Introduction to Primary Care and Scope Flashcards
Short history of PAs:
Start: formally established in the United States in the late 1960s
Why: response to shortage and maldistribution of physicians
Market: to improve access to health care and enhance existing health care delivery system
Resource: returning Vietnam era military corpsmen
Why create the role of a PA?
Need: there was a shortage of physicians in the 1960s; access to healthcare was limited in many areas; healthcare disparities resulted from access and financial barriers
Opportunity: medics returning from the Vietnam war had skills, but no job opportunities to use them
Advantages of PAs
Cost effective, efficient, flexible, accepted, adaptable
When was the first U.S. PA program?
1965
Who and where was the first PA program established?
Dr. Eugene A. Stead Jr. establishes “physician assistant” education program at Duke University
When was National Commission on Certification of Physician Assistants (NCCPA) established?
1975
Describe the scope of practice of a PA
PAs are educated in the medical model and work as members of healthcare teams.
PA scope of practice is determined by:
1. Education and experience
2. State law
3. Facility policy
4. Delegatory decisions made by the supervising physician
When was AAPA founded?
1968
When was the first national PA day?
1987 (20th anniversary of the graduation of the first PAs)
When was JAAPA founded?
1987
When did PAs have prescribing authority in all 50 states (plus DC and Guam)?
2007
Distribution of PAs in the U.S. 2021:
23.7% of certified PAs work in primary care (27.5% in Minnesota in 2020):
- Family medicine/general practice
- Internal medicine
- General pediatrics
Top 10 areas of medicine that PAs practice in?
- Primary care
- Family medicine/general practice
- Emergency medicine
- Orthopedic surgery
- Internal medicine/general practice
- Dermatology
- Hospital medicine
- Cardiothoracic and vascular surgery
- General surgery
- Cardiology
Describe the geographic locations of where PAs practice (2020 stats)
51.6% work in metropolitan areas with population > 1 million
Only 2.5% work in completely rural areas with population <2,500 and not adjacent to a metro area
Median PA compensation (2019)
Base salary: $110,000
Hourly wage: $62.73
Productivity pay: $145,000
Profession-wide compensation: $117,000 (2021)
Annual bonus: $5,500
___% of all PAs are completely or mostly satisfied with their job
70.5%
Top 5 specialties with the highest burnout rates (2021)
- Critical care medicine
- Emergency medicine
- Oncology
- Hospital medicine
- Family medicine/general practice
What year did the first formally trained PA began practicing in MN?
1970
When did Augsburg accept its first PA program?
1995
When was the first PA program developed in MN?
1973 – St. Cloud PA Program began with two graduating classes (1975 and 1976), but program did not receive accreditation
When did St. Kate’s start its first PA class?
2012
What other countries have PAs/a form of PA?
USA, Canada, Netherlands, The Ministry of Health of England, Germany, Scotland, The Ministry of Health of Australia, New Zealand
Of note: in some of these countries, PAs do not have prescriptive authority or require significant supervision.
What is the official title of a PA profession?
The official title of the PA profession is “physician associate.”
As the organization representing the PA profession, AAPA has transitioned to the American Academy of Physician Associates.
PAs should continue to use “physician assistant” or “PA” as their official legal title in a professional capacity, particularly in clinical settings and with patients.
AAPA is transitioning to the use of “physician associate” when possible and when it does not present a legal or regulatory conflict.
What is primary care?
Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.
What is integrated care?
Comprehensive (address any problem at any age/stage)
Coordinated (provide various healthcare services and information;
how are these services connected?; use of community resources)
Continuous (care by the healthcare team over time; communication of healthcare information)
Where does primary care take place?
Clinic, patient’s home, nursing home, group home
What are the components of primary care?
Family Medicine
Internal Medicine
Pediatrics
(OBGYN)
These roles can overlap!
