SPA - Surgical Physician Assistant Program The Physician...

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Unformatted text preview: Surgical Physician Assistant Program The Physician Assistant Profession University of Alabama at Birmingham History of the Physician Assistant Profession During WW II, U.S. Coast Guard utilized a 4-month training program to train 800 purser mates to provide health care to merchant marines. The Physician Assistant Profession In 1961, Eugene Stead M.D. developed an educational and clinical PA program for hospital hospital nurses at Duke University. 1930s, military corpsmen received on-theon-thejob training within the Federal Prison System to assist with medical care of prison inmates. In 1960, the civilian Physician Assistant Profession was proposed by Charles Hudson M.D. The Duke University program was subsequently rejected as unsuitable for nurses by the National League of Nursing. The Physician Assistant Profession Established in 1965 at Duke University by Eugene Stead, MD general internist Eugene Stead, MD a general internist First class at Duke University consisted of four students students Goal was to increase patient access to medical services in rural areas of North Carolina The Duke University program’s philosophy was to provide students with an education similar to medical school but with a greater clinical emphasis. 1 PA Profession in the 1970s PA Profession in the 1970s An increase in the number of PA Programs occurred in the 1970s in response to the under supply of physicians. Several types of programs were created: Certificate, Associate degree, Baccalaureate Certificate Associate degree Baccalaureate degree degree programs PA Programs were 2-year condensed versions of 2medical schools. Approximately 50 PA programs developed in the country. Class size ranged from 10-20 students 10 Students were 80% male & 20% female Little ethnic diversity existed. Abundant Federal funds were available for program operation. Some early PA students had little or no formal collegiate education. Their clinical skills were obtained in the military without any formal training in basic science or physiology PA Profession in the 1970s Today’s PA profession During the l970s, about 70% of PAs were employed in primary care, 15% were employed in surgery and 15% worked in medical specialties. PA’s are a partial solution to attempts to improve patient access & reduce the high costs of the health care system. In contrast, about 25% of physicians worked in primary care and 75% worked in specialties. Managed care health care system has require PA’s to be part of the provider formula. US medical system was largely a fee-forfee-forservice system A flexible approach to the rapidly evolving health care system is an important strategy for future PAs & the PA profession. Why a Shortage of MDS? Physician training and practice post-World War II postchanged dramatically physicians were pursuing advanced post-graduate posttraining (internal medicine subspecialties, etc.) subspecialty physicians were remaining in areas of population density no family practice residency existed military drafted newly trained physicians for service in Vietnam “Old“Old-time” general practitioners were not being replaced following retirement and death Who Were the First PAs? First PAs primarily recruited from navy corpsmen and army medics returning from Vietnam relatively large numbers of highly motivated individuals with previous ti military training usually possessed a great deal of practical, hands experience experience exceeded their formal education 2 The Duke Experiment Goals Dr. Stead developed an educational program that provided previously experienced individuals with: Graduates were expected to: improve access to basic medical services for those living in medically underserved areas one year of formal didactic education in medical sciences (anatomy, physiology, physical diagnosis, etc.) one year of clinical training under community physician sponsor Commitment to Excellence Early decisions enabled the PA profession to produce one of the most competent clinicians outside of the traditional physician model Competency based education provide these services under the direct supervision of a physician do so as formally trained medical professionals with the knowledge and skills expected of a “profession” Where Are We Today? From meager beginnings in 1970, the profession has experienced sustained experienced sustained growth growth 70000 60000 50000 