What is a PA?

doctorsaboutPhysician assistants, or PAs, are health care professionals licensed, or in the case of those employed by the federal government, are credentialed to practice medicine with physician collaboration. As part of their comprehensive responsibilities, PAs perform physical exams, diagnose and treat illnesses, order and interpret tests, give advice on preventive health care, assist in surgery, and write prescriptions. PAs exercise autonomy in medical decision making and provide a broad range of diagnostic and therapeutic services within the Physician-PA relationship. A PA’s practice may also include education, research, and administrative services.

The PA profession was founded in 1965 at Duke University in North Carolina to address the shortage and uneven distribution of physicians. Ten years later, there were approximately 1500 practicing physician assistants. The first PA Practice Act in Illinois was passed that same year, 1987.  Currently, there are 3,300 licensed PAs in Illinois.  Although PAs working in family and general medicine constitute the largest group, PAs are also found in specialities of medicine and surgery. In fact, the November 2009 CNN Best Job report ranked Physician Assistant second in the list of top 50 jobs forecasting a 27% growth in demand for the position in the next decade.

(https://money.cnn.com/magazines/moneymag/bestjobs/2009/full_list/index.html).

Increased utilization of PAs may result in improved distribution and access to health care services, especially in rural and medically underserved areas. Patient waiting times are reduced, and PAs may have more time for questions, counseling and education. This helps to increase the level of patient understanding and compliance, which in turn reduces the cost of health care. Research has demonstrated that PAs provide excellent care and are cost effective ( JAAPA. 2002 Nov;15(11):39-42, 45, 48 passim).

PA responsibilities may include, but are not limited to:

  • Obtaining medical histories
  • Performing physical examinations
  • Providing preventive health services and promoting wellness
  • Ordering, assessing the results and sometimes performing
    diagnostic and laboratory tests
  • Diagnosing and treating medical or surgical conditions
  • Assisting in surgery
  • Providing emergency and critical care
  • Prescriptive privileges for all legend drugs and controlled substances II-V
  • Patient counseling and patient education
  • Making rounds in hospitals and nursing homes.

PAs practice medicine on healthcare teams with physicians and other providers.

Physician Assistants work in a wide variety of health care environments, including:

    • Private and group practice settings
    • Hospitals
    • Veterans’ Administration and military settings
    • Nursing homes
    • Community health centers
    • Rural health centers
    • School based health centers
    • Occupational medicine settings
    • Correctional institutions

Physicians and health care organizations are continually expanding where and how PAs can best serve the needs of patients and communities.

Physician assistants receive a broad medical education. Because of the close working relationship the PAs have with physicians, PA education is designed to complement medical training. Criteria for admission to a program include previous health care experience and completion of a variety of basic science as well as other general courses. PA educational programs average 24-27 months in length. They are accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) and sponsored by schools of allopathic or osteopathic medicine, colleges and
universities affiliated with appropriate clinical teaching facilities and medical education facilities of the federal government.

The professional curriculum for PA education includes basic medical, behavioral, and social sciences; patient assessment and clinical medicine; supervised clinical practice; and health policy
and professional practice issues. Supervised clinical practice experiences for students include rotations in emergency medicine, family medicine, internal medicine, general surgery (including operative experiences), geriatrics, pediatrics, prenatal care and women’s health, psychiatry and/or behavioral medicine. Although PA Programs may confer a variety of degrees to their graduates. PA education is conducted at the graduate level. Consequently, a bachelor’s degree and clinical health care experience are prerequisites to most programs.

Upon graduation, physician assistants take a national certification examination developed by the National Commission on Certification of PAs in conjunction with the National Board of Medical Examiners. To obtain a license in Illinois, a PA must pass this exam. After passing the exam, the Illinois PA uses the credential PA-C. To maintain their national certification, PAs must log 100 hours of continuing medical education every two years and pass a national recertification exam every six years. PA education continues throughout a provider’s career with mandatory continuing medical education as well as the ongoing professional interactions between health care providers.

State laws and regulations define the physician assistants scope of practice as well as serve to establish licensure and competency requirements. The responsibilities of the supervising physician are also specified. In Illinois, licenses are obtained through the Department of Financial and Professional Regulation. More information about the Illinois PA Practice Act can be found at: IDFPR. PAs provide physician services which are compensated by insurers, Medicare, Medicaid, SCHIP, and other health care payers through payments to PA employers. PAs may submit claims using their own personal NPI # but they are not directly reimbursed for their services.

PLEASE NOTE: the following information is provided for educational purposes and should not be considered as legal advice.

  1. Can PAs prescribe medications?
    • PAs can prescribe medications in all 50 states and US territories. In Illinois PAs can prescribe Schedule II, III, IV, and V controlled substances.
  2. What is the definition of physician supervision in Illinois?
    • PAs always work with a supervising/collaborating physician but the physician need not be personally present at the place where the PA practices medicine. A PA may manage patients and perform procedures he or she is authorized to do without the physician being physically present. However a physician needs to be readily available by telecommunications.
  3. Do PAs in Illinois need a written supervisory/collaborative agreement?
    • Yes and No. In Illinois, PAs that work in most settings and prescribe medications require a written supervisory/collaborative agreement. However, there are certain exceptions for hospital based PAs who do not require outside prescription authority.
  4. Do PAs in hospitals or hospital affiliates need controlled substance licenses to give medications?
    • When ordering controlled substances for hospitalized patients or writing prescriptions for discharge, a controlled substance license is not necessarily needed. However, this also depends on your hospital bylaws and/or facility policies.
  5. Can PAs see their own panel of patients?
    • Yes, PAs can see patients independently and are often considered a patient’s PCP.
  6. Can PAs bill/charge for services?
    • Yes, A PA’s employer can submit claims using the PA’s NPI number and list them as the “rendering provider” of services. However, all payments must go directly to the employer who submitted the claim. Payments cannot be made directly to the PA.

PA and Illinois Medicaid

  1. Can PAs see Medicaid Patients?

    • Yes. PAs can see all Medicaid patients including new patients.

  2. Can PAs bill for Medicaid patients?

    • Yes. PAs need to submit claims with their supervising/collaborating physician listed as the “billing provider” and the PA listed as the “rendering provider”.