally rotate alongside medical students and residents. We understand how to develop a differential diagnosis. We practice medicine. We are trained to think the way you think.
Q. What is the downside to having a PA?
A. We hope that after reading the above you will agree with us – there really aren’t any!
At present, New Jersey statutes require that a supervising physician countersign PA documentation. This was a common requirement in many states, but most have come to see it as a nuisance which hampers patient care. While NJSSPA is working to alter this requirement, electronic medical record keeping has made countersignature much less of a burden.
Q. I’m sold. Where do I find a PA?
A. There are around 2000 of us in New Jersey, so it shouldn’t be too hard. A great place to start is by advertising with NJSSPA: