PA Training and Supervision: A Conversation with SEMPA Leadership

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A conversation with Fred Wu, Secretary/Treasurer of the Society of Emergency Medicine Physician Assistants (SEMPA)

Part 1 of 2 of the interview with Fred Wu – Click here to read ‘Fact v. Fiction: The Truth Behind a Few Common EMPA Misconceptions’

EPM: Despite it being acknowledged that the role of PAs is unquestionably essential in the operation of a contemporary ED, there are some ongoing concerns about ED-specific training.   What is SEMPA’s position on PAs seeking “Certificates of Added Qualifications [CAQs] in Emergency Medicine from the National Commission on Certification of Physician Assistants?


Fred Wu: Here are some highlights from SEMPA’s position statement on the CAQ: SEMPA encourages appropriately qualified physician assistants and qualified members to obtain the CAQ in emergency medicine as is deemed necessary for the practice environment, career advancement and objectives of the emergency medicine physician assistant and the attestation of the supervising physician. Whereas the CAQ is a mastery level competency process, it cannot be viewed as the entry-level credential for physician assistants beginning a practice in emergency medicine, and therefore should not be utilized to define minimum standards for hospital credentialing or employment. Whereas the CAQ has as a prerequisite valid state licensure and national certification as a PA-C, the CAQ should not be used by any regulatory or credentialing body as a mandatory requirement for practice. Nor for the same reasons should it be viewed by any third-party payer as a mandatory requirement for reimbursement.

EPM: What role, if any, did SEMPA have in developing the criteria to earn a CAQ in EM?

FW: SEMPA did not have a direct role in developing the criteria for the CAQ. We do have board members involved with the exam writing/review process.


EPM: The current requirements for obtaining a CAQ in EM includes obtaining 150 hours of CME credit and seeing 3,000 ED hours. Given that the exam is given only once a year, it would seem that it may take a PA years before they can sit for the exam.  The problem—how do ED managers know that PAs without a CAQ in EM (which is the vast majority) are qualified to practice in an ED (given that the main focus of PA training is on primary care?  Seems ED directors would want some assurances BEFORE a PA began working in an ED.  Learning on the job is dangerous business in the ED.

FW: The requirements for obtaining a CAQ in EM include 150 hours of EM CME, 3000 hours of EM experience, supervising physician attestation to experience/procedures and a written exam. In addition to the annual exam offering, NCCPA also offers the exam in conjunction with SEMPA 360, which is SEMPA’s annual conference in the spring. While the origins of PA education are in primary care, some students now try to tailor their clinical training to EM. For example, students may choose electives in Pediatric EM, critical care or additional EM time to further enhance their education and experiences. Post graduate residencies/fellowships are also now an option and range from 12-18 months duration. Learning on the job is not dangerous as long as there is adequate supervision. This supervision is the responsibility of the employer, whether that be the physician or EM group. Many facilities incorporate an orientation/training period along with varying levels of supervision depending on the PAs experience level.

EPM: Many PAs have expressed concern that ED physicians often provide inadequate supervision — claiming being busy with their own patients or expressing a general reluctance to see patients at the request of the PA.  What’s SEMPA’s advice when this is occurring?

FW: We all want what is best for our patients but these scenarios can increase everyone’s risk in the ED and compromise patient safety. 1) PAs should keep in mind that when you ask for assistance the timing should be taken into consideration. In an ED with multiple physicians, consider requesting assistance from the physician who is not overwhelmed with ten patients or a critical trauma patient. 2) If the supervising physician is more comfortable caring for a particular patient/case instead of supervising the PA currently caring for the patient/case, the physician should assume responsibility. 3) If the rules of supervision remain unclear, discussions with the Lead PA or Medical Director may also help clarify expectations and roles of supervising physicians. These measures can help enhance the PA/physician relationship and benefit the patient, which is the ultimate priority.


EPM: Inadequate supervision seems to be at the heart of the growing number of law suits against PAs.  What is SEMPA doing to apprise PAs of the risks associated with inadequate supervision and how to respond to it.

FW: I’m not aware of the growing number of lawsuits against PAs. A 2011 study in Medical Economics found that the combination of PAs and their supervising physicians have a low rate of malpractice compared to physicians overall. I think this highlights the collaborative relationship PAs have with their supervising physicians. 2001-2010 data from the Physician Insurers Association of America found that emergency medicine only accounted for 6% of all PA malpractice claims. Finally, in 2011, a majority of surveyed ACEP members did not feel that PAs are more likely to commit malpractice than other providers. Not only should PAs be concerned about the risks of inadequate supervision, but so should supervising physicians because inadequate supervision can also increase their liability. I had the honor to represent SEMPA at ACEP’s 2014 Scientific Assembly by giving a lecture discussing strategies for safer supervision such as chart review, education, collaboration, pro-activeness and establishing guidelines.

EPM: What is the range of hourly pay for PAs in the ED?

FW: According to the 2013 AAPA Salary Report, the national median for EMPA compensation is $108,000. A 2014 survey by Clinical Advisor showed the mean EMPA salary to be $113,393.

EPM: What services is SEMPA providing to PAs and what are they doing to encourage enrollment?

FW: SEMPA supports the professional and personal growth of EMPAs through education, advocacy and networking. We are engaged at a national level regarding advocacy and federal/legislative affairs. We offer EMPA CME not only at our annual conference but we also have a great deal of online CME available. We assist EMPAs from all over the country on issues ranging from clinical practice topics, compensation and credentialing, just to name a few. SEMPA has also established a charitable fund to support student scholarships, research and the EMPA profession. If you look at the benefits that SEMPA offers ( it’s clear the value and benefit we are able to provide EMPAs.

The answers above are my opinion and official SEMPA position statements have been provided when appropriate.


Fred Wu, PA-C, MHS is the Lead PA in the emergency department at Kaweah Delta Medical Center (Visalia, CA) and serves on the Board of Directors for the Society of Emergency Medicine Physician Assistants (SEMPA).

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