How to Become a PA Specialized in Nephrology

According to an article by Nephrology News & Issues, the demand for physician assistants (PAs) in nephrology continues to soar, due to an increasing number of patients in the U.S. with kidney disease. In fact, the rate of individuals with kidney disease is far outpacing the number of trained nephrologists.

The baby boomer generation remains the fastest segment of dialysis patients, many of which suffer from multiple, chronic health problems caused by their renal disease. The result is a need for closer monitoring by physician assistants, who serve as the eyes and ears of nephrologists.

Physician assistants in nephrology have established themselves as a critical component of the nephrologist-led team, working to ease the workload for nephrologists and manage a mounting population of dialysis patients,.

The Job Scope and Duties of Physician Assistants in Nephrology

According to the American Academy of Physician Assistants (AAPA), physician assistants increase the availability of high quality, efficient treatment at all points of care, including hospitals, outpatient clinics, and dialysis clinics. Although a supervising physician always backs PAs working in nephrology, much of the work they perform is autonomous.

Nephrology physician assistants are involved in nearly every aspect of renal medicine. These medical providers have a diverse scope of practice, caring for renal patients and performing duties that cover the entire spectrum of nephrology.

Nephrology physician assistants work in all areas of nephrology, so their duties range from performing dialysis rounds to seeing office patients. They also manage interdisciplinary teams at dialysis units and educate patients and new practitioners through the Medicare authorized Kidney Disease Education classes.

The AAPA reports that nephrology PAs see, on average, 110 outpatient dialysis patients a week, and they provide follow-up visits to about 23 patients weekly.

According to the American Academy of Nephrology Physician Assistants, nephrology physician assistants perform the following duties most often:

  • Treat dialysis patients
  • Treat chronic kidney disease for patients at stage 4 and 5
  • Provide access management
  • Perform hospital rounds
  • Perform daily hemodialysis
  • Take call

Their duties in nephrology depend on the needs of the practice or institution in which they work. This may include:

  • Anemia management
  • Assisting in the diagnosis and management of all aspects of kidney disease
  • Directing and monitoring patient care in hemodialysis centers
  • Evaluation and treatment of kidney stones
  • Monitoring hypertension, diabetes, and dyslipidemia
  • Ordering and following up lab and imaging studies
  • Providing follow-up care for kidney transplant patients

In the hospital setting, PAs in nephrology perform:

  • Admission physicals
  • Hospital rounds
  • Consultations
  • Post-surgical follow-ups
  • Procedures, such as the placement of vascular catheters for hemodialysis and plasmapheresis patients

Education, Training, and Certification Requirements

Every individual interested in becoming a physician assistant must first complete a bachelor’s degree in a behavioral or biological science. If the undergraduate degree is in a different area of study, individuals must complete specific requirements in the behavioral or biological sciences to gain admission to a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) – a requirement for national certification and state licensure.

These graduate-level programs, which take about 27 months to complete, consist of a rigorous curriculum that prepares students to work as a physician assistant in any specialty, including nephrology.

All PA programs include at least 2,000 hours of clinical rotations in a number of specialties. Physician assistants interested in exploring nephrology may choose to complete another elective round in nephrology.

Upon completion of 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 state licensure to practice as a physician assistant.

Post-graduate PA programs provide newly graduated physician assistants with the opportunity to pursue advanced study and training in their medical subspecialty of choice. The Association of Postgraduate PA Programs maintains a list of physician assistant postgraduate fellowships.

Professional Certification in Nephrology

Professional certification through the NCCPA’s certificate of added qualifications (CAQ) program allows nephrology physician assistants to receive an industry credential that shows their advanced expertise in nephrology.

Candidates who want to achieve the Nephrology CAQ must meet a number of requirements, which include possessing:

  • A PA-C designation
  • A valid, unrestricted licensed to practice as a physician assistant in at least one U.S. jurisdiction
  • At least two years of experience, which must include at least one year of experience working in nephrology
  • A Category I specialty CME
  • Attestation from a supervising physician working in nephrology that the PA has performed patient management techniques or understands how and when appropriate techniques should be applied in the following areas:
    • Case management of patients in one of the following nephrology subspecialties:
      • Chronic kidney disease
      • End-stage renal disease
      • Hospitalist care involving acute dialytic therapy
      • Kidney transplantation
    • Diagnosis and management of:
      • Acute dialytic therapy
      • Adjustment of medication doses to GFR
      • Anemia
      • care/assessment/management of kidney donors and recipients, both pre- and post-transplant
      • Catheter malfunction/infections
      • Examination and interpretation of urine specimen
      • Complications of dialysis
      • Hypertension
      • Medication management in patients with compromised renal function
      • Metabolic bone disease
      • Nutrition management
      • Peritoneal dialysis catheter placement
      • Uremia
      • Vascular access management/complications in hemodialysis
      • Vascular access preparation and placement
      • Volume management

Once candidates display proof that they have met minimum requirements, they must take and pass the Nephrology Specialty Exam, which consists of the following sections:

  • Acute renal failure/ICU nephrology: 3 percent
  • Chronic dialysis: 19 percent
  • Chronic kidney disease: 14 percent
  • Clinical pharmacology and miscellaneous: 10 percent
  • Diabetes mellitus: 10 percent
  • Hypertension: 13 percent
  • Kidney transplantation: 6 percent
  • Renal pathophysiology: 15 percent
  • Secondary glomerular/vascular disorders: 7 percent
  • Tubular/interstitial and cystic disorders: 3 percent

Resources for Physician Assistants in Nephrology

Networking with other professionals in nephrology and staying up-to-date on the latest trends and news related to the specialty are just a few of the reasons why physician assistants in nephrology become members of professional associations like these:

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