Myth #1: PAs are not rigorously medically educated
The PA educational system is comprehensive, rigorous, and purposeful. Following the medical model of education, PAs are trained as generalists to diagnose illness, create management plans for patients, prescribe medications, see their own patients, and often serve as principal healthcare providers.
Prospective PA students are typically very competitive academically and professionally. Applicants are required to have a bachelor’s degree, usually in a premedical, basic, or behavioral science field, similar to that of medical school applicants. Additionally, many incoming students also have significant medical experience through required shadowing and professional work prior to entering their formal medical education. All PA programs field a tremendous number of applications from well-qualified applicants and are able to be highly selective of incoming students. With nearly 300 accredited PA programs in the US, these highly qualified students make up over 9000 PA graduates each year (1).
All PA programs are accredited by the same review commission – the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The ARC-PA sets rigorous accreditation standards for all programs and is composed of representatives from all national PA organizations, the general public, and many physician organizations, including the AMA, AAFP, the ACS, and the ACP. Accreditation requires an initial PA program evaluation and frequent continuing evaluations to ensure programs regularly adhere to these rigorous standards. The ARC-PA currently accredits PA programs at the Master’s degree level.
The average PA program lasts 27 months, or three academic years. Each program has a didactic phase consisting of classroom instruction and early clinical exposure. Didactic phases cover basic medical sciences (e.g., anatomy, physiology, pharmacology), clinical application (e.g., clinical medicine, physical diagnosis, pathophysiology), and behavioral sciences (e.g., medical ethics, cultural humility, determinants of health). Didactic phases typically involve between 12 and 15 months of intense, full-time instruction. Didactic phases are followed by clinical phases consisting of 12 to 15 months of full-time clinical rotations in all primary medical and surgical specialties, including family medicine, pediatrics, emergency medicine, psychiatry, women’s health, internal medicine, and general surgery. Individual programs may also include intensive elective rotations in other medical and surgical subspecialties. The clinical phase consists of over 2000 hours of supervised clinical practice experience. In addition to didactic and clinical phases, PA programs also offer coursework in nonclinical aspects of medicine, including healthcare regulation, licensing and credentialing, reimbursement, billing, coding, patient safety, and quality improvement. In all, PA education is a Master’s level, intense, full-time medical educational system that uses modernized, evidence-based pedagogical approaches to quality education (1). PAs are trained to enter the healthcare workforce upon program completion having demonstrated competency in entrusted professional activities required of a clinician.
Following PA program graduation, PAs must pass a national certifying examination and become licensed by a state to practice medicine. PAs must also maintain their certification by completing 100 hours of continuing medical education every two years and taking a recertification examination every 10 years. PAs are the only medical profession that requires all certified practitioners to take a comprehensive medical examination to maintain certification.
During their professional careers, many PAs seek additional educational and training opportunities. PAs may seek added certifications, doctoral degrees, or clinical experiences (such as specialty-specific PA fellowships), in addition to their continuing education requirements, to better enhance their knowledge and skills in a more specialized area of the healthcare workforce. Today, some PAs are also leaving full time clinical practice to take roles in healthcare administration, clinical research, medical affairs, and government based on their advanced medical education and skills.
On July 1st, 2021, The VAPA legislation that creates a patient-care team model and replaces the term “supervision” with “collaboration and consultation” took effect.
- American Academy of PAs (2021). PA education – preparation for excellence. https://www.aapa.org/download/61328/. Accessed September 7, 2021.
- Virginia Academy of PAs (2021). https://www.vapa.org/2021-legislation-pa-scope-of-practice/
Myth #2: PAs and NPs are interchangeable
In general, all healthcare providers are educated to provide high-quality, safe, effective care for patients. Physicians, nurse practitioners, and PAs are the only three primary care providers named by the Affordable Care Act. PAs and NPs, while often occupying similar roles within the healthcare systems, are in fact quite different considering their educational, clinical, and regulatory features.
PAs are medical providers who diagnose illness, manage patient treatment plans, prescribe medications, and often serve as a patient’s primary healthcare provider. PAs have thousands of hours of medical education and training. PAs practice in every state and every medical setting and specialty, improving healthcare access and quality. In Virginia, a physician assistant working under a practice agreement with a licensed doctor of medicine or osteopathy specializing in the field of radiology is authorized to use fluoroscopy for guidance of diagnostic and therapeutic procedures provided such activity is specified in his protocol and has met the required qualifications.
