The December 2019 EMN article, “The Invasion of the Physician Assistants,” by Thomas Cook, MD, failed to mention numerous facts regarding PAs that readers should know. (2019;41:1; http://bit.ly/37ZBQOv.)
PAs are highly competent APPs trained in a medical model based on the medical school curriculum. Admission to PA school is highly competitive, and requires science or degree prerequisites similar to the premedical requirements for medical school entrance. PA school consists of more than 1230 hours of rigorous classroom-based didactic training across three academic semesters of full-time study, followed by more than 2000 hours of immersive clinical rotations across seven medical specialties.
PA programs constitute approximately three academic years of full-time, comprehensive medical training. All PAs must pass the PA national certifying exam (PANCE) administered by the National Commission on Certification of Physician Assistants before receiving a license to practice medicine, complete 100 hours of CME every two years, and successfully pass a recertification exam every 10 years. (AAPA. http://bit.ly/2tjYFwd.)
PAs are uniquely positioned to practice as APPs in EM. ARC-PA standards require rigorous didactic training in EM topics as well as a full clinical rotation in EM for all PA students. (ARC-PA. September 2019; http://bit.ly/2toKyG8.) PAs can receive the demanding EM-CAQ certification, which requires EM-specific CME, more than 3000 hours of full-time EM practice, letters of recommendation from EPs, and successful completion of a comprehensive EM-specific standardized exam administered by the NCCPA. (NCCPA. http://bit.ly/2LXouc0.)
PAs recognize that physicians have advanced training beyond that of NPs and PAs. PAs have not made a push for independent practice due to this consideration, and are seeking optimal team practice in which PAs assume clinical and medicolegal responsibility for the clinical care that they provide while respecting the physician-PA team approach. (AAPA. http://bit.ly/2LXoQzm.)
Curvin L. Gordon, PA-C
Dr. Cook responds: Thanks for sharing your opinions. I have received several spirited items of correspondence from the columns I have written over the past six months on the dramatically changing landscape of supply v. demand for emergency physicians.
Your letter seems to contradict itself by stating that “PAs have not made a push for independent practice” and then that there is a desire for PAs to “assume clinical and medicolegal responsibility for the clinical care that they provide.” This sounds to me like there is growing interest in achieving more autonomy.
You also listed a number of statistics about the training for PAs, including 2000 hours of clinical training. A residency-trained emergency physician, however, completes at least two full years of clinical training in medical school before participating in another three years of clinical training during residency. During this time, they work approximately 5000 hours just in the emergency department, with the vast majority of those hours in high-volume, high-acuity environments with highly-trained, dedicated academic emergency physicians who have spent their careers creating educational content. The clinical and academic experiences of PAs in emergency medicine do not compare.