Fred Wu, Secretary/Treasurer of the Society of Emergency Medicine Physician Assistants (SEMPA), tells us his favorite myths about PAs.
Part 2 of the interview with Fred Wu – Click here to read ‘Training and Supervision: A Conversation with SEMPA Leadership’
MYTH: EMPA training isn’t very rigorous
FACT: PA education utilizes the medical model of training, lasting approximately 26 months and confers a master’s degree. PA programs include both didactic instruction and clinical rotations. The clinical training is more than 2,000 hours and includes rotations in specialties such as emergency medicine, pediatrics, internal medicine, family practice, surgery and more. Most programs also require prior patient care experience (eg. paramedic, corpsman, registered nurse, etc.). Graduates further their emergency medicine education by on the job orientation (internship) or postgraduate residency training.
MYTH: EMPAs do not have specialty certification
FACT: PA specialty certification in emergency medicine is offered by the National Commission on Certification of Physician Assistants (NCCPA) through the Certificate of Added Qualification (CAQ). CAQ candidates must demonstrate advanced knowledge and experience in emergency medicine. Requirements for certification include 150 hours of Category 1 Continuing Medical Education in emergency medicine, at least 3000 hours of practice experience, attestation from a supervising emergency physician that the PA is competent in emergency medicine procedures/patient care and successful completion of a written exam. Recertification is required every 10 years.
MYTH: If I don’t co-sign charts or interact with PAs, I won’t get sued
FACT: Most states have a statutory requirement of co-signing PA charts or a percentage of PA charts. Not reviewing PA charts may actually increase your liability. Keep in mind that not co-signing a PA’s chart does not absolve the supervising physician of the legal obligation of PA supervision. If a lawsuit is filed, the supervising physician will likely also be named as a co-defendant, so why not support your EMPAs instead of avoiding them. Collaboration will decrease risk and improve patient care.
MYTH: Co-signing charts of Medicare patients will enable me to bill 100%
FACT: Medicare currently reimburses PA services at 85 percent of the physician fee schedule. Shared Visit billing, which allows for reimbursement at 100 percent of the physician fee schedule, requires the physician to have face-to-face time with the patient along with physician documentation of the E/M services provided.
MYTH: PAs cannot bill for higher acuity patients
FACT: Centers for Medicare and Medicaid Services (CMS) allows PAs to bill for critical care services, as long as the billing requirements are met.
MYTH: PAs only see low acuity patients in Fast Track settings
FACT: A 2009 survey conducted by the NCCPA, in collaboration with SEMPA and ACEP found that nearly 70% of PA respondents reported their primary practice site to be in the main emergency department, rather than in a fast track/triage/urgent care setting.
MYTH: EMPAs are going to replace physicians
FACT: PA practice is based on a dependent relationship and collaboration with supervising physicians. PA’s are not seeking to be independent practitioners, nor are they looking to replace physicians. Workforce studies completed by the AAMC in 2005 and by ACEP in 2008 both project significant future physician shortages. PA’s are seeking to augment the emergency medicine health care team affording patients access to safe, efficient and quality emergency care.
MYTH: PAs can’t do procedures
FACT: PA education includes basic procedure training such as suturing, I&D and basic orthopedic procedures. EMPA’s gain additional procedural training by attending CME courses and/or by on the job training provided by our emergency physician colleagues. The 2009 NCCPA/SEMPA /ACEP survey found EMPA’s performing procedures such as multiple layer laceration repair, arthrocentesis, fracture/dislocation reduction, lumbar puncture, intubation, central venous access and tube thoracostomy.
Photo by Eden, Janine, and Jim