CALIFORNIA ACADEMY OF PHYSICIAN ASSISTANTS
W ith the printing of the 13th edition of The Physician Assistant, we at CAPA can
look back and see the progress that our profession has made over the years. All those
who came before us should be recognized, for it is because of their hard work we have
matured to the great profession we are today. The Physician Assistant booklet is an
excellent educational tool for those who want to learn about physician assistants and
the critical role we play in the health care team. CAPA is here to fulfill our mission as
The Mission of the California Academy of Physician Assistants is to
represent and serve PAs statewide. As an advocate of its members
for quality health care and for their valued, unique alliance with
supervising physicians, CAPA will enhance, educate and empower
physician assistants for the ultimate benefit of their patients.
The Physician Assistant
History and Concept
P hysician assistants provide medical,
diagnostic and therapeutic services
diabetes. Physician assistant practice
is centered on patient care and may
under the supervision of licensed include education, research and
physicians. administrative activities.
The supervising physician may delegate Physicians of any specialty may employ
to the PA most medical services and a PA. Just as there are many kinds of
duties that are routinely performed physician specialists, there are many
within the normal scope of the kinds of PAs.
physician’s practice and which the PA is
competent to perform. The supervising
physician has ultimate responsibility for
the patient and supervision of the PA.
The physician assistant concept was
born during an era when primary
care physicians were in short supply,
particularly in rural and inner city
areas. In 1965, in an effort to augment
scarce medical care, Dr. Eugene Stead
of Duke University established the first
PA training program. He believed that,
under the supervision of a physician,
PAs could safely and effectively provide
services previously provided solely by
physicians. He was accurate in his vision.
Today, there are 135 accredited PA
programs and over 58,000 physician
assistants nationwide. PAs perform a
wide variety of medical and surgical
functions, depending on their training,
practice setting, and the needs of their
In practice, most PAs routinely elicit
complete medical histories and perform
comprehensive physical examinations.
They see patients with common acute
problems such as infections and injuries.
They do minor surgical procedures
and provide ongoing care for common
chronic problems such as arthritis,
low back complaints, hypertension and
The Supervising Physician
E very physician assistant must have
a supervising physician. A PA may have
and can assess first hand the ability
and potential of a PA. Many preceptors
multiple supervising physicians and a go on to hire PAs for their practice.
supervising physician may supervise more Physicians wishing to become preceptors
than one PA. or to locate qualified physician assistants
for their practice should contact
In California, “supervision” means the individual training programs or
reviewing with the PA, as needed, either the California Academy of Physician
directly or by electronic means, the Assistants.
findings of the history and physical
examination and the tasks performed by
the PA. Supervision need not be given
prior to treatment, nor must supervising
physicians be on the premises as long
as they are available by phone or
other electronic means.
team must establish,
in writing, guidelines
for timely supervision.
They may be general
or specific and may
include standing orders,
protocols, drug order
guidelines, and chart
The physician has
the responsibility of
following the patient’s
progress to ensure
that the PA does not
Very often physicians
serve as preceptors
for students in a
training program prior
to employing a PA.
As preceptors they
become involved in
the teaching process
Services PAs May Perform
P As may perform tasks or services
delegated to them by their supervising
following appropriate training and
demonstrated competency. Including
but not limited to:
physician. The scope of practice of the
supervising physician determines the type Biopsies
of services rendered by the PA.
Medical procedures and tasks PAs may Vein harvesting
perform in California include, but are not And many others depending
limited to, the following: on specialty
1. Take a thorough history, perform an 5. Recognize and evaluate situations which
appropriate physical examination and call for immediate attention of the primary
make an assessment and diagnosis care physician and institute, when necessary,
therefrom, and record and present emergency treatment procedures essential
pertinent data in a manner meaningful to for the life of the patient.
