Brief                    Physician Assistants in
                         Gastroenterology and Hepatology
PAs working with gastroenterologists perform a          but also his discretion in knowing when to turn over
wide range of...
dealing with difficult courses of treatment, PAs
provide the education, support, and encouragement              Information...
The following publications are available from the AAPA store.
Order on-line at, or call 703/787-804...
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Physician Assistants in Gastroenterology and Hepatology


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Physician Assistants in Gastroenterology and Hepatology

  1. 1. Issue Brief Physician Assistants in Gastroenterology and Hepatology Physician assistants in gastroenterology and hepatology play GI PAs: Benefits for Employers roles as varied as the needs of the practices and patients and Patients they serve. These PAs provide care for patients in settings Hiring a PA brings several related benefits including outpatient clinics and offices, HMOs, inpatient to employers and patients. Because the hospital settings, and government institutions such as VA physician-PA team reduces appointment hospitals. waiting time, patients can be seen The physician-PA team enhances medicine by design. The quickly — a large boost to patient education of PA students in a traditional medical school satisfaction. PA patient education and communication skills improve outcomes model, including intensive study in basic medical sciences and free physicians to attend to more and clinical subjects, prepares them to be effective providers complicated cases. of physician-directed medical care. This knowledge base allows the PA to be an effective team member. In all The health care system, institutions, and individual practices can realize states, the District of Columbia, and Guam, physicians considerable savings when PAs are fully may delegate to PAs those medical duties that are within utilized. According to the Medical the physician’s scope of practice, the PA’s training and Group Management Association, PAs experience, and state law. In the case of federally employed generate revenues covering far more PAs, federal agency guidelines rather than state law than what their compensation costs determine their scope of practice. employers. According to 2002 data, for Physician assistants are educated in PA programs accredited every dollar of charges a primary care PA by the Accreditation Review Commission on Education for generates for the practice, the employer the Physician Assistant. The average PA program curriculum pays on average 28 cents to employ is 26 months and is characterized by a rigorous, competency- the PA. For surgical PAs, the employer pays 32 cents for every dollar of charges based curriculum with both didactic and clinical generated. (Physician Compensation components. The programs are offered at medical schools, and Production Survey, 2003 Report colleges and universities, and teaching hospitals. Based on 2002 Data. Colorado, 2003. The first year of PA education provides a broad grounding Reprinted with permission from the in medical principles with a focus on their clinical Medical Group Management Association, applicability. In the second year, students receive hands-on 104 Inverness Terrace East, Englewood, clinical training through a series of clerkships or rotations Colorado 80112-5306; 303/799-1111.) in a variety of inpatient and outpatient settings. Physician assistant students complete on average more than 2,000 hours of supervised clinical practice prior to graduation. The PA’s scope of practice typically includes taking patient histories, performing physical exams, ordering laboratory data and preliminary radiological studies, formulating a differential diagnosis and establishing treatment plans, prescribing medications, and providing in-depth patient education about treatment of both chronic and acute GI and hepatology conditions.
  2. 2. PAs working with gastroenterologists perform a but also his discretion in knowing when to turn over wide range of diagnostic and therapeutic procedures, highly complex cases to the practice physicians for including flexible sigmoidoscopies, paracentesis, diagnosis and care. liver biopsies, esophageal and rectal manometry studies, and assisting with PEG tube placement. In A Key Team Member at Busy the hospital setting, they perform rounds, dictate Hospital-Based Clinic daily progress notes, and order discharge summaries. Another gastrointestinal PA anchors a busy clinic on the campus of an Arizona hospital with a team A recent survey of gastrointestinal PAs found of five supervising GI physicians. Since hiring her, physician assistants in this field treating patients the clinic has reduced average waiting time for an for GERD, esophageal dysmotility, esophageal appointment from a couple of months to several cancer, gastroduodenal ulcer disease, celiac disease, weeks if the patient chooses the option of seeing the gallbladder disease and diseases of the biliary tree, PA for initial work up — dramatically increasing acute and chronic pancreatic and other pancreatic patient satisfaction and access to care. The PA sees diseases, hepatitis B, hepatitis C, non-alcoholic fatty approximately 30 new patients a week and 40 for liver disease, hemachromatosis, autoimmune liver follow-up visits. disease, cirrhosis of various etiologies, irritable bowel syndrome, and inflammatory bowel diseases such The PA remains at the clinic full-time while the as Crohn’s disease and ulcerative colitis, as well as physicians travel back and forth between the evaluating patients for colon cancer screening. endoscopy center, clinic, and hospital. She follows her own patients in the office, sharing responsibility Facilitating Quality Care with her supervising physicians and consulting them at the Scripps Clinic whenever necessary. The PA and her supervising A PA at the Scripps Clinic in San Diego discovered physicians keep open lines of communication a passion for hepatology while participating in a about the patients she sees — an integral part of PA liver research fellowship. Hired to join the clinic practice. The PA’s supervising physicians have more after developing a close professional partnership time to handle complex cases, perform procedures, with one of its lead investigators, he now sees and round at the hospital. patients with a variety of conditions. Working with a team of renowned hepatologists, the PA sees The PA treats a large number of patients with about 90 percent of first-time patients, conducting hepatitis C, non-alcoholic fatty liver disease, evaluations for hepatitis B and C and cirrhosis of the Crohn’s disease, and ulcerative colitis, irritable liver. He performs liver biopsies and orders triphasic bowel syndrome, and acid reflux, but also enjoys the CT scans. The PA routinely sees patients for acid challenges of a broad array of other GI conditions. reflux disease and general abdominal pain and To promote patient education, she developed files of performs flexible sigmoidoscopies. GI-related resources for patients and their families. Patients receiving treatment for cirrhosis are seen PAs Enhance Coordination of Care by the PA at least once a month. The PA engages Two PAs help a busy gastroenterology/hepatology both patients and their families in an intensive practice bridge the realms of office and hospital by education about liver transplantation. The PA- providing follow-up care for chronic hepatology patient communication link enhances quality of care conditions in both settings. In the office, the PAs and outcomes. This well-coordinated and collegial generally see patients who require additional testing team practice is based on the mutual trust and and long-term treatment. Hepatitis counseling is a confidence not only in the PA’s diagnostic abilities, key aspect of the PAs’ responsibilities. For patients
