Most dermatologists are familiar with physician assistants (PAs) working in dermatology. In the United State, there are more than 100,000 certified PAs. While the largest percent of PAs practice in primary care, more than 4% of PAs (nearly 2,500) practice in dermatology.1 PAs also work in many other specialties and perform a wide variety of activities and procedures.
The PA profession, which got its start in 1965, was created in response to physician shortages and an uneven distribution of primary care physicians. Eugene Stead Jr, MD, of Duke University, taught the first class of PAs comprised of former US hospital corpsmen. The curriculum was based on the fast-track physician-training program implemented by the military during World War II. As the profession grew, so did the many uses for PAs. Use of PAs in specialty care emerged due to long patient wait times to see specialists. However, use of PAs in specialties has helped to improve patient access to care, reduce wait times and enhance quality of care.
PAs can be found in all specialties of medicine and surgery. Trauma surgery, orthopedic surgery, cardiothoracic surgery and emergency medicine are examples of specialties that regularly use PAs. They also fill an important role serving in medically underserved areas.
In Dermatology
The PAs role in dermatology began with the first dermatology PA in 1975. The utilization of the PA profession in dermatology has grown, with 40% of dermatology practices reporting hiring a PA or advanced registered nurse practitoner.2 Most PAs work autonomously within a dermatology office much like staff dermatologists seeing a range of medical, surgical and cosmetic patients but always with a physician available either in person or via telecommunication to provide input and consultation as required. Dermatology PAs work in a variety of settings within the field. Some conduct medical research. Other PAs work at academic institutions seeing more complex cases. Additionally, there are PAs who specialize in Mohs surgery.
PAs are skilled and flexible members of the medical team. In whatever capacity they serve, they complement the work of the dermatologist and make the practice of dermatology more responsive to the needs of patients and dermatologists.3
It is estimated that by 2020 there will be a shortage of 90,000 physicians in the United States.4 PAs play a vital role as part of the patient care team and the utilization of PAs will help ease the burden of physician shortages in the future.5 PAs have been successfully serving in specialty areas of medicine for nearly 50 years. In 2011, Health and Human Services Secretary Kathleen Sebelius called the work of PAs, “critical to our nation’s health.”6 PAs extend the care that physicians provide and increase access to care.
In Various Fields
Trauma surgery PAs are often first responders in busy Level 1 trauma centers. PAs in this field insert chest tubes, arterial lines and intracranial pressure monitors. They also intubate patients and assess patients for internal injuries as well as first assisting trauma surgeons in the operating room. One-third of major trauma care centers report using PAs and 19% of trauma centers that do not currently utilize PAs state that they intend to in the future.7 Evaluation of PA utilization in a Level II trauma center showed that use of a trauma surgeon–physician assistant model resulted in a 43% decrease in transfer time to the operating room, 51% decrease in transfer time to the intensive care unit, 13% decrease in overall length of stay and 33% decrease in length of stay for neurotrauma intensive care.8
PAs in orthopedic surgery work in outpatient settings seeing pre-op and post-op patients and act as first assistants during surgery. They perform hospital rounds, write orders, take calls and formulate and implement therapeutic treatment plans for patients. Procedures performed by PAs include injection of joints and trigger points, wound closures and debridement, tendon repair and fracture management.9 Currently, 10.9% of PAs practice in orthopedic surgery.10
PAs in cardiothoracic surgery are involved in all aspects of patient care. They perform patient histories and conduct physical exams. In surgery, they perform the critical retrieval of vascular tissue utilized in coronary bypass procedures. They serve as first assistant on adult and pediatric cardiac cases. They perform thoracentesis, chest tube insertions and placement of central venous, dialysis and Swan-Ganz catheters. In the clinic setting, they manage hypertension, diabetes, chronic obstructive pulmonary disease, asthma and other complex diseases.11
In emergency medicine, PAs work as an integral part of the patient care team. They take patient histories, perform physical exams, order medications and diagnostic tests, establish diagnoses and institute treatment. As in emergency medicine, they also perform advanced cardiac life support, arthrocentesis, cast and splint application, dislocation reduction management, endotracheal intubation, lumbar puncture, NG tube placement, paracentesis and thoracentesis.12 Use of PAs in emergency rooms has shown to decrease patient wait times therefore improving patient outcomes.13
PAs treat a broad range of diseases and conditions in specialty practice and primary care in underserved areas. They provide medical care for rural areas that have a limited number of healthcare professionals, inadequate access to medical equipment and limited financial resources. Underserved areas include not only rural areas, but also Indian reservations, inner city clinics and US prisons. A study by Grumbach et al14 showed that PAs perform a vital role in providing quality medical care to underserved areas.