6. Instruct and counsel patients regarding
2. Order or perform routine laboratory matters pertaining to their physical and
and screening procedures including, but mental health, such as diets, social habits,
not limited to, these examples: family planning, normal growth and
The drawing of blood and routine development, and the aging process.
examination of the blood
7. Assist the physician in the institutional
setting by arranging hospital and nursing
Catheterization and routine home admissions, providing services
urinalysis to patients requiring continuing care,
Nasogastric intubation and gastric including the review of treatment and
lavage therapy plans, and by evaluating patients
Pelvic examinations, including and performing the procedures and tasks
bimanual examinations and specified in subsections 1, 2 and 3 above.
8. Serve as first or second assistant in surgery.
3. Order or perform routine therapeutic
procedures including, but not limited to, 9. Initiate and facilitate the referral of
these examples: patients to the appropriate health
facilities, agencies and resources of the
Debridement, suturing and care of 10. Administer or furnish medication, write
superficial wounds a drug order or transmit an oral or
written prescription for medication,
Strapping, casting and splinting of
subject to certain limitations.
Incision and drainage of superficial PAs are subject to the limitations set forth
skin infections by their supervising physicians and to
the policies of the employing institutions,
4. Order or perform many specialized in addition to the laws and regulations
therapeutic and diagnostic procedures governing utilization of PAs in California.
Education and Certification
Education: examinations, ordering and interpreting
diagnostic tests, instituting therapeutic
There are 10 accredited primary care
plans, and patient education focusing on
physician assistant programs in California
and 135 accredited programs throughout
the country, most of which require 24-
48 months to complete. Many programs Examination:
require applicants to have completed two Every new PA in California must pass the
years of college prior to admission and to Physician Assistant National Certifying
have previous health care experience. Examination (PANCE) administered
by the National Commission on
Programs are accredited by the Certification of Physician Assistants
Accreditation Review Commission on (NCCPA). The examination is
Education for the Physician Assistant comprehensive in scope and assesses
(ARC-PA) based on quality standards academic and patient management
deemed essential for PA education. knowledge.
Most physician assistants nationwide
are trained in broad based primary care, Certification:
although there are PA specialists as well. PAs may maintain national certification by
earning 100 hours of continuing medical
Other California programs additionally education every two years, and are
offer postgraduate training in orthopedic retested every six years by the NCCPA.
and cardiothoracic surgery.
The education of PA students is similar
to that of medical students in that a To practice in California, each PA must
didactic phase of intense academic course be licensed by the Physician Assistant
work is followed by supervised clinical Committee of the Medical Board of
experiences or rotations. California. This requires submitting an
official application and fees, proof of
In the first year, students usually complete graduation from an approved program
courses in such topics as anatomy and successful completion of the National
and physiology, microbiology, physical Certifying Examination.
diagnosis, pharmacology, common
laboratory and screening techniques,
common medical and surgical procedures,
medical ethics, and a course in clinical
medicine, among others.
In the clinical phase, students apply the
skills they learned during the didactic
phase of training through rotations
in primary care and specialty settings
under the supervision of a physician.
Training emphasizes eliciting complete
patient histories, performing physical
P hysician assistants are employed in many
specialties. A partial listing includes general
hospitals, nursing facilities, intermediate care
facilities, and private homes.
and family practice; emergency medicine;
pediatrics; obstetrics and gynecology; The granting of hospital privileges to
surgery; orthopedics; geriatrics; women’s PAs is at the discretion of the individual
health; occupational medicine; psychiatry facility. A booklet entitled, “Physician
and mental health; cardiology and internal Assistants and Hospital Practice” is
medicine; oncology; and administrative produced by the American Academy of
research and educational fields. Physician Assistants and can be ordered
from API at (703) 787-8044.
California PAs practice in a variety of
rural and urban settings, always under the
supervision of a licensed physician. Typical
practice settings include:
Solo and group practices
Health maintenance organizations
Student health services
Veterans Administration facilities
Federal and State correctional
House calls/Home care
PAs may work in any medical setting in
which their supervising physician(s) practice,
including private offices, general acute care
hospitals, acute psychiatric hospitals, special
Acceptance and Quality of Care
Patient acceptance of PAs is excellent.
Surveys repeatedly indicate patients are
highly satisfied with the job competence
and professional manner of PAs. The
utilization of physician assistants has
resulted in improved access to health
care and enhanced patient satisfaction.
