As of 2014, there were 10,450 physician assistants (PAs) practicing in orthopedics and orthopedic surgery. Physician assistants in orthopedic surgery make up about 11 percent of all practicing PAs.
Physician assistants in orthopedics provide care in the office, assist in surgery, and provide orthopedic care in emergency departments and urgent care centers. The American Academy of Physician Assistants (AAPA) reports that PAs serve as an asset to any orthopedic practice, enhancing patient satisfaction and quality outcomes.
According to Physician Assistants in Orthopaedic Surgery (PAOS), the official specialty organization for the AAPA for physician assistants who practice in orthopedics (orthopaedics), physician assistants provide vital services, playing an important role in patient care within today’s healthcare system.
Physician Assistants in Orthopedic Surgery: Job Duties and Responsibilities
Physician assistants practicing in orthopedics, as part of the physician-led team, provide medical care under the supervision of an orthopedic surgeon. Their work ranges from performing examinations to interpreting diagnostic tests to prescribing medications to assisting the orthopedic surgeon in surgery. PAs in orthopedics work both in inpatient and outpatient settings.
Orthopedic surgeons delegate a range of responsibilities to physician assistants. As such, PAs exercise a high level of decision-making, providing care with delegated autonomy.
Job responsibilities of physician assistants include:
- Performing comprehensive and problem-focused history and physical examinations
- Interpreting laboratory and diagnostic procedures to establish a working diagnosis
- Implementing therapeutic intervention for specific conditions
- Ordering and performing diagnostic procedures and studies, such as:
- Compartment pressure measurements
- X-ray examinations
- Special x-ray examinations, including CT, MRI, and bone scans
- Performing procedures like regional anesthesia and digital blocks
- Performing minor outpatient procedures, such as:
- Hardware removal
- Incision and drainage
- K-wire removal
- Percutaneous pinning of fractures
- Tendon repair
- Wound closure
- Wound debridement
- Needle biopsy
- Wound management
- Performing diagnostic and therapeutic procedures, such as:
- Brace, cast, and splint applications
- Closed reduction of fractures and dislocations
- Injection of joints
- Joint and bursa aspirations
- Trigger points and bursa
- Assisting in surgeries as delegated by the surgeon
- Ordering, prescribing, dispensing, and administering medication
- Ordering, prescribing, dispending, and administering orthosis, orthotics, braces, and other orthopedic devices
- Evaluating, screening, and counseling patients on health maintenance
- Promoting the utilization of community resources
- Conducting post-operative rounds, writing orders, and performing admission and discharge work in the hospital setting
Difference between Physician Assistants in Orthopedics and Orthopedic Physician Assistants
There are two professional titles frequently used to describe assistants of orthopedic surgeons: Physician assistants (PAs) in orthopedics and orthopedic physician assistants (OPAs).
Although physician assistants in orthopedics and orthopedic physician assistants may sound like one in the same, they are very different professions. PAs have broad, medical training, and they work with physicians in any specialty, including orthopedics. All U.S. jurisdictions license them, and Medicare and Medicaid providers recognize them as providers of healthcare.
PAs diagnose and treat patients, order tests, and prescribe medications. OPAs, on the other hand, have a limited role in orthopedics, working with the surgeon in a supportive role.
OPAs receive their training on the job, and they work as surgical assistants or orthopedic technologists. OPAs may be certified, but their practice is largely unregulated. Only Tennessee has an OPA Practice Act, and New York allows OPAs to register as special assistants. California allows a limited number of OPAs who completed their education between 1971 and 1974 and who do not meet the requirements for licensure as PAs to provide services to orthopedic physicians. Medicare and Medicaid do not recognize OPAs as providers.
How to Become a Physician Assistant Specialized in Orthopedic Surgery
Becoming a physician assistant in orthopedic surgery starts by completing a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant.
Applicants to physician assistant programs must possess a bachelor’s degree, including at least two years of college courses in the basic and behavioral sciences. PA programs encompass a rigorous, competency-based curriculum with both didactic and clinical components. These programs are about 27 months in duration, and they include at least 2,000 hours of clinical rotations. Students with interest in orthopedic surgery often choose to pursue an elective rotation in this medical specialty to gain additional experience.
Upon completion of an approved PA program, graduates must take and pass the Physician Assistant National Certifying Examination (PANCE) and apply for a state license to practice as a physician assistant.
Post-graduate PA programs allow graduates to begin working in a paid capacity as a physician assistant to receive advanced training in their chosen specialty.
Post-graduate residency programs, which last about 12 months, include both didactic and clinical training. Graduates of orthopedic post-graduate PA programs gain an in-depth understanding of a number of areas within orthopedics. These programs offer extensive experience in triage and in the evaluation, treatment, and management of orthopedic problems.
Clinical rotations of these programs include:
- Orthopedic trauma surgery
- Total joint surgery
- Spine surgery
- Sports surgery
- Hand surgery
- Foot and ankle surgery
Residents of these programs participate in clinics, inpatient care, and first-assist in the operating room in each rotation. Graduates develop into expert first-assistants in the operating room.
Professional Certification for Physician Assistants in Orthopedic Surgery
The National Commission on Certification of Physician Assistants (NCCPA) offers the certificate of added qualifications (CAQ) program in Orthopedic Surgery for physician assistants that want to achieve recognition for their specialty skills and knowledge in this area of medicine.
To qualify to take the Orthopedic Surgery CAQ specialty exam and earn certification in orthopedic surgery, candidates must:
- Possess a PA-C designation and a valid, unrestricted licensed to practice as a physician assistant in at least one U.S. jurisdiction
- Possess at least two years of experience
- Possess a Category I specialty CME
- Submit attestation from a supervising physician that indicates that they have performed the following procedures and patient management relevant to the practice and/or they understand how and when to perform the procedures:
- Advanced wound management
- Compartment pressure management/management diagnostic/therapeutic needle aspiration/injections
- Diagnostic radiography/other modalities
- Fracture/dislocation management
- Operative/Preoperative Care
- Prevention, recognition, management of common orthopedic complications/conditions
Resources for Physician Assistants in Orthopedic Surgery
Physician Assistants in Orthopaedic Surgery (PAOS) is a professional organization for physician assistants who work in orthopedics. PAOS is dedicated to providing high-quality programs that support its members in achieving a high level of knowledge in musculoskeletal health care within the physician-led concept.
Membership and active participation in PAOS provides a number of benefits for certified and licensed PAs in orthopedic surgery:
- Offers CME in orthopedic and musculoskeletal healthcare care
- Serves as a forum for interaction
- Provides networking opportunities for information dissemination and job placement
- Keeps PAs up to date on physician assistant education, training, certification, and changing legislation
Other professional associations that may be of interest to physician assistants specialized in orthopedic surgery include:
- American Association of Surgical Physician Assistants
- American Academy of Orthopaedic Surgeons
- American Orthopaedic Association
- American Orthopaedic Society for Sports Medicine
- American Society of Orthopedic Professionals