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Physician Assistant Job Description: The physician assistant in orthopedic surgery will assist in medical and surgical care of orthopaedic department patients in both the inpatient and outpatient setting as outlined in the Principal Duties and Responsibilities below and will participate in all aspects of patient care as indicated. The P.A. will also have direct
reporting responsibility to the Attending Physician of the respective patients for all evaluations and other duties performed.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Inpatient Wards (20%):
Complete individual daily rounds on all inpatients and documentation of medical plan
Participate in rounding with Attending Physician several times per week
Provide routine medical management of inpatient care including ordering of diagnostic tests, labs, x-rays, medications (within the scope of the PA license) and nutrition, managing adjunctive care
Participate in multidisciplinary rounds and communication of treatment plans with orthopedic physician, nursing staff, and families.
Conduct procedures (under direction and appropriate level of supervision of the Attending Physician), including but not limited to: placement of indwelling lines and catheters , placement of skeletal hardware, management
of closed fractures, aspiration/injection of bursae, joints, tenosynovia, anatomic compartments, cysts
Initiate appropriate emergency care in the inpatient and outpatient setting until the arrival of the supervising physician.
Manage discharge of patients with appropriate disposition, followup planning, adjunctive therapy management and education
Make assessment of emergency conditions and, in conjunction with attending physician, implement management

Surgery (20%):
Prepare patients for surgery, including education, positioning, skin
preparation and administration of local anesthetic, and preparation of equipment
Function as first or second assistant in the operating room including performing surgical exposure, surgical dissections, layer closure of wounds, harvesting of autologous graft materials, application of immobilization devices
Assist with use of monitoring devices, including radiographic equipment

Outpatient Clinics (40%):
Attend outpatient clinic and participates in initial evaluation and longitudinal care
Obtain medical history and perform physical examination
Develop and implement plan of care with attending supervision
Complete appropriate documentation of all evaluations, care, and services rendered in the medical record
Make appropriate referral for consultations
Provide pre-and post-operative patient education to patients and their families
Respond to telephone inquiries of patients and provide appropriate medical care, referral for consultation or counseling
Communicate with referring or primary care physicians regarding patient care and treatment
Provide follow-up and health maintenance care including the appropriate adjustment of medications in accordance with established protocols or in response to specific instructions from the Attending Physician
Prescription of medications to accomplish the plan of treatment

Education (20%)

Participate in educational curriculum of daily lecture and lab series as outlined
Read assignments
Teach other providers as appropriate for level of experience.

REQUIRED QUALIFICATIONS (Knowledge, Skills & Abilities):
Education:
Physician Assistant Degree
Certification by NCCPA
Licensure or eligible for licensing as a Physician’s Assistant in the State of Virginia
Intermediate knowledge of and experience utilizing a personal computer.
Intermediate word processing skills required

SUPERVISORY RESPONSIBILITIES:

This position does not have any positions reporting to it. However, the incumbent provides training and guidance to clinic support staff and others as appropriate.

WORKING CONDITIONS:

General busy clinical environment including office, clinics, operating room, hospital (Including inpatient floors) and Radiology for film review.Incumbent is required to help move patients when needed. There is requirement for prolonged standing and walking.

SUCCESS FACTORS:

Good organizational skills.
Incumbent should have the ability to manage multiple tasks in a busy clinical environment.
Exceptional customer service skills.
Above average oral and written communication skills
Demonstrated ability to work independently
Ability to effectively communicate and work with physicians, residents, nurses, patients, families, staff, other health care professionals, and management.
Ability to work with and maintain confidentiality of patient, patient account, and personnel data.
The ability to work as a team member is necessary for this position.
Committee to advancement of physician assisting as a career
Maintenance of credentialling and licensing
Adherence to Allied Health bylaws and regulations
Seeking continuously to improve the quality of care provided by the  Department of Orthopaedics