Quality of Care:
Results of studies comparing the primary
care services of physician assistants with
those of general or family physicians
and general internists have consistently
shown no discernible difference in the
quality of their diagnostic or therapeutic
care. Most findings indicate that PAs
spend more time per patient visit,
provide more thorough medical record
documentation, and devote more time
to patient education.
Physician assistants contribute
positively and significantly to health
care delivery, particularly in rural and
underserved areas. Depending on the
setting, PAs may provide 65-90% of the
procedures routinely performed by
physicians in general or family practice,
with a comparable level of skill to that
Cost Effectiveness: Physician assistants have proven to be an
asset in reducing malpractice exposure in
PAs have been found to be highly cost
private practice settings. This is attributed
effective when fully utilized. Research has
to the extra time PAs devote to patient
shown that patient visit costs are less
education and counseling, improved
when PAs are employed in physicians’
patient compliance, and the close
practices. At the same time, practice
teamwork between the physician and PA.
productivity measured in patient visits
increased and practice income rises
accordingly. Most physicians who hire PAs Reimbursement:
do so less for the added profit than for Physician assistants usually don’t charge
the added freedom, time, and flexibility directly for their services. Reimbursement
employing a PA affords them. is made commonly through the
supervising physician or the employing
There is no fixed salary scale for physician
Medicare currently reimburses for
assistants. Salaries today vary widely and
physician services provided by PAs,
reflect the type of practice, the practice
including surgical assists, under Parts
location, the experience of the PA, and
A and B at 85% of the physician fee
the benefit of the PA to the practice. The
schedule. In certain outpatient situations,
American Academy of Physician Assistants
it may be at 100%.
(AAPA) maintain information on practice
profiles, salaries and benefits which are
In California, the Medi-Cal program
reimburses for services provided by PAs
at 100% of the supervising physician’s
Professional benefits such as continuing
reimbursement rate. Medi-Cal has some
medical education time and alternative
specific requirements for physicians
payment arrangements such as profit
sharing can all be negotiated on an
individual basis and formalized by written
The private insurer reimburses at varying
or verbal agreement.
rates up to 100% of that of the physician.
Liability insurance covering the PA is
generally paid by the employing physician
and can be arranged in one of two ways. In
the first, the PA is covered by the umbrella
policy or “rider” of the physician. Many
carriers do not increase the premium
when a PA is employed; some increase it
only slightly, while others may increase it
significantly. Physicians should consult their
carrier about their particular policy. In the
second method, the PA may take out a
separate individual policy .
P erhaps the best way to understand what
a PA does is to visualize one in practice.
Here is a possible scenario involving one
two of his own patients; a new mother who
desires to learn the various methods of
contraception, and an obese man wanting
physician who has fully incorporated a to start a diet and exercise program.
PA into his practice. They have worked
together for two years. Dr. Q will attend a local continuing
education seminar the next day; they have
Dr. Q, a physician in private general practice, scheduled patients for Mr. J for that time.
arrives at his office at 8:00 a.m. His PA, In the past Dr. Q was forced to close the
Mr. J has just walked in. They look at their office on such occasions. He will carry a
patient schedules for the day and discuss beeper so that the PA can contact him
any potential problems. Mr. J inquires about immediately should any problems arise.
changing the insulin regimen of a diabetic Tonight Mr. J will be on call, as he is two
patient he has been following, and together nights every week. At week’s end, Dr. Q
they work out a better dose schedule. will review the PA’s charts and countersign
them. This process has become easy as his
At 9:00 a.m., they start seeing patients in assistant’s knowledge and experience have
separate exam rooms, with the nursing grown. Dr. Q feels pleasure in having taught
staff assisting both. The PA handles the PA much during their work together,
uncomplicated new cases, does physical and realizes that both of them stay mentally
exams required for school or employment, sharp as a result.
