Physician assistants in orthopedic practice. A national study.

Orthopedics is the third most common specialty practiced by physician assistants (PAs), but little is known at a national level about PAs backgrounds or specific contributions to orthopedic practices. We sought to describe, from a nationally representative sample, the demographic and practice characteristics of PAs working in orthopedics. Methods: Surveys were sent to 1,200 PAs, identified from American Academy of Physician Assistants data, who reported orthopedics as their specialty between 2005 and 2007. Information was collected on demographic and educational background, PA training, current practice characteristics, clinical activities, and physician supervision. Results: After three mailings, the adjusted response rate was 55.8%. Of respondents, 45% reported working in general orthopedics, and the remainder in orthopedic specialties. A majority (76.5%) completed a 4- to 8-week rotation in orthopedic surgery during PA school, but most did not complete any advanced postgraduate orthopedic training. Orthopedic group practices were the most commonly reported employer type (57.6% of respondents). Respondents performed an average of 59 outpatient visits per week and 16 inpatient visits per week. A large proportion (87.6%) participated in surgery on a regular basis, most often working as first assistants. Many orthopedic generalists and specialists performed a broad range of clinical activities, including ones suggestive of general, rather than close and direct, physician supervision such as closing surgical incisions independently and taking first call. Conclusions: PAs contribute to orthopedic care in many inpatient and outpatient settings and perform a wide variety of clinical tasks, often with only general supervision and little or no formal postgraduate training. Health workforce planning and the development of appropriate training models for PAs in orthopedics and other medical and surgical specialties require understanding the content of PA specialty practice. J Allied Health 2011; 40(4):174-180. THE PHYSICIAN ASSISTANT (PA) profession has emphasized primary care training and practice since its founding in the late 1960s.1 A primary care specialty, family practice, continues to be the most common specialty among PAs, followed by emergency medicine.2 The third most commonly reported specialty, however, is a surgical subspecialty, orthopedics.2 In fact, approximately 25% of all PAs practice in a some type of surgical subspecialty.2 PAs have worked in surgical roles since the early days of the profession. Starting in 1970, the University of Alabama in Birmingham pioneered the use of PAs as surgeons' assistants, training 53 individuals over the course of 9 years. Two thirds of that group were employed either in general or cardiothoracic surgery, while the remaining PAs chose other surgical subspecialties.3 In 1971,the Montefiore Medical Center was the first to use physician assistants as surgical house officers.4 In 1973, two Duke PA program graduates were hired for the cardiothoracic service at Emory University Medical Center, where there has been a continuous PA presence to the current time.5 Other early surgical PA programs included Yale University (which trained the first trauma PAs), Cornell University, the University of North Carolina at Chapel Hill, and Cuyahoga Community College in Cleveland.6 While the roles and contributions of PAs in primary care have been fairly well documented in the health services literature, 7-10 the roles and contributions of PAs practicing in surgical specialties, and orthopedics in particular, have not been as well studied. Despite being the most common surgical specialty among PAs, little is known at a national level about the characteristics of PA orthopedic practice. The specific objectives of the current study were to describe the PA orthopedic workforce from a nationally representative sample in terms of demographic and educational background, practice specialty, practice characteristics, practice activities, and physician oversight. …