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Physician Assistants Playing Larger Role in Health Care

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CEDAR RAPIDS, Iowa -- It probably comes as little surprise to Eastern Iowans who have recently visited a clinic, doctor's office, nursing home or hospital emergency room that physician assistants are growing in number and playing a greater role in health care.

Supervised by physicians and surgeons, physician assistants are formally trained to provide diagnostic, therapeutic, and preventive health care services. They take medical histories, examine and treat patients, order and interpret laboratory tests and x rays, and make diagnoses.

Physician assistants also treat minor injuries by suturing, splinting, and casting. They record progress notes, instruct and counsel patients, and order or carry out therapy.

Physician assistants also may prescribe certain medications. They sometimes are the principal care provider in rural clinics where a doctor is present for only one or two days each week.

"With the profession achieving some sort of a critical mass, I think the public is becoming more aware of physician assistants and the role they play in health care," said David Asprey, assistant dean, Office of Student Affairs and Curriculum, in the Carver College of Medicine at the University of Iowa. "The physician assistant profession also has really taken off in other countries over the last 10 years."

Dr. Dustin Arnold, chief medical information officer at St. Luke's, said physician assistants fill a critical role in today's health care system.

"They are extremely important because we continue to experience a shortage of primary care physicians," Arnold said. "They are more than capable of handling many situations involving the basics of medical care, particularly in rural communities. We have no reservations releasing someone from the hospital to their care when a patient returns to their community."

Almost 83,500 physician assistants are practicing in the United States, representing a 100 percent increase over the last 10 years, according to the American Academy of Physician Assistants. And the U.S. Bureau of Labor Statistics is projecting that number to increase by 38 percent by 2018 as an aging population requires more services and health care cost containment becomes a major priority.

A report issued in November by the University of Iowa Healthier Workforce Center for Excellence found 3 out of 4 Iowans surveyed by phone would be willing to see nurse practitioners and physician assistants, instead of doctors, to reduce health care costs.

A nurse practitioner is an advanced practice registered nurse with either a master's or a doctoral degree and is licensed or certified through the state nursing board rather than the medical board. They are not required to work under the supervision of a doctor or surgeon.

Iowa has nearly 1,000 practicing physician assistants, roughly the same number as surrounding states with the exception of Illinois. Women outnumber men as physician assistants by about 2 to 1 in nationally.

Asprey, who supervises the UI physician assistant program, said the profession originated in the early 1960s when doctors felt they were overwhelmed and unevenly distributed.

"They really wanted someone who could come alongside them," Asprey said. "They initially thought of the medic model in the armed forces because medics already had a lot of the necessary training.

"The very first physician assistant program was started by Duke University's School of Medicine in 1965 and the University of Iowa admitted its first class of physician assistants in 1972."

U.S. News ranks the Duke physician assistant program No. 1 in the nation and the UI program is tied with the University of Utah for No. 2.

Asprey said the UI physician assistant program differs from most others in the country in that students take their courses alongside those in the college's M.D. program.

"We admit a class of 25 annually to our physician assistant program, which lasts for 25 months," Asprey said. "The students in the program start in May with several courses and report writing in the summer semester and join the sophomore M.D. students in the fall semester, taking their classes together. The same thing occurs in the second year of the program, which provides the physician assistants and doctors a real understanding of the training that each other receives."

Physician assistants graduate from the UI program with a master of science degree in physician assistant studies. While not required to complete a residency, many do in subspecialties such as pediatric cardiology and emergency room medicine.

Emily Appleton, a physician assistant with St. Luke's Physicians & Clinics Mount Vernon Family Practice, said she has a degree of autonomy that allows her to handle many of her patients' diagnoses and treatment.

"I always submit my notes to a doctor for them to sign off and I can always ask them a question if it is required," Appleton said. "I've been a physician assistant for 12 years and I really enjoy what I do. I had the opportunity to shadow several physician assistants before I make the decision to enter the profession."

Rachel Burns, a senior student in the UI physician assistant program, agrees with Appleton that taking classes alongside future physicians has its advantages.

"The opportunity to interact with your future colleagues is really great," said Burns, 27, of Minnetonka, Minn. "There are many other physician assistant programs where the students have absolutely no interaction with medical students and that makes no sense to me. You're going to be team members from this point forward, so why wouldn't you work together?"

Chelsea Peoples, a native of Woodward, Iowa, spent a year working in the emergency room at St. Luke's Hospital before enrolling in the UI physician assistant program. Peoples, 24, was initially a pre-med student at UI during her freshman year, but changed to pre-physician assistant after learning more about the profession.

"It was really a magic fit," Peoples said. "I felt that this was really my dream job because it would allow me to really help people."

Peoples has narrowed her choices to family practice, pediatrics or emergency room medicine when she graduates from the UI physician assistant program.

"I've always been interested in pediatrics," she said. "In all the courses I took during my undergraduate years, the cardiology sections were always more interesting to me. We typically learn more about adult cardiology in our course work, but pediatric cardiology is totally different.

"Whether I'm working in family practice or an emergency room, I will more than likely encounter children as patients."

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