Writing about a day in the life of an emergency medicine PA only paints a small picture of what it truly takes to become an EM PA. A “typical” workday will look entirely different for every PA due to the nuances of the ED setting and the part of the ED a PA is assigned to. So, our goal here is to paint a full picture of the many facets of working as a PA in emergency medicine and to demonstrate what makes us an integral part of the team.
Before we dive into what it looks like to work as an EM PA, let’s explore how the profession evolved in the first place - and what it takes to get into this field.
PA Profession History
The PA profession is consistently ranked as a U.S. News “best job” because the double-digit employment growth rates demonstrate the need to fill healthcare gaps that have been present for decades.
The career was originally created in response to a physician shortage in the 1960s. Eugene A. Stead Jr., MD, of the Duke University Medical Center, aimed to improve and expand access to healthcare by assembling the first PA class in 1965. Dr. Stead recruited 4 Navy Hospital Corpsmen with combat medical training and modeled their curriculum after that of WWII fast-track physician training.
On October 6, 1967, the first class of PAs graduated from the Duke University PA program. (Fun fact: this is why we kick off the celebration of PA week starting on October 6th!)
It should also be noted that shortly after, Richard A. Smith, MD, similarly played a pioneering role in the founding of the PA profession. He founded the MEDEX program at the University of Washington, focusing on training military corpsmen into “physician-extenders” as a solution to the lack of healthcare access in rural and underserved populations. (The entire history of the MEDEX program can be found here.)
PAs in the Emergency Department
Of the 168,000+ PAs currently practicing medicine in the US, approximately 10% (16,000 PAs) practice emergency medicine or urgent care.
A recent 2023 systemic review in the Journal of the American College of Emergency Physicians Open identified several themes about the role of the PA in the ED. Physician perception included a decreased malpractice risk, improved flow and efficiency, and increased patient satisfaction - all of which were accomplished without compromising patient safety.
Patient insight was similar in terms of patient satisfaction with care received from PAs. The majority of patients were willing to see a PA if it meant waiting longer to see an EM physician, and positive feedback included good communication as well as patient‐centered care.
Flow is also positively correlated with PAs being on duty.PAs have been found to decrease wait time, initial assessment time, length of stay, and left without being seen numbers. Readmission rates for patients cared for by a PA were either lower or the same as their physician counterparts. Numerous studies demonstrate that PAs in the ED are a safe and valuable asset to patients, physicians, and healthcare systems alike.
EM PA Training
PAs are educated as medical generalists at one of 300 nationally ARC-PA accredited graduate programs, which consist of didactic courses and clinical rotations. In order to work as a PA in the emergency department, a PA must complete the following steps:
- Undergraduate Education: A bachelor's degree in a healthcare-related field is typical, although broader educational backgrounds are also considered an asset, and prerequisite coursework must be met regardless. Prerequisites are parity to those for medical school (and vary depending on the program), including biology, chemistry, anatomy, physiology, and other sciences.
- Direct patient care: Prior to matriculating into PA school, the average applicant has over 3,000 hours of patient care experience, such as medical assisting, athletic training, military medicine, EMT, scribing, phlebotomy, surgical tech, etc.
- PA Program: Completion of an accredited program includes a master's degree. PA school education is based on the medical model and aligned with medical school curriculum. These graduate-level programs typically take 2-3 years to complete and include both didactic and clinical training. The didactic phase consists of basic medical and clinical sciences: anatomy, physiology, pathology, microbiology, pharmacology, psychology, medical ethics, and clinical practice. Students generally complete 2,000 to 2,500 clinical hours in a variety of rotations, getting hands-on experience in various specialties, including emergency medicine.
- Licensure: After graduating from a PA program, individuals must pass the Physician Assistant National Certifying Exam® (PANCE) and obtain a state license to become a certified PA.
- Certification maintenance: Every 10 years, a PA must pass the NCCPA recertifying exam and complete 100 credits of CME every 2 years.
- Specialization: An EM PA may consider additional training in the field of emergency medicine or pursue certifications to enhance their skills and knowledge. Two options are currently available and detailed below.
NCCPA EM Certificate of Added Qualifications (CAQ)
To qualify to take the NCCPA Emergency Medicine CAQ specialty exam and receive board certification in emergency medicine, candidates must possess the following:
- A PA-C designation and a current license to practice as a physician assistant in at least one U.S. jurisdiction
- At least 150 credits of Category I CME in emergency medicine
- At least 18 months of full-time experience in emergency medicine within the last 6 years
Emergency Medicine Post-Graduate Training
Newly graduated PAs or seasoned PAs who are changing specialties will go through an immersive training program (commonly referred to as a fellowship, residency, or post-graduate training program). These programs average anywhere from 12 to 24 months to complete.
There are approximately 30 EM PA postgraduate training programs and usually a program only accepts 1-2 PAs annually. Most programs include orthopedics, ultrasound, anesthesiology, trauma, and pediatric ED rotations in addition to their EM-focused curriculum. Research projects, simulation labs, conferences, and journal clubs are also available at many of these programs. (More details about PA postgraduate programs can be found here and here.)
It should be noted that while completion of a postgraduate program can offer a streamlined option for obtaining additional EM-specific training, it is not common, nor is it a necessity. Most EM PAs thrive in their career with a strong onboarding program offered by their employer/group.
EM PAs Go Beyond
As the AAPA states, PAs in general are “trusted, rigorously educated and trained healthcare professionals. PAs are dedicated to expanding access to care and transforming health and wellness through patient-centered, team-based medical practice.” EM PAs are no exception, as demonstrated by their rigorous training and the barriers to entry requiring nuanced experience and/or additional certification/education.
The AAPA’s PA week theme is “Go Beyond.” But what does it really mean to go beyond? As quoted directly from the AAPA:
- Quality medical care goes beyond prescriptions and procedures. It’s a commitment to putting patients first and appreciating what makes you one of a kind. PAs go beyond by communicating clearly, collaborating closely, and advocating tirelessly. In every healthcare situation we approach, PAs go the extra mile to get results. With our unique blend of medical expertise and compassionate care, PAs put the human connection in healthcare.
- PAs know what to do —and help patients understand why. Whether we’re working in the operating room or providing primary care in a rural community, PAs are up to date on the latest in medicine and always take time to educate you about your health.
- PAs lead with expertise —and follow through with human connection. PAs know the importance of patient-centered care, prioritizing your individual needs as we work collaboratively within the healthcare team.
- PAs provide quality care —and we’re transforming the healthcare system. As a fast-growing workforce of rigorously trained, dynamic clinicians, PAs increase access to quality medical care for patients across the country.
- PAs advocate for patients —and improve the health of entire communities. PAs are leaders in public health, providing essential preventive care that leads to improved health outcomes and stronger communities.
It’s clear that EM PAs are a valuable asset to emergency medicine. The required advanced education, modeled after physician didactic and clinical training, as well as abundant resources, experience, and training allows EM PAs to safely treat patients with significant autonomy in collaboration with a licensed EM physician.
This is by no means an exhaustive blog on what it takes to become an EM PA, but it’s meant to serve as an introduction to the profession and the training it takes. The Society of Emergency Medicine PAs, SEMPA, is a great resource for those seeking more information about the EM PA profession.
Next month in part 2 of this series, we will address the setting and structure in which EM PAs practice, including what a shift in the ED might look like and how EM PAs collaborate with EM physicians. Stay tuned!
More information:
https://pubmed.ncbi.nlm.nih.gov/33853588/
https://pubmed.ncbi.nlm.nih.gov/33608373/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806319/