PAs and NPs have different educational models. PAs follow a rigorous medical education curriculum modeled after traditional medical school spanning at least three academic years. PA education is full time, and most programs do not allow students to work outside of their academic schedule. NPs follow curricula based on the nursing model of education. Many master’s of nursing programs can be completed in as little as 18 months. Still, many NP schools are offered only online with little oversight during clinical education, and many NPs attend school on a part-time basis.
PAs and NPs are often also regulated differently. In nearly every state, PAs fall under the state’s medical licensing board, and some states also have a unique PA board of directors that collaborates with the medical board. NPs often fall under a state’s nursing board of directors with minimal or no collaboration with a state’s medical board or licensing agency.
Myth #3: PAs are held to lower standards than physicians
In clinical practice, PAs are held to the same standards of care as their physician colleagues. PAs are responsible for evaluating, diagnosing, treating, and following the patients that they see. Many PA practice settings employ different models of PA care and physician collaboration. In many settings, PA see their own panel of patients and may be the only medical provider onsite. In other settings, PAs and physicians manage patients together, sometimes seeing patients on their own and sometimes managing patients as a team. Still, in other settings, such as in surgical specialties, PAs and surgeons rotate patient care responsibilities such as preoperative care, postoperative care, hospital rounds, and follow up visits in which either sees a patient independently or together, depending on the circumstance. During surgery, PAs often serve as a surgical first-assist for operations. PAs also can perform minor surgeries and procedures independently.
Since PAs are responsible for providing high-quality, safe, effective care for their patients, patients can expect that PAs are providing the same standard of care as a physician. PAs are trained in a rigorous medical educational model and must pass a high-stakes, national certification exam upon graduation in order to apply for a state license. PAs must maintain their certification through intense continuing education, and PAs are responsible for staying up to date on the standards of medical care, much like physicians. Many studies demonstrate that PAs provide similar care to that of physicians across specialties and care settings (1,2).
- Jackson, G. L., et al. (2018). Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants: A Cohort Study. Annals of Internal Medicine, 169(12): 825- 835
- Rymer, J.A., et al. (2018). Advanced Practice Provider Versus Physician-Only Outpatient Follow-Up After Acute Myocardial Infarction. Journal of the American Heart Association, 7(17): e008481.
- Virginia Academy of Physician Assistants: https://www.vapa.org/wp-content/uploads/2022/06/PA-Regs-4-1-22.pdf
Myth #4: Patients only trust physicians for medical care
PAs are very well trusted by patients and their families. In fact, recent polls have shown that 93% of patients trust a PA as their healthcare provider, 92% of patients view that PAs make access to care easier, and 91% of patients state that PAs improve their quality of care (1).
Patients will see PAs in every medical specialty and in every practice setting. There are over 160,000 PAs in the US that account for over 400 million patient interactions each year (1). Patients can trust that PAs are able to provide safe, quality, effective medical care during those interactions.
- American Academy of PAs (2019). What is a PA? https://www.aapa.org/wp-content/uploads/2019/08/What_Is_A_PA_Infographic_LetterSize_Jan2020.pdf. Accessed November 2, 2021
Myth #5: PAs only see delegated patients
PAs work as vital members of a patient’s healthcare team. The most successful healthcare teams are those that utilize the skills, abilities, and expertise of each team member most fully to best meet the needs of the patients. Since PAs are highly trained and skilled healthcare providers, PA-healthcare teams are most effectives when PAs are able to practice at the top of their license and skill set.
PAs can take on unique roles within each healthcare team. In many practices, PAs manage their own patients and may be the only medical providers on site. Other practices may use a model in which a PA and another provider care for patients both individually and together. In surgical practices, PAs perform preoperative care, perform procedures, first assist during surgery, and provide a full scope of postoperative management. PA-surgeon teams have been shown to reduce operative anesthesia times and patients’ length of stay in the hospital.
In the Commonwealth of Virginia, PAs collaborate with physicians to provide care, and this can take on many different forms, most of which allow PAs to practice at the top of their licenses. This collaboration is best determined at the practice level between the PA and the other members of the healthcare team. In Virginia, physicians are not vicariously liable for the care a PA provides when the physician is not involved in a patient’s care. This highlights the responsibility that PAs take when caring for patients.