Future Outlook
PAs in dermatology are just one small piece of a much larger puzzle, but an essential piece. The larger puzzle includes the entire healthcare team. The goal of the team is to provide outstanding healthcare. As healthcare team members, we must come together, support one another and provide collaborative efforts to bring quality healthcare to all.
Ms. Mast is a current director at large for the Society of Dermatology Physician Assistants (SDPA). Prior to this role, she served as the SDPA Legislative Affairs Committee Chair for 3 years. She has been a practicing dermatology physician assistant for 13 years in Merritt Island, FL.
Ms. Davis is vice president of Constituent Organization Outreach and Advocacy for the American Academy of Physician Assistants.
Disclosure: The authors report no relevant financial relationships.
References
1. National Commission on Certification of Physician Assistants. 2013 Statistical Profile of Certified Physician Assistants. https://www.nccpa.net/Upload/PDFs/2013StatisticalProfileofCertifiedPhysicianAssistants-AnAnnualReportoftheNCCPA.pdf. Accessed October December 1, 2014.
2. Chaudhari R. Considerations when adding a physician extender. Dermatol World. 2012;22(10):16-18.
3. American Academy of Physician Assistants. Specialty Practice Issue Brief: Physician Assistants in Dermatology. https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=621. Accessed December 1, 2014.
4. Association of American Medical Colleges. Physician shortages to worsen without increases in resident training. https://www.aamc.org/download/286592/data/. Accessed December 1, 2014.
5. Hooker RS, Berlin LE. Trends in the supply of physician assistants and nurse practitioners in the United States. Health Aff (Millwood). 2002;21(5):174-181.
6. Herman L. States, the VA embracing the vital roles of PAs. Oregon Healthcare News. February 10, 2014. https://www.orhcnews.com/articles/03-2014/or-lherman-0314.html. Accessed December 1, 2014.
7. Nyberg SM, Keuter K, Berg GM, Helton AM, Johnson AD. Acceptance of physician assistants and nurse practitioners in trauma centers. JAAPA. 2010;23(1):35-37.
8. Miller W, Riehl E, Napier M, Barber K, Dabideen H. Use of physician assistants as surgery/trauma house staff at an American College of Surgeons-verified level II trauma center. J Trauma. 1998;44(2):372-376.
9. Physician Assistants in Orthopaedic Surgery. Job description for physician assistants in orthopaedic surgery. https://www.paos.org/info/job-description. Accessed December 1, 2014.
10. American Academy of Physician Assistants. 2013 AAPA Annual Survey Report. https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=2902. Accessed December 1, 2014.
11. Thourani VH, Miller JI, Jr. Physicians assistants in cardiothoracic surgery: a 30-year experience in a university center. Ann Thorac Surg. 2006;81(1):195-199.
12. Society of Emergency Medicine Physician Assistants. PAs in the ED. https://www.sempa.org/resources/pas-in-the-ed/#scope. Accessed December 1, 2014.
13. McHugh M, Van Dyke K, McClelland M. Moss D. Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. (Prepared by the Health Research & Educational Trust, an affiliate of the American Hospital Association). Agency for Healthcare Research and Quality Publication No. 11(12)-0094. Rockville, MD: Agency for Healthcare Research and Quality; October 2011.
14. Grumbach K, Hart LG, Mertz E, Coffman J. and Palazzo L. Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington. Ann Fam Med. 2003;1(2):97-104.