Ex: Family medicine with obstetrics
Ex: Med-Peds providers
Role of PAs in Primary Care
There is a shortage of primary care providers (by 2032 projected shortage of 21,000 - 55,000 primary care physicians)
PAs see a higher percentage of uninsured/publicly insured patients
PAs are used to a greater degree in nonurban areas and in smaller facilities
PAs can improve access to primary care, particularly for female patients
Variation in level of independence/autonomy (may work closely with supervising physician (share patient panel), may have high degree of autonomy (minimal supervision; own patient panel))
Scope of practice for acute care for eye, ear, nose (most common)
Eye (conjunctivitis, corneal/eyelid disorders, dacryocystitis, nystagmus/vertigo)
Ear (cerumen impaction, otitis (media, externa), tinnitus)
Nose/Throat (rhinitis/sinusitis, pharyngitis (strep, mono), laryngitis, oral lesions)
Scope of practice for acute care for pulmonary, neuro (most common)
Respiratory (bronchitis, bronchiolitis, influenza, pertussis, pneumonia, COVID, exacerbations of chronic lung disease)
Neuro (acute headaches, cranial nerve palsies, concussion, carpal tunnel syndrome)
Scope of practice for acute care for GI, GU (most common)
GI (abdominal pain, acute constipation/diarrhea, GI bleeding (hemorrhoids, etc.), anal fissures, diverticulitis, peptic ulcer/gastritis, hernia)
GU (infections (UTIs, prostatitis, epididymitis, vaginitis, STIs), ovarian cysts, testicular lumps/pain)
Scope of practice for acute care for ortho, heme, breast (most common)
Ortho (bone/soft tissue injuries, low back pain, other joint pain)
Hematology (anemia, thrombocytopenia)
Breast (breast lumps, mastitis)
Scope of practice for chronic care in primary care setting? (part 1)
Hypertension, hyperlipidemia, diabetes mellitus (and complications), thyroid disorders, GERD, obesity, mental health (anxiety, depression, ADHD), osteoarthritis, gout, osteoporosis, spinal stenosis, peripheral vascular disease, peripheral neuropathy
Scope of practice for chronic care in primary care setting? (part 2)
COPD, asthma, sleep apnea, chronic headaches/migraines, CKD, urinary incontinence/OAB, menopause and menstrual problems, erectile dysfunction, BPH, chronic skin problems (acne, rosacea, eczema, psoriasis), IBS, vitamin disorders
Prevention/early detection screenings that can be done in primary care? (part 1)
Cancer screening (cervical, breast, prostate, colon, lung), lipid/glucose screening, hepatitis C screening, vision/hearing screening, STI screening (including HIV), screening for CKD, thyroid screening, depression screening, osteoporosis screening, cognitive impairment screening, fall risk assessment, diabetic foot exam, AAA screening
Prevention/early detection screenings that can be done in primary care? (part 2)
Periodic health examination (“physical”), welcome to Medicare, Medicare annual wellness visit, sports physical (scoliosis, hypertrophic cardiomyopathy), pre-op visits, pediatric WCC and screening, vaccinations
Of note: peds screening: lead, anemia, autism, developmental delay
Name 3 risk calculations commonly used in the primary care setting
Risk calculations:
1. Cardiovascular risk
2. Breast cancer risk
3. Fracture risk
Procedures that can be done in primary care?
IUD removal (sometimes insertion depending on training), I&D of abscesses, laceration repair, skin biopsy, vasectomy, Nexplanon™ insertion/removal, colposcopy, endometrial biopsy, toenail removal, thrombosed hemorrhoid drainage, splinter removal, foreign body removal, removal of impacted cerumen, joint injection/aspiration
Of note: procedures done in primary care setting depend on the training/comfort level of each individual provider
What are some diagnostic tests that PAs in primary care can order and/or interpret?
On-site (often): lab, x-ray, EKG, spirometry
Usually not on-site: CT, MRI, US (unless POCUS), joint injection (w/ fluoroscopy), EMG/NCS, sleep study