DUTIES AND RESPONSIBILITIES: 
Obtains detailed history and performs physical examinations on assigned patients; assesses and treats acute/chronic medical problems and provides direct patient care to a specified patient population. 
Assists in providing pre-op and post-op care; writes appropriate orders, including those for narcotics, stimulants, and depressant drugs. 
Performs emergency life saving procedures in cases such as cardiac arrest, respiratory arrest, massive hemorrhage, or similar emergencies. 
Notifies attending physician on call, house physician on call, or supervising physician regarding any unusual or unexpected events or problems requiring direct physician consultation. 
Practices safety, environmental, and/or infection control methods. 
Supervises and/or coordinates the activities of patient care and support staff within the clinic. 
Writes progress notes on patients' charts indicating patient status and treatment procedures performed; maintains other records as required. 
Provides health education to patients and families; may train and supervise medical residents engaged in specific clinical activities. 
Enhances professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops. 
May perform clinical research related to specific operations. 
Performs miscellaneous job-related duties as assigned. 
MINIMUM JOB REQUIREMENTS:

Bachelor's degree; no previous work experience required.

State of New Mexico Certified Physician's Assistant; Certification by the National Commission on Certification of Physician's Assistants. 

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

Ability to observe, assess, and record symptoms, reactions, and progress. 
Ability to perform medical examinations using standard medical procedures. 
Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments. 
Ability to make administrative and procedural decisions. 
Knowledge of CPR and emergency medical procedures. 
Knowledge of primary care principles and practices. 
Skill in preparing and maintaining patient records. 
Knowledge of current and emerging trends in technologies, techniques, issues, and approaches in area of expertise. 
Knowledge of clinical operations and procedures. 
Ability to react calmly and effectively in emergency situations. 
Ability to maintain quality, safety, and/or infection control standards.
Knowledge of drugs and their indications, contraindications, dosing, side effects, and proper administration. 
Knowledge of OR, pre-op and/or post-op procedures. 
Knowledge of patient care charts and patient histories. 
Ability to clearly communicate medical information to professional practitioners and/or the general public. 
Knowledge of related accreditation and certification requirements. 
Ability to educate patients and/or families as to the nature of disease and to provide instruction on proper care and treatment. 

CONDITIONS OF EMPLOYMENT: 

Must be credentialed per UNM HSC policies and procedures if billing for services under Medicare/Medicaid. 
Successful candidate must submit to post offer, pre-employment physical examination/medical history check. 
May be required to submit to annual TB and rubella screening. 
UNM will provide Hepatitis vaccination, candidate may decline vaccination through declination form or may provide record of vaccination from previous employer. 
Must be credentialed per UNM HSC policies and procedures if billing for services under Medicare/Medicaid. 
CPR Certified 

WORKING CONDITIONS AND PHYSICAL EFFORT: 

Work is normally performed in a typical interior/office work environment. 
Moderate physical activity. Requires handling of average-weight objects up to 25 pounds or standing and/or walking for more than four (4) hours per day. 
Work environment involves exposure to potentially dangerous materials and situations that require following extensive safety precautions and may include the use of protective equipment. 
Will work with blood or blood-borne pathogens and will require OSHA training. 

The role of the physician assistant requires intelligence, sound judgment, intellectual honesty, appropriate interpersonal skills and the capacity to react to emergencies in a calm and reasoned manner. An attitude of respect for oneself and others, adherence to concepts of privilege and confidentiality in communicating with patients, and commitment to the patient’s welfare are essential attributes.

Physician Assistant Job Description
The specific tasks performed by individual physician assistants cannot be delineated precisely because of the variations in practice requirements mandated by geographic, political, economic and social factors. At a minimum however, physician assistants are educated in areas of basic medical science, clinical disciplines and discipline-specific problem solving. Physician assistant practice is characterized by clinical knowledge and skills in areas traditionally defined by family medicine, internal medicine, pediatrics, obstetrics/gynecology, surgery and psychiatry/behavioral medicine. Physician assistants practice in ambulatory, emergency, in-patient, and long term care settings. Physician assistants deliver health care to diverse patient populations of all ages with a range of acute and chronic medical and surgical conditions. They need knowledge and skills which allow them to function effectively in a changing health care environment.

Position Code Title – Physician Assistant-A Physician Assistant 12
This is the first advanced level. The employee may function as a lead worker or senior worker. At this level, employees are responsible for overseeing the work assignments of other professionals or have regular assignments which have been
recognized by Civil Service as having significantly greater complexity than those assigned at the experienced level in the series.