Most dermatologists are familiar with physician assistants (PAs) working in dermatology. In the United State, there are more than 100,000 certified PAs. While the largest percent of PAs practice in primary care, more than 4% of PAs (nearly 2,500) practice in dermatology.1 PAs also work in many other specialties and perform a wide variety of activities and procedures.
The PA profession, which got its start in 1965, was created in response to physician shortages and an uneven distribution of primary care physicians. Eugene Stead Jr, MD, of Duke University, taught the first class of PAs comprised of former US hospital corpsmen. The curriculum was based on the fast-track physician-training program implemented by the military during World War II. As the profession grew, so did the many uses for PAs. Use of PAs in specialty care emerged due to long patient wait times to see specialists. However, use of PAs in specialties has helped to improve patient access to care, reduce wait times and enhance quality of care.
PAs can be found in all specialties of medicine and surgery. Trauma surgery, orthopedic surgery, cardiothoracic surgery and emergency medicine are examples of specialties that regularly use PAs. They also fill an important role serving in medically underserved areas.
In Dermatology
The PAs role in dermatology began with the first dermatology PA in 1975. The utilization of the PA profession in dermatology has grown, with 40% of dermatology practices reporting hiring a PA or advanced registered nurse practitoner.2 Most PAs work autonomously within a dermatology office much like staff dermatologists seeing a range of medical, surgical and cosmetic patients but always with a physician available either in person or via telecommunication to provide input and consultation as required. Dermatology PAs work in a variety of settings within the field. Some conduct medical research. Other PAs work at academic institutions seeing more complex cases. Additionally, there are PAs who specialize in Mohs surgery.
PAs are skilled and flexible members of the medical team. In whatever capacity they serve, they complement the work of the dermatologist and make the practice of dermatology more responsive to the needs of patients and dermatologists.3
It is estimated that by 2020 there will be a shortage of 90,000 physicians in the United States.4 PAs play a vital role as part of the patient care team and the utilization of PAs will help ease the burden of physician shortages in the future.5 PAs have been successfully serving in specialty areas of medicine for nearly 50 years. In 2011, Health and Human Services Secretary Kathleen Sebelius called the work of PAs, “critical to our nation’s health.”6 PAs extend the care that physicians provide and increase access to care.
In Various Fields
Trauma surgery PAs are often first responders in busy Level 1 trauma centers. PAs in this field insert chest tubes, arterial lines and intracranial pressure monitors. They also intubate patients and assess patients for internal injuries as well as first assisting trauma surgeons in the operating room. One-third of major trauma care centers report using PAs and 19% of trauma centers that do not currently utilize PAs state that they intend to in the future.7 Evaluation of PA utilization in a Level II trauma center showed that use of a trauma surgeon–physician assistant model resulted in a 43% decrease in transfer time to the operating room, 51% decrease in transfer time to the intensive care unit, 13% decrease in overall length of stay and 33% decrease in length of stay for neurotrauma intensive care.8
PAs in orthopedic surgery work in outpatient settings seeing pre-op and post-op patients and act as first assistants during surgery. They perform hospital rounds, write orders, take calls and formulate and implement therapeutic treatment plans for patients. Procedures performed by PAs include injection of joints and trigger points, wound closures and debridement, tendon repair and fracture management.9 Currently, 10.9% of PAs practice in orthopedic surgery.10
PAs in cardiothoracic surgery are involved in all aspects of patient care. They perform patient histories and conduct physical exams. In surgery, they perform the critical retrieval of vascular tissue utilized in coronary bypass procedures. They serve as first assistant on adult and pediatric cardiac cases. They perform thoracentesis, chest tube insertions and placement of central venous, dialysis and Swan-Ganz catheters. In the clinic setting, they manage hypertension, diabetes, chronic obstructive pulmonary disease, asthma and other complex diseases.11
In emergency medicine, PAs work as an integral part of the patient care team. They take patient histories, perform physical exams, order medications and diagnostic tests, establish diagnoses and institute treatment. As in emergency medicine, they also perform advanced cardiac life support, arthrocentesis, cast and splint application, dislocation reduction management, endotracheal intubation, lumbar puncture, NG tube placement, paracentesis and thoracentesis.12 Use of PAs in emergency rooms has shown to decrease patient wait times therefore improving patient outcomes.13
PAs treat a broad range of diseases and conditions in specialty practice and primary care in underserved areas. They provide medical care for rural areas that have a limited number of healthcare professionals, inadequate access to medical equipment and limited financial resources. Underserved areas include not only rural areas, but also Indian reservations, inner city clinics and US prisons. A study by Grumbach et al14 showed that PAs perform a vital role in providing quality medical care to underserved areas.
