Introduction
When a person is admitted into a hospital , he or she often comes across various medical care personnel, each of whom is a specialist in a particular field. Suffice to say, medical care is no longer limited to duly licensed medical doctors anymore. These days, we have an influx of registered nurse, nurse practitioners, and physician assistants. The latter serves as the concentration for my paper. By definition, a Physician Assistant is a person who has served in the medical field for at least 4 years prior to attending the 26 month PA training schools offered in various hospital teaching schools, colleges and universities.
He is a duly licensed medical practitioner who works in the same function and can therefore considered a medical practitioner along the realms of a medical doctor, although under the direct supervision as well, as a licensed physician. As such, a PA should never be mistaken for a medical assistant because the latter only performs administrative and clinical procedures under the direct supervision of doctors, Registered Nurses, Nurse Practitioners, or Physician Assistant’s.
Main Text
The emergency room of any hospital is always the busiest area due to the high volume of patients that come in for first aid or major medical treatment. Due to the continuing shortage of medical doctors in the field, hospitals have had to get creative with their manpower and delegate emergency room tasks to the most competent available hands. Since doctors are usually required to remain on the main floors of the hospital to attend to admitted and critical care patients, the next best thing to having a doctor in the emergency room is a Physician assistant who can be considered the Mini-Me of the medical world. There are approximately 50,000 clinically practicing PA’s, 5.000 of whom are assigned to work in the field of emergency medicine.
However, PA’s do not have the liberty to work the way doctors do. Considered as part of the emergency medical personnel, PA’s have to adhere to specific guidelines as outlined in the Emergency Medical Treatment And Labor Act ( EMTALA). The 3 main areas of function of a PA is directly regulated by The Emergency Medical Treatment and Labor Act, commonly known as the EMTALA. This act supervises the 3 main PA areas, namely; the implementation of medical screening exams, authority to transfer patients, and taking an active role in the ER.
Under the EMTALA ruling, PA’s are allowed perform emergency procedures provided that the PA is covered by written hospital policies that indicate their belief that the assigned PA is capable of performing the procedure. Patient transfers may also be authorized by a PA provided that he has properly consulted with the supervising physician of the patient and that the physician will co sign the order within a preset period of time and in accordance with hospital policies.
The original EMTALA law was passed in 1994 without any clear boundaries drawn regarding the roles of a PA in emergency health care. Aside from specifying that an on-call physician be always available for PA consults, there was no real limitation on the area of participation for the PA. So, upon the request of the AAPA and CMS, the authority of physicians to delegate certain roles to the PA was established on September 3, 2003.
The EMTALA has declared that the PA’s must functions in both administrative and medical care capacities. Therefore a PA’s duty in the ER includes, but is not limited to tasks such as completing of patient records, physical exams, noting findings in a patient chart, assisting in laboratory and patient screening procedures, ordering of diagnostic tests, and referrals, just to name a few of the minor responsibilities. Major responsibilities include patient intubation, abcess incision and drainage, Advanced Cardiac Life Support, anoscopy, as well as a host of other major and minor medical procedures as required by situations in the emergency room.
However, we are not to believe that a PA works a hundred percent like a duly licensed and educated medical doctor. There are still certain medical scenarios wherein the PA cannot function unless duly supervised by a medical physician or make decisions without having the supervising physician sign off on the proper forms.
The medical world has realized that doctors are in short supply and there is no respite seen in the future. Since doctors need to spend decades in training and specializing in their respective fields, there has been a severe lack of doctors who can practice general / internal medicine thus leaving the emergency room in a difficult position of having to deal with general concern patients who come in.
In a typical hospital setting, PA’s are members of doctor supervised medical and surgical teams. Emergency rooms across the nation often have PA’s attending to such cases in order to free up the doctors to concentrate on patients in need of specialized care while allowing general concern patients access to proper medical treatment through treatment from a PA. In effect, a PA works in partnership with doctors in situations requiring emergency care. Over 52 % of patients who see a PA eventually end up seeing a medical doctor as well. However, in an emergency room, 28% of the cases handled by a PA will never be seen by a physician.
That is not to say that the PA does not need a regular physician to consult with. On the contrary, a PA must consult with a doctor for more difficult cases and therefore the doctor must always be available to a consult whenever the PA deems it necessary. There is a also a monetary consideration for the presence of the PA in the emergency room. Since patients without insurance cannot ask for a Primary Care Physician, they must settle for treatment from a Physician Assistant instead. It is the same medical treatment with the only difference being that PA’s work in a different payment system than the Primary Care Physicians.
Conclusion
Technically, the Physician Assistants were given the duty to back up our limited medical care professionals in an effort to provide exemplary medical care to those who need it. The emergence of the PA strongly indicates that there is still a medical professional shortage in the hospitals across the country and the medical field is responding to the situation in the best way they know how through proper and responsible delegation of authority and functions among competent and highly trained medical professionals such as Physician Assistants and Practical Nurses.