Position Code Title – Physician Assistant-S
Physician Assistant 13
This is the second advanced level. The employee serves as a first level staff specialist in a recognized medical area of specialty that has been assigned by the agency and accepted by Civil Service.

JOB DUTIES NOTE: The job duties listed are typical examples of the work performed by
positions in this job classification. Not all duties assigned to every position are included, nor is it expected that all positions will be assigned every duty.
Accepts referral of patients from nursing staff, other health care professionals, custodial, and administrative staff.
Initiates an appropriate assessment of patient's health status, ranging from focused to comprehensive, depending upon the setting (e.g., emergency, structured screening, scheduled visit).
Obtains patients’ health history from interview of patient and others, and from review of pertinent health records.
Performs physical examinations.
Consults with colleagues, supervising physicians, specialists, and other health professionals as appropriate.
Orders pertinent diagnostic tests and procedures.
Performs diagnostic tests and procedures and therapeutic procedures, within the scope of practice, including venipuncture; intradermal tests; intramuscular and subcutaneous injections; electro-cardiogram; control of external hemorrhage; application of dressings and bandages; administration of medications; intravenous fluids; removal of superficial foreign bodies; cardiopulmonary resuscitation; auditory screening; visual screening; and aseptic and isolation techniques.
Performs medical procedures including incisions and drainage, wound care, debridgment, and suturing of lacerations; and applies and removes casts and traction devices.
Collects specimens for and carries out commonly performed blood, urine, and stool analyses and cultures.
Interprets health information and establishes diagnoses consistent with the accumulated data.
Formulates treatment plan, ensuring timely provision of necessary health care services.
Orders necessary medications and other therapeutic equipment and supplies within the scope of practice.
Educates and informs patients regarding the nature of the illness and the progress of evaluation and treatment.
Educates patients regarding health promotion and disease prevention.

Analyzes accumulated health information and collects additional observational, interview, historical, physical examination, and diagnostic data, modifying treatment as appropriate.
Makes health record entries which are legible, concise, and timely.
Advocates for the rights of patients.
Provides primary clinical therapy and treatment of individual and groups of patient(s).
Participates in formulating, interpreting, implementing, and evaluating objectives, policies, and procedures.
Participates in various committees to improve the quality of health care.
Participates in the collection and preparation of reports on patient care activities.
Participates in research projects and in the preparation of articles for publication.
Conducts audits related to advanced practice health care techniques and takes part in quality assurance programs.
Maintains current knowledge in the field of practice and informs staff of changes.
Maintains records and prepares reports and correspondence related to the work.
Performs related functions appropriate to the class as required.

ADDITIONAL JOB DUTIES
Physician Assistant 12 (Lead Worker)
Oversees the work of professional staff by making and reviewing work assignments, establishing priorities, coordinating activities, and resolving related work problems.
Physician Assistant 12 (Senior Worker)
Performs on a regular and recurring basis work that is identified by the agency and accepted by Civil Service as more complex than work performed at the experienced level of the classification series.
Physician Assistant 13
Provides expertise in a medical specialty area that has been identified by the agency and  by Civil Service.

Knowledge, Skills, and Abilities
NOTE: Some knowledge in the area listed is required at the entry level, developing knowledge is necessary at the intermediate level, considerable knowledge is required at the experienced level, thoroughnowledge is required at the advanced level, and extensive knowledge is required at the specialist level. Knowledge of health sciences, including anatomy, physiology, biochemistry, pathophysiology, pharmacology, and microbiology.
Knowledge of the fields of specialized medicine including internal medicine, general surgery, surgical subspecialties, obstetrics and gynecology, dermatology, emergency medicine, and psychiatry.
Knowledge of laboratory medicine.
Knowledge of patient history and physical examination methods.
Knowledge of clinical medical procedures.
Knowledge of patient rights and ethical professional practices.
Skill in performing physical examinations, and routine clinical and emergency procedures.
Skill in utilizing appropriate laboratory techniques.
Ability to develop a therapeutic relationship with patients.
Ability to relate and interpret medical data.
Ability to identify normal and abnormal findings and initiate appropriate follow-up.
Ability to serve as a member of a team.
Ability to provide direction and leadership to others.
Ability to maintain records, and prepare reports and correspondence related to the work.
Ability to communicate effectively with others.
Ability to maintain favorable public relations.