and sees patients with chronic problems
returning for maintenance care. He orders For these services, Dr. Q pays his PA a
and evaluates appropriate lab work, x-rays, competitive salary plus a percentage of the
EKGs and writes drug orders working office income. At first, during an adjustment
within protocols and formularies developed period, that salary was lower and there
together with his supervising physician. was no percentage while the two learned
to work together as a team. But as Dr. Q
At 11:30 a.m., Mr. J consults with Dr. Q saw his office income and productivity rise,
about a patient he has just seen who he increased the compensation accordingly.
appears to be in heart failure. They review Still, it is much less than a physician-partner
the case and decide to admit the patient would require, as his practice would not
to the hospital. Mr. J makes the admission accommodate a full partner. His malpractice
arrangements, and since he had planned premium is only slightly higher than it
to make hospital rounds for Dr. Q this was before he employed the PA. Both Dr.
afternoon, accompanies the patient to the Q and Mr. J are well satisfied with their
hospital. While there, he reviews the charts relationship.
of Dr. Q’s post-op patients, makes progress
notes and written orders under conditions At first, patients had questions about the
agreed on by Dr. Q, the hospital and the PA. PA, but after a short time they accepted
him without question and many now
Later he visits some of Dr. Q’s nursing specifically request to be seen by him
home patients, and returns to the office at when making their appointments. And,
the end of the afternoon to discuss patients many patients comment to Dr. Q that they
who he feels should see the physician at appreciate the extra time the PA takes to
their next visit. He also asks for advice explain his instructions and answer their
about two in-patient problem cases. Dr. Q questions. Some were frankly amazed when
asks the PA to spend some extra time with the PA made a house call.
For More Information About PAs
1. Up-to-date information on California Charles R. Drew University
PAs, and employment information: Physician Associate Program
1731 E. 120th St.
California Academy of Physician Assistants Los Angeles, CA 90059
3100 W. Warner Ave., Suite 3 (323) 563-5950
Santa Ana, CA 92704-5331 www.cdrewu.edu
(714) 427-0321 FAX: (714) 427-0324
www.capanet.org Stanford University
Physician Associate Program
1215 Welch Rd., Module G
. National information on programs, Palo Alto, CA 94305
legislation, and certification/ (650) 725-6959
American Academy of Physician Assistants, or UC Davis Medical Center
Association of Physician Assistant Programs Physician Assistant Program
950 N. Washington St. 2516 Stockton Blvd., Suite 254
Alexandria,VA 22314 Sacramento, CA 95817
(703) 836-2272 FAX: (703) 684-1924 (916) 734-3551
National Commission on Certification of Western University
Physician Assistants Physician Assistant Program
12000 Findley Rd., Suite 200 309 E. Second St.
Duluth, GA 30097 Pomona, CA 91766
(678) 417-8100 FAX: (678) 417-8135 (909) 623-6116
Samuel Merritt College
Physician Assistant Program
. California regulations, applications
450 30th St.
for licensure, and information for MD
Oakland, CA 94609
supervising physicians and PAs:
Physician Assistant Committee www.samuelmerritt.edu
Medical Board of California
RCRMC/RCC Primary Care
1424 Howe Ave., Suite 35
Physician Assistant Program
Sacramento, CA 95825-3237
16130 Lasselle St.
(916) 561-8780 (800) 555-8038 (CA Only)
Moreno Valley, CA 92551
. Doctors of Osteopathic Medicine who Loma Linda University
wish to supervise PAs should contact: School of Allied Health Professions
Physician Assistant Program
Osteopathic Medical Board of California
Nichol Hall, Room 2033
2720 Gateway Oaks Dr., Suite 350
Loma Linda, CA 92350
Sacramento, CA 95833
Touro University - California
Physician Assistant Program
. California PA training programs, 1310 Johnson Ln.
preceptorships, and general Vallejo, CA 94592
information: (888) 652-7580
USC School of Medicine
Physician Assistant Program San Joaquin Valley College
1000 S. Fremont Ave. Primary Care Physician Assistant Program
Unit 7, Bldg A-6, 4th Fl, Rm 6429 8400 W. Mineral King Ave.
Alhambra, CA 91803 Visalia, CA 93291
(626) 457-4240 (559) 651-2500 x351