Future Outlook
PAs in dermatology are just one small piece of a much larger puzzle, but an essential piece. The larger puzzle includes the entire healthcare team. The goal of the team is to provide outstanding healthcare. As healthcare team members, we must come together, support one another and provide collaborative efforts to bring quality healthcare to all.
Ms. Mast is a current director at large for the Society of Dermatology Physician Assistants (SDPA). Prior to this role, she served as the SDPA Legislative Affairs Committee Chair for 3 years. She has been a practicing dermatology physician assistant for 13 years in Merritt Island, FL.
Ms. Davis is vice president of Constituent Organization Outreach and Advocacy for the American Academy of Physician Assistants.
Disclosure: The authors report no relevant financial relationships.
References
1. National Commission on Certification of Physician Assistants. 2013 Statistical Profile of Certified Physician Assistants. https://www.nccpa.net/Upload/PDFs/2013StatisticalProfileofCertifiedPhysicianAssistants-AnAnnualReportoftheNCCPA.pdf. Accessed October December 1, 2014.
2. Chaudhari R. Considerations when adding a physician extender. Dermatol World. 2012;22(10):16-18.
3. American Academy of Physician Assistants. Specialty Practice Issue Brief: Physician Assistants in Dermatology. https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=621. Accessed December 1, 2014.
4. Association of American Medical Colleges. Physician shortages to worsen without increases in resident training. https://www.aamc.org/download/286592/data/. Accessed December 1, 2014.
5. Hooker RS, Berlin LE. Trends in the supply of physician assistants and nurse practitioners in the United States. Health Aff (Millwood). 2002;21(5):174-181.
6. Herman L. States, the VA embracing the vital roles of PAs. Oregon Healthcare News. February 10, 2014. https://www.orhcnews.com/articles/03-2014/or-lherman-0314.html. Accessed December 1, 2014.
7. Nyberg SM, Keuter K, Berg GM, Helton AM, Johnson AD. Acceptance of physician assistants and nurse practitioners in trauma centers. JAAPA. 2010;23(1):35-37.
8. Miller W, Riehl E, Napier M, Barber K, Dabideen H. Use of physician assistants as surgery/trauma house staff at an American College of Surgeons-verified level II trauma center. J Trauma. 1998;44(2):372-376.
9. Physician Assistants in Orthopaedic Surgery. Job description for physician assistants in orthopaedic surgery. https://www.paos.org/info/job-description. Accessed December 1, 2014.
10. American Academy of Physician Assistants. 2013 AAPA Annual Survey Report. https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=2902. Accessed December 1, 2014.
11. Thourani VH, Miller JI, Jr. Physicians assistants in cardiothoracic surgery: a 30-year experience in a university center. Ann Thorac Surg. 2006;81(1):195-199.
12. Society of Emergency Medicine Physician Assistants. PAs in the ED. https://www.sempa.org/resources/pas-in-the-ed/#scope. Accessed December 1, 2014.
13. McHugh M, Van Dyke K, McClelland M. Moss D. Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. (Prepared by the Health Research & Educational Trust, an affiliate of the American Hospital Association). Agency for Healthcare Research and Quality Publication No. 11(12)-0094. Rockville, MD: Agency for Healthcare Research and Quality; October 2011.
14. Grumbach K, Hart LG, Mertz E, Coffman J. and Palazzo L. Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington. Ann Fam Med. 2003;1(2):97-104.
