Physician Assistants have been working with plastic surgeons for over 30 years. Over the course of the profession's development, PAs have grown in number and in the range of medical services they provide to surgeons and physicians in every medical practice area, becoming an integral part of practices and institutions while carrying forward a new model of team medical practice.
In the mid-1960s, physicians and educators recognized there was a shortage and uneven distribution of primary care physicians. To expand the delivery of quality medical care, Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of PAs in 1965. He selected Navy corpsmen who received considerable medical training during their military service and during the war in Vietnam but who had no comparable civilian employment. He based the curriculum of the PA program in part on his knowledge of the fast-track training of doctors during World War II.
In October of 1967, Duke University PA program graduated the first PA students who went on to start practicing as PAs. Today there are over 79,000 graduates of PA programs. The United States Bureau of Labor Statistics (BLS) projects that the number of PA jobs will increase by 27 percent between 2006 and 2016. The BLS predicts the total number of jobs in the country will grow by 10 percent over this 10-year period. The PA profession was ranked the fourth fastest growing profession in the country by CNN.com and Forbes.com in 2007.
PAs are trained using an education model similar to that of physician training. As stated in the recently published American Academy of Physician Assistant's Issue Brief, Physician Assistants in Plastic Surgery (www.aapa.org/images/stories/plastisurg.pdf):
PA education is modeled after physician education and parallels medical school, with a rigorous curriculum including anatomy, physiology, pharmacology, physical diagnosis, behavioral sciences, microbiology, pathophysiology, medical ethics and clinical laboratory sciences. Following approximately 12 to 14 months of basic science and medical science classroom work, PA students complete on average 2,000 hours of supervised clinical practice before graduation.
All 50 states, the District of Colombia and Guam have state laws governing the delegation of duties, within the physician's own scope of practice, to their PA. Also, most third party payers have policy in place to cover physician services when rendered by a PA, including first assisting at surgery.
Approximately one quarter of practicing PAs are in surgery and surgical subspecialties. According to the American Academy of Physician Assistants 2008 Report, Primary Specialty of Practice: While PAs practice in more than 60 different specialty fields, 37 percent of PAs reported that their primary specialty was one of the primary care fields: family/general medicine (26%), general internal medicine (5%), general pediatrics (3%), and obstetrics/gynecology (2%). Other prevalent specialties for PAs include general surgery/surgical subspecialties (25%), emergency medicine (11%), the subspecialties of internal medicine (10%), and dermatology (4%).
A 2007 survey by the Association of Plastic Surgery Physician Assistants (APSPA) showed that a wide array of plastic surgery procedures are delegated to PA members of the plastic surgery team. Fillers, lasers, pre- and post-operative evaluation, inpatient rounding, and, of course, intra-operative duties are just a few of the areas where PAs are working to make the Plastic Surgeons' lives easier. Physician Assistants are unique in that they function as agents of their supervising physicians, working in medical team with doctors to extend services to patients and improve the quality of life of their employers. Supervising physicians delegate to PAs exactly those areas of their own scope of practice that they choose to share and feel would best suit their patient's needs. In this way, the PA concept is uniquely adaptable to a wide range of plastic surgery settings.
APSPA estimates that there are about 450 PAs working with plastic surgeons in the United States. The average salary for PAs in plastic surgery is $92,633 with a 2001 cost benefit analysis from a solo MD private practice showing a real, 82% return on their investment of a PA.
One satisfied plastic surgeon who supervises a PA described the benefits of employing her in this way: "In my practice, the PA has multifaceted roles. On the one hand, she is a first assistant in the O.R., consistently performing surgery to the standards I have set. In addition, she is a provider in the office. She sees pre-op and post-op patients and is an expertly trained filler and Botox injector. For me, having a PA allows me to more efficiently schedule patients and keep my operating room schedule filled."For more information about hiring a PA, or to post an available position please visit www.APSPA.net. Also, www.aapa.org is an in-depth resource on all aspects of the PA profession.
Submitted by Leah M. Kenney. PA-C
Leah is in practice with ASAPS Member, Glen S. Brooks M.D. in Longmeadow,
MA and was a founder of the Association of Plastic Surgery Physician
Assistants (APSPA). She also serves as the Liaison from the American
Academy of Physician Assistants to the American Society of Plastic Surgeons.