40000 30000 20000 What is a Physician Assistant? PAs are health care professionals licensed to practice medicine with physician supervision. Strong physician-PA team philosophy physician- Commitment to team practice Approximately 50,000 PAs in clinical practice 02 90 00 20 20 100 hours of CME per 2 years 0 80 10000 19 Recertification every 6 years (PANRE) The profession is still considered one of the top 10 fastest growing professions in the country 70 19 National graduate examination (PANCE) 19 Total PA's in Workforce What Can PAs Do? Obtain a comprehensive medical history Perform physical Perform physical examinations examinations Order and interpret diagnostic tests, including labs, radiological tests Diagnose and treat diseases and illnesses Patient education Assist in surgery Perform diagnostic procedures Take call for a practice Write prescriptions* *in most states 3 What Can PAs Do? In What Settings are PAs Employed? Scope of practice varies with training, experience, and state laws Scope of practice corresponds to the supervising physician’s practice supervising physician practice PAs are taught to “know their limits” and refer to physicians appropriately. Generally, more difficult or complex patients are referred to physicians or require physician consultation. consultation. What Areas of Medicine can Physician Assistants Work in? Primary Care Family medicine Internal medicine Pediatrics OB/GYN Medicine Specialties Neurology Gastroenterology Cardiology Emergency Medicine Oncology Etc The Surgical Physician Assistant Program Surgical Specialties Cardiovascular Orthopedics Neurosurgery General Plastics Urology Transplant Etc UAB S-PA Program Surgical Physician Assistant Program at UAB is one of only two entryentry-level surgical specialty program out of 137 physician assistant programs in the nation. Graduates are considered highly highly trained to work as physician’s assistants in any medical setting when a surgeon is responsible, including prepreoperative care, the operating room, recovery room, intensive care unit, and surgeon's office. Hospitals Clinics Emergency Rooms Operating Rooms Intensive Care Units Clinical Research Education University of Alabama at Birmingham School of Health Professions The UAB Experience The Established in 1967 by John Kirklin, MD cardiovascular surgeon recognized the need for specialized assistant to the surgeon Second oldest PA program in the country One of only 2 surgical PA programs Cornell University (New York, NY) 4 Program Philosophy Provide surgically focused, but well rounded training to prepare the graduate for practice as a surgical physician assistant PANCE Prepared Technically Proficient Intellectually Sound Excellent Judgment Superior Character Accreditation The program maintains full accreditation as an entry-level physician assistant program entry Accreditation Review Commission on Education for the Physician Assistant, Inc. Admissions Admission The Application and pp Admissions Process to the program is competitive and based on a minimum eligibility of Baccalaureate Degree GPA of 3.0 or higher in natural science, overall, and last 60 hours At least some previous healthcare experience Completion of prerequisite courses Admissions CASPA Application Available May 1 Due September 1 Supplemental Application Interviews Prerequisite Courses in December and January Matriculation in August 5 Biology General Chemistry Biology (6 sem hrs) Microbiology Anatomy (3(3-4 sem hrs) General or College Chemistry 8-9 semester hours hours and Physiology (6-8 sem hrs) Ph (6 Anatomy Physiology Anatomy and Physiology I & II Mammalian physiology and comparative vertebrate anatomy Inorganic chemistry sequence for chemistry majors Psychology and Statistics 3-4 semester hours of statistics- upper level statisticspopulation based health statistics preferred Not business statistics business statistics Selection Criteria 9 semester hours of psychology General Developmental Abnormal Selection Criteria for Interview Academic experience Science hours Course load Healthcare experience Academic quality Overall, science, and last 60 hour GPA number of months direct vs. indirect care surgical experience Miscellaneous references personal narrative The Interview Process 6 Interview Selection Criteria Academic potential Interpersonal skills Maturity Initiative & problem solving Technical potential Program Curriculum and Anticipated Costs Role congruity Average Length of Programs and UAB Program Length The UAB program is 27 months