Most dermatologists are familiar with physician assistants (PAs) working in dermatology. In the United State, there are more than 100,000 certified PAs. While the largest percent of PAs practice in primary care, more than 4% of PAs (nearly 2,500) practice in dermatology.1 PAs also work in many other specialties and perform a wide variety of activities and procedures.
The PA profession, which got its start in 1965, was created in response to physician shortages and an uneven distribution of primary care physicians. Eugene Stead Jr, MD, of Duke University, taught the first class of PAs comprised of former US hospital corpsmen. The curriculum was based on the fast-track physician-training program implemented by the military during World War II. As the profession grew, so did the many uses for PAs. Use of PAs in specialty care emerged due to long patient wait times to see specialists. However, use of PAs in specialties has helped to improve patient access to care, reduce wait times and enhance quality of care.
PAs can be found in all specialties of medicine and surgery. Trauma surgery, orthopedic surgery, cardiothoracic surgery and emergency medicine are examples of specialties that regularly use PAs. They also fill an important role serving in medically underserved areas.
In Dermatology
The PAs role in dermatology began with the first dermatology PA in 1975. The utilization of the PA profession in dermatology has grown, with 40% of dermatology practices reporting hiring a PA or advanced registered nurse practitoner.2 Most PAs work autonomously within a dermatology office much like staff dermatologists seeing a range of medical, surgical and cosmetic patients but always with a physician available either in person or via telecommunication to provide input and consultation as required. Dermatology PAs work in a variety of settings within the field. Some conduct medical research. Other PAs work at academic institutions seeing more complex cases. Additionally, there are PAs who specialize in Mohs surgery.
PAs are skilled and flexible members of the medical team. In whatever capacity they serve, they complement the work of the dermatologist and make the practice of dermatology more responsive to the needs of patients and dermatologists.3
It is estimated that by 2020 there will be a shortage of 90,000 physicians in the United States.4 PAs play a vital role as part of the patient care team and the utilization of PAs will help ease the burden of physician shortages in the future.5 PAs have been successfully serving in specialty areas of medicine for nearly 50 years. In 2011, Health and Human Services Secretary Kathleen Sebelius called the work of PAs, “critical to our nation’s health.”6 PAs extend the care that physicians provide and increase access to care.
In Various Fields
Trauma surgery PAs are often first responders in busy Level 1 trauma centers. PAs in this field insert chest tubes, arterial lines and intracranial pressure monitors. They also intubate patients and assess patients for internal injuries as well as first assisting trauma surgeons in the operating room. One-third of major trauma care centers report using PAs and 19% of trauma centers that do not currently utilize PAs state that they intend to in the future.7 Evaluation of PA utilization in a Level II trauma center showed that use of a trauma surgeon–physician assistant model resulted in a 43% decrease in transfer time to the operating room, 51% decrease in transfer time to the intensive care unit, 13% decrease in overall length of stay and 33% decrease in length of stay for neurotrauma intensive care.8
PAs in orthopedic surgery work in outpatient settings seeing pre-op and post-op patients and act as first assistants during surgery. They perform hospital rounds, write orders, take calls and formulate and implement therapeutic treatment plans for patients. Procedures performed by PAs include injection of joints and trigger points, wound closures and debridement, tendon repair and fracture management.9 Currently, 10.9% of PAs practice in orthopedic surgery.10
PAs in cardiothoracic surgery are involved in all aspects of patient care. They perform patient histories and conduct physical exams. In surgery, they perform the critical retrieval of vascular tissue utilized in coronary bypass procedures. They serve as first assistant on adult and pediatric cardiac cases. They perform thoracentesis, chest tube insertions and placement of central venous, dialysis and Swan-Ganz catheters. In the clinic setting, they manage hypertension, diabetes, chronic obstructive pulmonary disease, asthma and other complex diseases.11
In emergency medicine, PAs work as an integral part of the patient care team. They take patient histories, perform physical exams, order medications and diagnostic tests, establish diagnoses and institute treatment. As in emergency medicine, they also perform advanced cardiac life support, arthrocentesis, cast and splint application, dislocation reduction management, endotracheal intubation, lumbar puncture, NG tube placement, paracentesis and thoracentesis.12 Use of PAs in emergency rooms has shown to decrease patient wait times therefore improving patient outcomes.13
PAs treat a broad range of diseases and conditions in specialty practice and primary care in underserved areas. They provide medical care for rural areas that have a limited number of healthcare professionals, inadequate access to medical equipment and limited financial resources. Underserved areas include not only rural areas, but also Indian reservations, inner city clinics and US prisons. A study by Grumbach et al14 showed that PAs perform a vital role in providing quality medical care to underserved areas.