  3. 3. dealing with difficult courses of treatment, PAs provide the education, support, and encouragement Information Resources required to help them complete their treatment. The American Academy of Physician Assistants In the hospital the PAs conduct rounds, provide has numerous resources to assist a practice or consults, and coordinate care for patients with institution in effectively employing a physician hepatitis. The PAs are in constant contact with the assistant. Publications such as Physician team of five supervising physicians, and periodic Assistant-Third Party Coverage, Physician meetings ensure overall coordination of care. The Assistants and Hospital Practice, and Hiring a PAs find the contrasting environments of hospital PA may be purchased from AAPA’s On-Line and office stimulating, while their employers have Store at or by calling found much-improved coordination of care through 703/787-8044. Other information is available the ability to flexibly delegate care at both practice on the AAPA Web site, sites. The volume of patients visiting the practice has For more information on Gastrointestinal also increased with the advent of PAs as part of the and Hepatology PAs, contact AAPA’s Jennifer provider team. Anne Hohman at 703/836-2272, ext. 3220;;; or the Gastrointestinal g Specializing in Hepatology Physician Assistants (GIPA) at A North Carolina-based physician-PA team provides care to hepatology patients. Many patients require Reimbursement ongoing care: about 75 percent of the patients seen by the PA suffer from a form of hepatitis; the other Third-party payers typically reimburse for physician 25 percent have cirrhosis. A combination of clinical services provided by PAs. Medicare covers medical acumen and empathy helps this PA care for patients, services provided by PAs at 85 percent of the many of whom require large measures of time and physician fee schedule. Medicare generally allows attention. She sees about 60 patients a week in PAs to deliver the same services that physicians coordination with her supervising physician. provide (within the PA’s scope of practice as determined by state law), using the same Current After her supervising physician conducts initial Procedural Terminology (CPT) codes. Payment patient visits, the PA provides follow-up care to is made to the practice. Medicare follows state patients. She performs liver biopsies, therapeutic regulations regarding the degree of physician paracentesis, reviews charts, and conducts extensive supervision required. Under Medicare’s guidelines, patient education. The PA has developed a the physician supervisor need not be physically curriculum for teaching patients how to self-inject present with the PA when care is provided, unless interferon and holds classes to share the technique specifically required by state law or facility policy. and engender a sense of community. The PA also Private payer policies vary somewhat but tend to works as a sub-investigator on clinical trials led by follow Medicare’s lead. her supervising physician. American Academy of Physician Assistants Department of Government & Professional Affairs 950 North Washington Street Alexandria, VA 22314-1552 703/836-2272
  4. 4. The following publications are available from the AAPA store. Order on-line at, or call 703/787-8044. Hiring a Physician Assistant Contacts & Contracts: An Employment Guide for PAs This publication includes information about education This comprehensive manual helps both new graduates and requirements for physician assistants, guidelines regarding their experienced PAs identify and secure the perfect job. It includes scope of responsibilities and practice, and a pre-employment information about job opportunities, employment recruiters, checklist. The book also covers topics such as state regulations, resume and cover-letter writing, the interview process, and contract national certification, malpractice coverage, employment negotiation. Handy checklists for pre-employment issues, contract agreements, recruiting, and compensation. (68 pages) negotiations, and resigning procedures are also featured. (108 pages) Members $25.00 Nonmembers $50.00 Members $25.00 Nonmembers $50.00 Physician Assistant Third-Party Coverage Physician Assistants: State Laws and Regulations This resource summarizes third-party coverage policies for PA This publication is a detailed resource of state laws and regulations medical and surgical services, and outlines rules, regulations, and related to the PA profession, including a state-by-state summary billing concepts for coverage of physician services provided by PAs of statutes and regulations, with information on scope of practice, under Medicare, Medicaid, TRICARE/CHAMPUS, and private prescribing and dispensing, qualifications for practice, and the insurance companies. Practice issues such as strategies for handling definition of supervision. It contains summaries of more than two claim denials are also covered. This book provides the physician dozen key provisions of each state’s statute and regulations complete assistant with insight into courses of action that can be taken to with legal citations. (9th ed., 300 pages) help solve problems and maintain a more positive reimbursement Members $50.00 Nonmembers $100.00 environment. (100 pages) Members $25.00 Nonmembers $50.00 Annotated Bibliography of the PA Profession An annotated bibliography containing concise summaries of studies, Physician Assistants and Hospital Practice books, reports, and medical journal articles on the PA profession This publication is a summary of information on the practice published between 1986 and 1993. (4th ed., 281 pages) of PAs in hospitals. It contains policy statements from national Members $25.00 Nonmembers $50.00 organizations, information about JCAHO, patient restraints, EMTALA, model hospital bylaws, and a sample credentialing form. (74 pages) Addendum to the Annotated Bibliography, 1993-1999 Members $25.00 Nonmembers $50.00 Companion to the Annotated Bibliography. Contains descriptions of the most recent books, journal articles, studies, and reports on PAs. Categorized by practice setting, specialty, and other topics. (200 ed., 92 pages) Members $25.00 Nonmembers $50.00 American Academy of Physician Assistants Department of Government & Professional Affairs 950 North Washington Street Alexandria, VA 22314-1552 703/836-2272