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 erhaps
the best way to understand what a PA does is to visualize
one in practice. Here is a possible scenario involving one
physician who has fully incorporated a PA into his practice.
They have worked together for two years.
Dr. Q, a physician in private
general practice, arrives at his office at 8:00 a.m. His PA,
Mr. J has just walked in. They look at their patient schedules
for the day and discuss any potential problems. Mr. J inquires
about changing the insulin regimen of a diabetic patient he
has been following, and together they work out a better dose
schedule.
At 9:00 a.m., they start
seeing patients in separate exam rooms, with the nursing staff
assisting both. The PA handles uncomplicated new cases, does
physical exams required for school or employment, and sees
patients with chronic problems returning for maintenance care.
He orders and evaluates appropriate lab work, x-rays, EKGs
and writes drug orders working within protocols and formularies
developed together with his supervising physician.
At 11:30 a.m., Mr. J consults
with Dr. Q about a patient he has just seen who appears to
be in heart failure. They review the case and decide to admit
the patient to the hospital. Mr. J makes the admission arrangements,
and since he had planned to make hospital rounds for Dr. Q
this afternoon, accompanies the patient to the hospital. While
there, he reviews the charts of Dr. Q's post-op patients, makes
progress notes and written orders under conditions agreed on
by Dr. Q, the hospital and the PA.
Later he visits some of
Dr. Q's nursing home patients, and returns to the office at
the end of the afternoon to discuss patients who he feels should
see the physician at their next visit. He also asks for advice
about two in-patient problem cases. Dr. Q asks the PA to spend
some extra time with two of his own patients; a new mother
who desires to learn the various methods of contraception,
and an obese man wanting to start a diet and exercise program.
Dr. Q will attend a local
continuing education seminar the next day; they have scheduled
patients for Mr. J for that time. In the past Dr. Q was forced
to close the office on such occasions. He will carry a beeper
so that the PA can contact him immediately should any problems
arise. Tonight Mr. J will be on call, as he is two nights every
week. At week's end, Dr. Q will review the PA's charts and
countersign them. This process has become easy as his assistant's
knowledge and experience have grown. Dr. Q feels pleasure in
having taught the PA much during their work together, and realizes
that both of them stay mentally sharp as a result.
For these services, Dr.
Q pays his PA a competitive salary plus a percentage of the
office income. At first, during an adjustment period, that
salary was lower and there was no percentage while the two
learned to work together as a team. But as Dr. Q saw his office
income and productivity rise, he increased the compensation
accordingly. Still, it is much less than a physician-partner
would require, as his practice would not accommodate a full
partner. His malpractice premium is only slightly higher than
it was before he employed the PA. Both Dr. Q and Mr. J are
well satisfied with their relationship.
At first, patients had questions
about the PA, but after a short time they accepted him without
question and many now specifically request to be seen by him
when making their appointments. And, many patients comment
to Dr. Q that they appreciate the extra time the PA takes to
explain his instructions and answer their questions. Some were
frankly amazed when the PA made a house call.
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