Future Outlook
PAs in dermatology are just one small piece of a much larger puzzle, but an essential piece. The larger puzzle includes the entire healthcare team. The goal of the team is to provide outstanding healthcare. As healthcare team members, we must come together, support one another and provide collaborative efforts to bring quality healthcare to all.
Ms. Mast is a current director at large for the Society of Dermatology Physician Assistants (SDPA). Prior to this role, she served as the SDPA Legislative Affairs Committee Chair for 3 years. She has been a practicing dermatology physician assistant for 13 years in Merritt Island, FL.
Ms. Davis is vice president of Constituent Organization Outreach and Advocacy for the American Academy of Physician Assistants.
Disclosure: The authors report no relevant financial relationships.
References
1. National Commission on Certification of Physician Assistants. 2013 Statistical Profile of Certified Physician Assistants. https://www.nccpa.net/Upload/PDFs/2013StatisticalProfileofCertifiedPhysicianAssistants-AnAnnualReportoftheNCCPA.pdf. Accessed October December 1, 2014.
2. Chaudhari R. Considerations when adding a physician extender. Dermatol World. 2012;22(10):16-18.
3. American Academy of Physician Assistants. Specialty Practice Issue Brief: Physician Assistants in Dermatology. https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=621. Accessed December 1, 2014.
4. Association of American Medical Colleges. Physician shortages to worsen without increases in resident training. https://www.aamc.org/download/286592/data/. Accessed December 1, 2014.
5. Hooker RS, Berlin LE. Trends in the supply of physician assistants and nurse practitioners in the United States. Health Aff (Millwood). 2002;21(5):174-181.
6. Herman L. States, the VA embracing the vital roles of PAs. Oregon Healthcare News. February 10, 2014. https://www.orhcnews.com/articles/03-2014/or-lherman-0314.html. Accessed December 1, 2014.
7. Nyberg SM, Keuter K, Berg GM, Helton AM, Johnson AD. Acceptance of physician assistants and nurse practitioners in trauma centers. JAAPA. 2010;23(1):35-37.
8. Miller W, Riehl E, Napier M, Barber K, Dabideen H. Use of physician assistants as surgery/trauma house staff at an American College of Surgeons-verified level II trauma center. J Trauma. 1998;44(2):372-376.
9. Physician Assistants in Orthopaedic Surgery. Job description for physician assistants in orthopaedic surgery. https://www.paos.org/info/job-description. Accessed December 1, 2014.
10. American Academy of Physician Assistants. 2013 AAPA Annual Survey Report. https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=2902. Accessed December 1, 2014.
11. Thourani VH, Miller JI, Jr. Physicians assistants in cardiothoracic surgery: a 30-year experience in a university center. Ann Thorac Surg. 2006;81(1):195-199.
12. Society of Emergency Medicine Physician Assistants. PAs in the ED. https://www.sempa.org/resources/pas-in-the-ed/#scope. Accessed December 1, 2014.
13. McHugh M, Van Dyke K, McClelland M. Moss D. Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. (Prepared by the Health Research & Educational Trust, an affiliate of the American Hospital Association). Agency for Healthcare Research and Quality Publication No. 11(12)-0094. Rockville, MD: Agency for Healthcare Research and Quality; October 2011.
14. Grumbach K, Hart LG, Mertz E, Coffman J. and Palazzo L. Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington. Ann Fam Med. 2003;1(2):97-104.