Myth #6: Physicians can only supervise one PA
One-to-one PA-Physician teams are no longer the norm for most healthcare teams. Each state designates the number of PAs a physician may collaborate with through a practice agreement. Some states do not designate this kind of ratio and do not require practice agreements.
In the Commonwealth of Virginia, a physician can enter into a collaborative agreement at the practice level with up to six concurrent PAs. This allows for improved flexibility of the healthcare team to be able to best meet the needs of the patients. Physician collaborators do not have to be on site with a PA to provide collaboration, nor do physicians have to see a percentage of a PA’s patients or review a percentage of a PA’s medical records.
Myth #7: PAs can only practice when physicians are onsite
In many practices, PAs manage their own patients or are the only medical provider on site. Some practices use a model in which both the physician and PA care for patients together. PAs in surgical practices perform preoperative H&Ps, perform procedures, first assist in surgery, and provide a full scope of postoperative management.
On site requirements between collaborating physicians and PAs is determined by each state’s medical licensing board. In the Commonwealth of Virginia, collaborating physicians do NOT have to be on site when a PA is providing direct patient care. Additionally, state regulations in Virginia do not require collaborating physicians to see a percentage of a PA’s patients or review a percentage of a PA’s medical records. Any such requirements can be determined at the practice level between a collaborating physician and the PA.
Myth #8: PA cannot charge or reimburse for patient care
PAs strive to provide the most effective, safe, quality healthcare possible. PAs are highly trained through rigorous medical education to be able to provide this care. As such, Medicare, Medicaid, TRICARE, and nearly all commercial insurance payers cover the medical and surgical services delivered by PAs.
Medicaid: All 50 states and the District of Columbia cover medical services provided by PAs under Medicaid fee-for-service or Medicaid managed care programs. The reimbursement rate is either the same as or lower than that paid to physicians. Medicaid programs in forty-four states and DC specifically enroll PAs in their programs. Whether enrolled or not, most services PAs deliver to Medicaid beneficiaries are covered.
TRICARE: The health benefit program for all seven uniformed services of the U.S. military, TRICARE covers all medically necessary services provided by a PA. The physician with whom the PA works must be an authorized TRICARE provider. The employer bills, indicating the PA as the provider of care, and is reimbursed for services provided by the PA. Coverage under TRICARE for PAs is at 85 percent of the physician fee schedule, including surgical firstassisting. TRICARE does not allow for “incident-to” billing, however, there are some cases in which TRICARE will reimburse a maximum allowable amount for a PA’s service that may not exceed the allowable charge rendered by a physician. These are very specific instances.
Commercial Payers: In general, nearly all commercial payers reimburse for services provided by PAs based on each individual company’s terms. Typically, the allowable amount of reimbursement for care is the same as that of a physician.
Medicare: Historically, Medicare covers PA services in all practice settings at 85% of a physician’s fee. Claims can be submitted to Medicare using the PA’s NPI number. Despite the 15% differential, this approach still allows for maximum efficiency in scheduling patients with Medicare given the cost differential between PAs and physicians.
Medicare also allows for PAs to bill for services under a physician’s NPI number in certain circumstances. These circumstances are called “incident-to” and “shared” billing and have specific rules for submitting claims. If these rules are followed, Medicare can reimburse at 100% of the normal fee schedule for the care provided.
Medicare billing for PAs is undergoing changes. Current proposed legislation has deemed that PAs could now be able to directly bill Medicare for services rendered, eliminating the 15% fee reduction when claims are submitted directly using a PA’s NPI number.
- American Academy of PAs (2020). Third-party reimbursement for PAs. https://www.aapa.org/download/48117/. Accessed November 2, 2021.
Myth #9: PA cannot provide mental health services
While there is a low percentage of PAs in the specialty of psychiatry, PAs see patients daily with mental health issues and treat them well. Primary care PAs provide a high number of mental health services to patients. PAs also have the option to obtain further training through NCCPA CAQ (Certificates of Added Qualifications) in Psychiatry. PAs are reimbursed by Medicare, Medicaid, and private insurance. PAs also give flexibility for uninsured patients to have selfpay options.