in length Seven semesters 115 semester hours semester hours Estimated Tuition and Fees Year 1 60 50 40 30 Matriculation in August Graduation in December 20 10 0 12-17 Estimated Tuition and Fees Year 2 18-21 22-24 25-27 28-32 33-51 Number of Programs Estimated Tuition and Fees Last Semester 7 First Year Curriculum 1st Year: Fall Semester Primarily consists of didactic instruction in basic medical sciences, clinical sciences, physical diagnosis, and technical skills Fall Semester Hours With 60 semester hours in the first year it is like going to school full-time, TWICE in one year full Very demanding curriculum Not so much because of difficulty but pace and quantity 1st Year: Spring Semester Spring 5 PA 615 Introduction to the Profession 615 th PA 602 Medical Physiology 1 PA 601 Human Gross Anatomy 4 PA 610 Clinical Laboratory Medicine 3 PA 605 Pathology 3 TOTAL 18 1st Year: Summer Semester Summer Semester Hours Semester Hours PA 614 Operating Room Techniques 2 4 PA 619 Fund Clinical Research 619 Fund Clinical Research 3 PA 611 History & Physical Exam I 3 AHS 530 Health Admin. & Management 3 PA 608 Surgical Disease I 3 PA 604 Pharmacology II 3 PA 613 Surgical Techniques 2 PA 616 Electrocardiography 1 PA 603 Pharmacology I 3 PA 606 Clinical Medicine I 606 Cli TOTAL TOTAL 11 16 Second Year Curriculum 2nd Year: Fall Semester Fall Semester Hours PA 617 Applied Behavioral Medicine PA 607 Clinical Medicine II 2 48 weeks of hands on, clinical training 24 weeks of required general medicine 6 PA 612 History & Physical Exam II 3 PA 618 Risk Management 1 PA 620 Literature Evaluation 2 PA 609 Surgical Diseases II 3 TOTAL 17 TOTAL DIDACTIC HOURS 60 16 weeks of required surgical rotations 8 weeks of elective rotations Most rotations are rigorous and require 40+ hours per week 8 Clinical Sites 2nd Year: Clinical Rotations General Medicine (6) Inpatient Outpatient Emergency Medicine Pediatric Practice OB/Gyn Psychiatry Electives (2) Elective Rotations General Surgery (4) General Surgery Orthopedic Surgery Cardiovascular Surgery any combination of core and elective rotations Trauma Transplant Plastics Surgical Oncology Neurosurgery Outpatient surgery Urology Birmingham: UAB Hospital UAB Highlands Hospital UAB West Hospital Brookwood Medical Center Trinity Hospital St. Vincent Hospital St. Vincent Hospital-East Hospital Princeton Medical Center Shelby Medical Center Area Local clinics Gadsden Alabama Riverview Medical Center Gadsden Baptist Hospital Jackson Mississippi North Mississippi Medical Center Tupelo Mississippi Mississippi Baptist Medical Center Additional Clinical Year Requirements Master’s Project (1 hour) Master’s Seminars (6 hours) Program Outcomes and Graduate Data PANCE Pass Rate First Time PANCE Pass Rates UAB Percent Passed PANCE Performance National Average 2002 83 90 2003 90 89 2004 88 90 2005 96 91 2006 100 92 91 90 5 Year Average 9 Distribution of Graduates by Specialty Choice Employment Trends Over 80% of graduates seek employment in surgical disciplines The most common disciplines 1969-present 1969 # 1- CV/Thoracic 1 # 2 -Orthopedics The most common recently # 1- Orthopedics 1 # 2 -CV/Thoracic 60% 50% 40% 30% 20% 10% Distribution of Graduates by Geographic Region Most graduates seek employment near home 80% 40% 59% This is because surgical practice is referral based requires hospitals and ICU’s es W tra hc en nt ce rt h surgery, 80% graduates work in the hospital 20% Most of these, spend most of th ti their time in the OR th OR Graduates may also spend additional time caring for patients pre and post-operatively post in the intensive care units in the ER 52% 15% O pe ra tin g R In oo pa In m tie te nt ns iv U e ni t Em Ca re er U ge ni nc t y R oo m 0% Urban Suburban Rural Inner City Distribution of UAB Graduates by Employer 80% 40% 13% 10% ut Distribution of Graduates by Work Setting Because of the nature of 60% 46% So No l l t ra as ea he ut rt h So Even so, UAB graduates can be found in every region and almost every state t 0% No 31% Most graduates work in medium to large cities 20% st Since students are recruited Since students are recruited mainly mainly from the Southeast, most obtain employment here th er Distribution of Graduates by Employment Locale 60% O O C V/ Th or ac ic rt ho pe G di en cs er al Su rg er N y eu ro su rg er y 0% Most physician practices are organized as single specialty groups an orthopedic group practice a CV group practice SA’s are also frequently hired by hospitals Provide OR assistance Hospitalists 10% 