Additional Knowledge, Skills, and Abilities
Physician Assistant 12 (Lead Worker)
Ability to organize and coordinate the work of others.
Ability to set priorities and assign work to other professionals.
Physician Assistant 12 (Senior Worker)
Ability to perform on a recurring basis work that is of a highly complex nature.

Physician Assistant 13
Knowledge of a specialized medical area.

Working Conditions
Some jobs are located in a correctional facility, mental health facility, social services agency, or hospital facility.
Physical Requirements
The job duties require an employee to bend for extended periods.
The job duties require an employee to stand for long periods.
The job duties require an employee to work under stressful conditions.
The job duties require an employee to handle the physical demands of the work, including lifting and restraining patients.

Education
Possession of a bachelor of science degree in medicine or completion of an equivalent professional physician assistant program.

Experience
Physician Assistant P11
No particular type or amount is required.
Physician Assistant 12
One year of professional experience as a physician assistant.
Physician Assistant 13
Two years of professional experience as a physician assistant.

Special Requirements, Licenses, and Certifications
Certification as a Physician Assistant by the National Commission on the Certification of Physician Assistants (NCCPA) and possession of a Physician Assistant license issued by the Michigan Bureau of Occupational and Professional Regulations.

 First, you need to review the Supervising Physican Registration Form and it's instructions.  How this form is completed and submitted to the Texas State Board of PAs is what determines who has prescriptive privileges.  Your PA License Number and Prescriber ID is the one and the same for dangerous drugs

If your supervising physician has given you prescriptive privileges, then your script pad must  include the name of your supervising physician, the practice location, practice phone number, your name and your PA License Number. 
Many practices for cost-savings, include the physician's DEA number so those pads can be used jointly but there is no requirement for this. 

Your supervising physician can authorize you to call in (under his name and DEA number) as a designated agent (and this should be on file with the local pharmacies) for Controlled Substances III, IV and V, however this must be done on a patient by patient basis -- there can be no standing orders or protocols regarding their use except for obstetrical care.
Schedule II drugs are very strictly monitored and require a special script pad that is only available from the Department of Public Safety and that can only be signed by a physician.  It is very unwise and quite illegal for a physician to presign these special scripts and leave them for your use.

If you have any questions regarding what drugs fall into which category, Controlled or Dangerous, please refer to the latest info on the Texas State Board of Medical Examiners website.

For your information, HB 1095 has been signed by the Gov. Perry.  With that signature, physicians will be allowed to delegate Controlled Substance III, IV, and V privileges to physician assistants, which will require us obtaining a DEA number.  This number will probably replace your PA License number on the prescription pad and greatly simplify the life of many rural and medically underserved area physician assistants. 

 How does a Physician Assistant become credentialled provider with a health insurance company?

 Your supervising physician must request that the insurance company credential you (the physician assistant) as a provider for that health plan.  Many plans will also require you to sign a contract with them prior to you being allowed to see their patients.  Some like Aetna will not credential you, despite state law, which requires that they do.
This is actually the only way to find out how to bill for physician services performed by a physician assistant and know what the insurance company will pay. 
Remember, it is not PA Services but rather physician services performed by a physician assistant -- technical but it is the wording that is needed.  No plan pays for physician assistant services but most pay for physician services performed by a physician assistant.

 Is there any restrictions on Physician Assistants see new patients to a practice?

 The only specific guidance that is given regarding a Physician Assistant seeing new patients is from Medicare, when the practice chooses to use Medicare's Incident-To rule for that particular Medicare patient's visit.
There are no restrictions place in the Texas Physician Assistant Licensing Act that prevent a physician assistant from see a new patient.
The only restrictions that are placed on the Physician Assistant regarding the treatment of new patients are those imposed by the supervising physician, the facility where the services are provide, and the specific agreement between the provider and the third party payer.
Those restrictions on seeing a new patient or an established patient with a new problem, if imposed by the supervising physician or the facility, should be based on the training and experience of the physician assistant, along
with the comfort level of the supervising physician and the facility's staff. 
As the relationship between members of the Physician-PA team matures is is not unusual for the any restrictions, if established, to be relaxed or abolished.

These are articles that can serve as a starting point for discussion between your supervising physician and you:

 Can a Physician Assistant may the decision for surgery?

