An aging population placing an unprecedented demand on medical services, reductions in physician resident duty hours, and a continued deficit of medical school graduates has made it imperative that physician assistants (PAs) stem the shortage of physicians in our nation’s hospitals.
Physician assistants are vital members of today’s multidisciplinary hospital team, improving the quality of patient care, expediting access to healthcare services, and increasing patient satisfaction for the hospital patient.
Physician assistants may have become particularly crucial to the inpatient setting, but they certainly aren’t new to this role. In fact, PAs have been providing care in hospitals for decades, and according to the 2009 census conducted by the American Academy of Physician Assistants, nearly 38 percent of all physician assistants worked in the hospital setting.
Working as a Physician Assistant in Hospital Medicine
According to the American Academy of Physician Assistants (AAPA), the hospital is the ideal setting for collaborative relationships among healthcare professionals, as the modern hospital requires close working relationships among a variety of medical professionals in order to deliver comprehensive patient care.
Work Settings
Physician assistants in hospital medicine work in nearly every department and with physicians of every medical and surgical specialty.
Although they may work throughout the hospital, they most often practice in the following settings, according to the AAPA:
- Emergency departments (25 percent)
- Operating rooms (23 percent)
- Outpatient units (20 percent)
- Critical care or intensive care units (4 percent)
- Other inpatient units (18 percent)
They may be employed by a hospital or hospital system or by medical practices or other outside organizations. According to the AAPA, physician assistants in hospital medicine enjoy specialized privileges in the hospital setting. Therefore, many hospitals hire PAs as house staff for emergency departments, intensive care units, and surgical and medical departments.
Although hospital policy and state law define the level of physician supervision, all states laws allow physician assistants to work rather independently, provided a physician can deliver off-site supervision, if necessary.
Duties and Responsibilities
Although the duties physician assistants perform vary according to the institution and even the state, they typically round daily, admit patients, and plan discharges.
Physician assistants specialized in hospital medicine practice medicine throughout the hospital system. This may include performing a wide range of duties that include:
- Admitting patients on behalf of the attending physician
- Conducting patient rounds
- Evaluating and treating patients in the emergency room
- Evaluating changes in patient conditions
- Issuing orders for medications, treatments, and lab tests
- Performing patient histories and physicals
- Providing surgical first assistant coverage in the operating room
- Writing discharge summaries
How to Become a Physician Assistant Specialized in Hospital Medicine
The first step to becoming a physician assistant specialized in hospital medicine is to complete formal education that includes a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).
These master’s-level programs, which take about 26 months to complete, include a rigorous classroom component, laboratory experiences, and about 2,000 hours of clinical rotations in a variety of medical subspecialties, which prepares students to work as PAs in a number of settings, including hospitals.
Admission requirements for PA programs vary; however, most require a bachelor’s degree and specific undergraduate courses in the biological and behavioral sciences. Some programs also require some type of healthcare experience.
Upon completing an accredited PA program, graduates must take and pass the National Commission on Certification of Physician Assistants’ (NCCPA) Physician Assistant National Certifying Examination (PANCE) and apply for a physician assistant license in the U.S. jurisdiction in which they plan to practice.
Post-Graduate Physician Assistant Programs in Hospital Medicine
Due to the wide scope of practice among physician assistants in hospital medicine, many medical institutions interested in adding PAs to their hospital medicine practice seek those who have completed a structured post-graduate program.
The Mayo Clinic Arizona was the first of its kind to offer a post-graduate PA fellowship dedicated to hospital medicine because they found it difficult to recruit PAs who had training in hospital medicine. Until then most PAs received their training in primary care; those who had hospital experience had knowledge of a specific medical subspecialty.
Since the inception of the Mayo Clinic’s post-graduate PA fellowship in hospital medicine, a number of other programs followed suit, allowing graduates of PA programs to receive extensive training aimed at general medicine patients in the hospital setting.
Post-graduate fellowships are paid programs, consisting of a combination of clinical rotations and didactic training. They are usually about 12 months in duration and modeled after the Society of Hospital Medicine’s Core Competencies, which encompass hospital systems and operations.
PAs in a post-graduate fellowship program work under the supervision of emergency medicine, surgical, and critical care physicians, with rotations encompassing the emergency department, the trauma center, intensive care units, and medical and surgical inpatient floors. Rotations offer PAs the opportunity to care for critically injured and seriously ill patients and perform emergency interventions. They can also expect to receive procedural training in:
- Central lines
- Arterial lines
- Intubations
- Chest tube placement
- Thoracentesis
- Paracentesis
- Lumbar punctures
Professional Certification Option for Physician Assistants in Hospital Medicine
Recognizing the need to distinguish PA leaders in hospital medicine, the NCCPA began offering the certificate of added qualifications (CAQ) in Hospital Medicine in September 2014. The CAQ program allows experienced PAs to receive board credentials for their advanced training and skills in specific areas of medicine, including hospital medicine.
To qualify to take the Hospital Medicine specialty exam and receive the Hospital Medicine CAQ credential, candidates must possess the following:
- A current PA-C and state license to practice as a physician assistant in at least one U.S. jurisdiction
- At least 3,000 hours (18 months) of experience in hospital medicine
- At least 150 credits of relevant CME
- Attestation from a supervising physician that they possess the ability to perform and/or have knowledge of the following principles of system-based practice in hospital medicine:
- Care of the hospitalized adult patient, including elderly and vulnerable populations
- Communication
- Diagnostic decision-making
- Drug safety; pharmacoeconomics and pharmacoepidemiology
- Evidence-based medicine
- Information management
- Leadership
- Management practices
And the following techniques and methods:
- Paracentesis
- Thoracentesis
- Chest tube placement
- lumbar puncture
- Ultrasonography
- Intubation
- Arthrocentesis
- Vascular access
- Cardiac testing
Resources for Physician Assistants in Hospital Medicine
Staying current on the hospital medicine industry and the physician assistant profession via professional associations is important for networking, career advancement, and continuing education opportunities. Related professional associations and other organizations include: