Author: wolvenmedia

http://www.raconline.org/rss/fundingtopic46.xml This is a great article and resource……

The positions of nurse practitioner and physician assistant were created approximately 30 years ago. Since then, the role and responsibilities of these individuals have developed and grown and now may include involvement in the care of hospitalized patients. The intent of this statement is to suggest a manner in which nurse practitioners and physician’s assistants may participate in and contribute to the care of the hospitalized child on the general inpatient unit, among other areas.

During the 1960s, nurse practitioner (NP) and physician assistant (PA) training programs were initiated1 in response to a perceived shortage of physicians, especially in medically underserved communities that were often also economically deprived. NPs and PAs were originally considered to be alternative health care personnel who would function under the supervision of physicians, extending the ability of the physician to provide service to a greater number of patients.

During the last 10 years, however, the scope of practice of NPs and PAs in pediatrics has been expanded to include the care of hospitalized patients.2 This expansion has been driven by continuing regional shortages of physicians, efforts to reduce the cost of health care, and decreasing funding for graduate medical education which means fewer residents (residency positions). A major concern has been that the expansion of the scope of practice of NPs and PAs may impact on the management of pediatric inpatients3 and create a two-tier system of health care. Another issue is that resident experience may be diluted when NPs and PAs assume some of the responsibilities for patient care.

As initially conceived, the roles of NPs and PAs in pediatrics were to assist the physician in the provision of primary care for well children and those with acute minor illnesses. During the past 30 years, subspecialty areas for NPs, such as the neonatal NP, have developed. PAs have been used more extensively in hospital departments of surgery, in which they may obtain initial histories and perform physical examinations and minor surgical procedures, under physician supervision.

Despite the original intent for the roles of NPs and PAs, current economic pressures have promoted their increased use and expanded scopes of practice. This is true despite data from ambulatory settings clearly demonstrating that although NPs and PAs individually earn lower incomes than physicians, their involvement in care costs the same or more per patient encounter because they tend to spend more time with each patient and usually work a 40-hour week, while physicians treat patients more expeditiously and work longer hours.5,6

However, a role may exist for NPs and PAs on the pediatric inpatient unit. The NPs and PAs who are used in such positions require additional precepted education, beyond that required for certification. The additional precepted education should be the responsibility of the pediatric unit director and should include orientation to hospital and departmental policies and protocols and direct teaching of clinical skills needed for the specific unit. The NPs and PAs should work under the close direct supervision of an attending physician, and the patient’s primary physician must always remain readily available to answer questions and provide backup to the NP or PA. Decisions regarding the need for admission, management plans, and appropriateness for discharge must be made with the involvement of the attending physician.

NPs or PAs working with a physician have a meaningful role in the management of hospitalized children. Having already demonstrated their abilities to perform in supervised intensive care settings, NPs and PAs should be effective on the general pediatric inpatient unit. As the scope of ambulatory care continues to expand, the children admitted to the general inpatient unit of the hospital have increasingly more complex illnesses. The responsibility for the management of the hospitalized child should be under the supervision of a qualified physician, because the physician has the most education and training for this role. Nevertheless, the NP and PA can play a valuable role in the care of the hospitalized child by contributing specialized skills that improve the quality of patient care. The NPs and PAs who participate in the care of the hospitalized child must have the additional education and training that such involvement requires.

Physician Assistants
by Wendy J. Meyeroff
Monster Contributing Writer

Working alongside physicians, Bill Mahaffy has harvested arteries and treated patients in cardiac-care units, but he’s not a physician; he’s a physician assistant (PA), an occupation that is expected to be one of the fastest-growing over the coming years.

PAs, who work under the supervision of doctors, are highly trained, licensed healthcare professionals who treat and diagnose patients, perform various medical procedures and act as a liaison with nurses, lab techs and others on the healthcare team. In 48 states and the District of Columbia, PAs can even prescribe medication.

With greater demand for healthcare services, Mahaffy says PAs are “taking care of about 80 percent of what the doctors used to,” freeing doctors to focus on more complicated cases.

For those willing to undergo the rigorous required medical training, the PA profession offers excellent prospects and a variety of opportunities for specialization.

Fast-Growing Field

Mahaffy, a certified physician assistant (PA-C) at Evangelical Community Hospital in Columbia, Pennsylvania, became a PA about 10 years ago after 25 years as a paramedic. “I had colleagues who were PAs, and it seemed like a logical progression,” he explains. “It was the best career choice I ever made.”

It’s a promising one as well. According to the US Bureau of Labor Statistics, the occupation will be the third fastest-growing professional job in the nation through 2012, when the number of PAs is expected to increase to 94,000, up 49 percent from 2002. The median annual salary is about $65,000, with the top 10 percent earning more than $90,000.

While salaries are high, aspiring PAs must be willing to tackle one of the more extensive health education programs outside of traditional medical school. Most physician assistant programs [http://www.aapa.org/pgmlist.php3] require applicants to have previous healthcare experience and some college education. The typical applicant holds a bachelor’s degree and has worked in healthcare for four years, according to the American Academy of Physician Assistants [http://www.aapa.org/]. PA training usually takes about two years full-time. In addition, graduates must pass a national certifying exam to obtain their state licenses. Continuing education is also required.

Like Mahaffy, many PAs segue naturally into the occupation from other healthcare fields. Mahaffy has seen former nurses, exercise physiologists, fitness trainers and even two mortuary technicians become PAs.

The Adrenaline Rush

PAs can be generalists or specialize in areas such as cardiology, pediatrics, psychiatry or trauma. [https://members.aapa.org/extra/constituents/special-menu.cfm]

Mahaffy, who is president of the American Association of Surgical Physician Assistants, [http://www.aaspa.com/] is a surgical PA specializing in cardiothoracic procedures. He’s harvested arteries for cardiac surgeons, put in dialysis catheters and inserted feeding tubes. Today, as a hospitalist (another specialty), he works anywhere outside the OR where surgical expertise is needed. For example, one of his duties in the cardiac-care unit is providing chest drainage to patients with congestive heart failure.

Mahaffy works five days on, five days off, starting at 5:30 a.m. or 6 a.m. for what are supposed to be 10 or 12-hour shifts, but he stays as long as he’s needed. His specialty can be “a young man’s game,” he admits. “You can live on adrenaline and caffeine.”

In a Family Way

Charlene Morris, MPAS, PA-C, offers another look at a PA’s life. A former lab tech, Morris has been a family-practice PA for 24 years. While she has been employed at major medical centers, she now works alongside a family-practice physician at the B.F. Taylor Medical Arts Family Medicine Clinic in the small town of Burkesville, Kentucky.

She describes the relationship with the doctor she supports as “very complementary” and says she loves the versatility of family medicine. “I’ll handle everything from colds and rashes, to sports injuries, to people with diabetes,” says Morris, who is president of the Association of Family Practice Physician Assistants. [http://www.afppa.org/]

Earlier this year, she widened her work’s scope by dividing her time between the clinic and the Cumberland County (Kentucky) ER. “I’ve had to go back and expand my suturing skills, and we have to be up on advanced cardiac life support,” she says.

Morris and Mahaffy emphasize the flexibility in their careers and agree that they could move into other areas, from neonatal to aerospace medicine. “PAs can work in any and all settings with their physician colleagues,” Mahaffy says.

source: http://healthcare.monster.com/articles/physicianassistant/

It’s one of the fastest growing careers in the country. Learn about how to get into a top program.
By Brian Burnsed
Posted August 6, 2010

After graduating from Manhattan College in 2004, Jason Lightbody had aspirations to pursue a career in the medical field, but didn’t want to sacrifice his personal life to the rigors of medical school, a residency, and life as a physician. He remembered being treated by a physician assistant for injuries he sustained as a soccer player at Methodist University during his first two years of school, and soon realized that pursuing a career as a PA would be rewarding while allowing him a full life outside of the one he lived in his scrubs. Lightbody graduated from the Yale School of Medicine Physician Assistant Program in 2007. “I never want to regret not living life to the fullest and I thought that if I were to go to med school then I wouldn’t be able to do a lot of things in my life that I wanted to do,” he says. “I’m still certain I made the right decision.”

The decision between PA school and medical school is one that an increasing number of college graduates and young medical professionals are facing. With the economy tight in recent years, demand for physician assistants has increased, as they are capable of practicing medicine at roughly the same level as a full-fledged physician, but at a much lower cost, which makes them an appealing asset to medical providers looking to trim budgets. And, given that most programs are only two years, PA students amass far less debt than their counterparts in medical school. The American Academy of PAs estimates that there will be 150,000 practicing PAs in the U.S. in 2020, up from 70,000 last year. Like Lightbody, more people are taking note of the profession. “Ten years ago when I introduced myself patients would ask, ‘What’s a PA?'” says Mary Jo Wiemiller, chair of physician assistant studies at Marquette University College of Health Sciences. “Now, when treating patients, they respond with something like, ‘Oh, my niece or nephew is in PA school.'”

But the appeal that is spurring job growth may make it tougher for aspiring PAs to get into school. According to Wiemiller, the number of applications to Marquette’s PA program has quadrupled over the past year. Due to the increased interest, the school can only accept 10 percent of applicants. “With heightened awareness of the PA profession in the last decade, it has become increasingly more competitive to gain acceptance to a PA training program,” says Wiemiller.

Given the heightened competition, it’s important for applicants to understand what matters most to PA admissions committees. These three top the list, according to officials at PA schools:

1. Medical experience: Your life working in the medical field will not begin once you’ve graduated from a PA program; it should start well before that. For students hoping to jump directly from their undergraduate studies to a physician assistant program, it is imperative that they spend as many college summers as possible, or use their free time during school, working or volunteering at a hospital or doctor’s office. For those students who wish to wait to attend PA school—the average age of people entering PA programs nationwide is 27—find a full-time job working in the medical field after earning your undergraduate degree. “We really are looking for—and I think a lot of other programs are, too—students who’ve had some previous healthcare experience where they’ve had some direct interactions with patients,” says David P. Asprey, director of the Physician Assistant Program at the University of Iowa Caver College of Medicine, which is U.S. News’s top-ranked PA program. “[It] adds a level of maturity.”

2. Science classes count most: Take as many core science classes—anatomy, biological sciences, and organic chemistry, to name a few—as you can and focus intensely on this coursework. PA programs not only look at your overall GPA—many schools require at least a 3.0 for admission—but give extra weight to your performance in science courses. “Obviously it would be a tragedy if we invited a student to join our program and we could anticipate that they would have difficulty with the academic rigors that are associated with it,” says Asprey. “It’s not for the faint of heart.”

3. Show compassion: Your GPA is stellar and you’ve amassed an impressive amount of medical work experience in the little spare time you have while keeping your grades pristine, but you still get that dreaded rejection letter. Why? You didn’t do enough volunteer work. Volunteering exemplifies your desire to help your fellow man—the attribute identified by schools as one of the most integral to becoming a successful PA. “Students who have had experience in working with underserved populations, rural or diverse populations, performing volunteer service or disaster relief, or other experiences that illustrate a drive and compassion for others often stand out to the admissions committee,” says Wiemiller.

http://www.usnews.com/articles/education/best-graduate-schools/2010/08/06/why-physician-assistant-school-may-be-right-for-you.html?PageNr=2

By Barbara C. Phillips, NP on June 15, 2010

Nurse Practitioners that accept Medicare in their practices need to be aware of how this will impact their practices. With the exception of Midwives, NPs are allowed only 85% of the physician allowable. Here is the update:

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.

This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.

We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.

Source: LEARNRESOURCE-L Email Update, National Institutes of Health, U.S. Department of Health and Human Services dated June 14.

This post focuses on a key question in health care reform — will there be enough doctors to go around? With plans to extend insurance to some 47 million people, the current primary care doctor shortage will only get worse, many say. One solution could be to increase the role of nurse practitioners.

The piece generated positive feedback and lots of interesting responses from readers across the spectrum about primary care, nursing and the reform debate. I also heard from a group of providers who felt overlooked: physician assistants.

I hope folks don’t see this as an intentional slight, as the story was a narrowly-focused piece looking at one slice of the health care debate. But it is true that using more physician assistants is among the solutions being tossed around to help fill the primary care gaps. And some observers think they could play an important role.

Physician assistants work under the supervision of a doctor and diagnose illness, order and interpret tests and, in most states, can prescribe medication. Training includes graduation from an accredited physician assistant program and passage of a certification exam.

Locally, more than 1,800 physician assistants are practicing in Maryland — about 90 percent of those in the Baltimore and Washington suburbs, according to the Maryland Academy of Physician Assistants. Like nurse practitioners, physician assistants work in a variety of disciplines, from primary care to specialty fields.

Welcome to the Litton Resource Blog. We are glad you stopped by to see what we are all about. The purpose of this blog is to share information, articles and hot job postings of Physician Assistant, Nurse Practitioner, Nurse Anesthetists, Clinical Nurse Specialists that we hope visitors will find interesting and informative. We will share opinions and advice on career related matters that we hope will help you in your job search. We will also share articles that we find on the net that pertain to healthcare and specifically advanced practice professionals. We hope you enjoy the information about nurse practitioner, physician assistant, clinical nurse specialists, nurse anesthetists as much as we enjoy providing it.