 The Physician Assistant Licensing Act makes the supervising physician, or in this case, the surgeon responsible for the care of the patients that are seen by the physician assistant. Regardless of training or experience of the physician assistant, the surgeon is ultimately responsible for the surgery decision.
There is no question that a physician assistant can make a recommendation for surgery.  How closely that recommendation will be followed will depend on the physician assistant's training, experience, and their relationship with their supervising surgeon/physician.  These factors will also determine the latitude that the physician assistant has in actually setting up the
surgery prior to the patient being seen by his/her supervising surgeon.
The American Association of Surgical Physician Assistants at www.aaspa.com would be a good place to learn about the training of Surgical Physician Assistants and their utilization. 

 How should a Physician Assistant be credentialled in a health care facility?

 The physician assistant should clearly undergo a process that is very similar to the one that physicians undergo in your facility.  The supervising physician must clearly indicated that he, the supervising physician, is ultimately responsible for the care of his patients that is rendered by the physician assistant. 
I would also recommend that the physician assistant complete a privilege list, just like the physician's,
with the supervising physician clearly indicating item by item whether the physician assistant is authorized to perform that activity in your facility.
It would still be up to your facility to accept, modify or deny those requested activities.

 What is the role of Physician Assistants in providing services for Texas Workforce Compensation Commission programs?

 Physician assistants in Texas are the legal agent of the physician in health care matters (enacted in the 77th Legislature).  As such, at the Texas Academy of Physician Assistants prompting, theTWCC's legal staff's reviewed the document and they agreed that the bill authorized the physician assistant to work as the agent of the physician regarding TWCC matters. 

This long overdue change allows physician assistants to not only see the patients but to also sign the various TWCC forms. [Caution: the physician is still the authorized provider of services and the physician name belongs in the provider box. However, the physician assistant may sign these documents as the agent.] 

 What is the chart review requirements for Texas Physician Assistants, outside of a RHC or Alternate Practice Site?

 The short answer according to the TSBPA rule is none.
The easiest and quickest way to determine if there is any requirement that might exist is to review the current Intent to Practice/Supervise a Physician Assistant form or the older Delegation of Prescriptive Authority form and review the Board Rules for the physician assistant's practice site.
The only locations at that have a stipulated chart review by state or federal law are Federally Qualified Rural Health Clinics and Alternate Practice Sites.  Both of these locations mandate at least a ten percent chart review and the supervising physician visting the location at least once every ten days.
However, all locations are required, especially if prescriptive priviledges are delegated, continuous supervision, although the constant physical presence of the physician is not required.  This allows the supervising physician and the physician assistant a great amount of latitude in developing the mechanism which would indicate that there is indeed an ongoing review/supervision process.
It could be as simple as an indication in the planning section of  the SOAP note that the patient was discussed with the physician to as formal as the mechanism that is used in the RHCs or medical underserved areas.
Whatever process that is utilized should be documented and reviewed annually, along with any other practice guidelines that are used.  Such an action would greatly reduce the risk of accusation that the physician assistant's activities are unsupervised.

 How would I write a Physician Assistant's job description?

 There are many formats for PA job descriptions, however the basic information that should be included is generally the same.  There is a link below to a sample of an ED Physician Assistant Description from the American College of Emergency Physicians that gives you one example of a job description format that is used in that particular setting.

The General Description might read like this:

The physician assistant shall perform all duties required by the Medical Director, the Supervising Physician and as may be determined from time to time by the Hospital, including but not limited to the following:
Serve as a staff physician assistant in the field of family medicine at the Clinic.

A. Provide professional medical services, within the scope of services of a physician assistant, on a full-time basis to any individual patient at the Clinic.

B. Supervise staff, including but not limited to nursing staff, nursing aides, and clerical employees of the Clinic on a day-to-day basis.

C. Assist from time to time in providing continuing medical education to the Clinic associates, upon request of Hospital.

D. Provide care for the Clinic's inpatients, as directed by the Supervising Physician.

A relatively simple list of job duties could be the following:

(a) The practice of  the physician assistant includes providing medical services delegated by a supervising physician that are within the education, training, and experience of the physician assistant.