20% 54% 16% Single MD Group Hospital-based Multi-MD Group Other 10 What Can You Expect to Earn after Graduation? Graduates earn starting salaries between $70,000 and $80,000 Experienced graduates Experienced graduates salaries salaries can exceed $100,000 The three highest paid PA specialties are Emergency Medicine CV/Thoracic Orthopedics What Does Making a Higher Salary Really Mean? UAB graduates earn relatively higher salaries, but Work more hours per week Take more call hours per month Experienced Graduate SalariesUAB versus All PA’s $125,000 $100,000 $75,000 $50,000 $25,000 $0 10 25 50 75 90 Salary Percentiles UAB All Average Hours Worked per Week- UAB Graduates versus All PA Graduates 51 52 50 48 45 46 44 42 UAB All Average On-Call Hours per Month- UAB Graduates versus All PA Graduates 200 178 106 150 100 50 Soooooooo….. Why Not Not Medical School 0 UAB All 11 The Pre-Medical Student Medical School 4 years of professional school after college 2 years of basic medical sciences 2 years of clinical education years of clinical education Complete minimum coursework in: biology, chemistry, physics, math Students chosen based on grades, MCAT scores, letters of reference, work experience, pre-requisite precourses, and personal interview The MCAT Standardized test which assesses mastery of basic concepts in biology, chemistry, physics, facility with scientific problem solving and critical thinking, and writing skills. Must perform well on the MCAT (Medical (M College Admissions Test) The MCAT Used to help schools predict which of the applicants will be successful in medical school Extent to which the test results are used in admission decisions varies from school to school Can be taken in April or August of junior year in college What happens after medical school? Additional relevant work and volunteer experiences helpful Very competitive admissions process Residency: 2-5 years of specialization Pediatrics - 3 years OB/Gyn - 4 years Surgery - minimum of 5 years usually Sur Fellowship: 1-4 years of add’l specialization more academically and research focused Pediatric cardiology Transplant surgery Cardiology Average Salary Profiles Family Practice: $142,516 Pediatrics: $143,516 CV Surgery: $558,719 Ortho Surgery: $346,224 12 Board Certification Training in the Medical Model After completing a residency training program, physicians take a comprehensive examination which, if passed successfully, allows them to be board-certified in that boardspecialty Fellows take similar type of test after fellowship training The relationship between physician and PA begins in PA school where physicians, PAs, begins in PA school where physicians, PAs, and and others provide instruction in a curriculum following the medical model. PrePre-requisite coursework similar to requirements for medical school Physician or Physician Assistant? The Medical Model of Training PA students share facilities, classrooms, and clinical rotations with medical students clinical rotations with medical students. Physicians and PAs develop a similarity in medical reasoning during their schooling which leads to homogeneity of thought in clinical practice and a commitment to team practice Challenges for the PA Profession Recognition Utilization Uniformity from state to state Uniformity in education/training Education requirements not as long requirements not as long Scope of clinical practice not as extensive in most cases PAs have more flexibility to change their practice setting and medical specialty Common Myths Supply and demand Reimbursement Key Differences: PAs are dependent practitioners PAs can not be sued “I’d rather be a PA than a physician because th they don’t work as hard and it would allow it me to have a family” PAs can not see patients by themselves and must consult a physician each time they see a patient 13 The Perks… Able to practice medicine without having the long educational/training requirements that physicians have The down side… Able to work in a variety of practice settings Job market is good in most areas with a good salary Struggle for recognition Struggle for recognition Potential for lawsuits Educational programs can be expensive Challenging: continuous process of learning Often work long hours Rewarding: helping people on many levels For More Information… American Academy of Physician Assistants www.aapa.org THANK YOU ! UAB Surgical Physician Assistant Program www.uab.edu/surgicalpa (205) 934-4605 934- 14 ...
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