(b) Medical services provided by a physician assistant may include:

    (1) obtaining patient histories and performing physical examinations;

    (2) ordering or performing diagnostic and therapeutic procedures;

    (3) formulating a working diagnosis;

    (4) developing and implementing a treatment plan;

    (5) monitoring the effectiveness of therapeutic interventions;

    (6) assisting at surgery;

    (7) offering counseling and education to meet patient needs;

    (8) requesting, receiving, and signing for the receipt of pharmaceutical sample prescription medications and distributing the samples to patients in a specific practice setting in which the physician assistant is authorized to prescribe pharmaceutical medications and sign prescription drug orders in compliance with state and federal laws.

    (9) signing or completing a prescription

    (10) making appropriate referrals and

    (11) and other duties as assigned by the supervising physician.

(c) The activities listed by Subsection (b) may be performed in any place authorized by a supervising physician, including a clinic, hospital, ambulatory surgical center, patient home, nursing home, or other institutional setting.

(d) A physician assistant's signature attesting to the provision of a service the physician assistant is legally authorized to provide satisfies any documentation requirement for that service established by a state agency. 

(e) A physician assistant is the agent of the physician assistant's supervising physician for any medical services that are delegated by that physician and that:

    (1) are within the physician assistant's scope of practice; and

    (2) are delineated by protocols, practice guidelines, or practice directives established by the supervising physician.

 Can Physician Assistants Order Tests at Independent Diagnostics Testing Facilities?

 Yes, Physician Assistants can order tests in an Independent Diagnostic Testing Facility, except when the facility is an Ambulatory Surgery Center during it's normal operating hours. 
This should not be confused with the supervisory requirement for Physician Assistants performing tests in the facility, which may be very limited. 

 Registering for Controlled Prescriptive Privileges

 Warning: Passage of the HB 1095 does not mean you may ignore state or federal adminstrative requirements because they have not yet been created or implemented yet -- to do so can easily result in the denial of your application for controlled substance privileges by DPS and the restriction, suspension or loss of your PA License by the TSBME/TSBPAE due to violation of the Controlled Substance Act and the rules and regulations prolumgated by DPS.

TAPA-LAC has been in communication with the DPS and the DEA regarding the enactment of HB 1095. 
     The first step in registering for delegated scheduled drug authority is to obtain a state narcotics license from the DPS. This must be done before registering with the DEA.
     According to the DPS - Narcotics Section Registration, the agency will have to develope registration forms for physician assistants, generate appropriate rules and regulations for these new prescribers of scheduled drugs and post them for comment before any physician assistant narcotic licenses can be issued. They anticipate a 30-60 day period to accomplish this. When complete, DPS anticipates working with the TXSBME to contact physician assistants of the registration process availability. The fee for DPS registration will be $25.00
     Once a state narcotics license is obtained, the prescriber may register with the DEA. This process is already in place, however, the application takes 6-8 weeks to process in that the registration goes through Washington , D.C. The fee for DEA registration is $230.00
     TAPA-LAC will work to keep you informed of information that is applicable to this new prescribing authority with updates to this site. You are encouraged NOT to call the DPS or DEA at this time. It is very probable, based on available information, that you will receive notification by mail on begining the registration process when the time is appropriate to commence the process and after the DPS has all it needs in place to accomplish the task.

 Is it considered adequate physician supervision if a physician assistant in a rural health clinic carries the charts needing to be reviewed to his supervising physician's primary practice site, instead of the supervising phyisian making an on-site visit?

 Per Chapter 193 -- there is no question that the physician must make a personal on-site visit to comply with the rules.

Chapter 193.6(B)2
2) Physician supervision at site serving medically underserved populations. Physician supervision of a physician assistant or an advanced practice nurse
at a site serving a medically underserved population will be adequate if a delegating physician:

(A) receives a daily status report to be conveyed in person, by telephone, or by radio from the advanced practice nurse or physician assistant on any complications or problems encountered that are not covered by a protocol;
> 
> (B) visits the clinic in person at least once every ten business days during regular business hours during which the advanced practice nurse or physician assistant is on site providing care, in order to observe and provide medical direction and consultation to include, but not be limited to:
(i) reviewing with the physician assistant or advanced practice nurse the case histories of patients with problems or complications encountered;
(ii) personally diagnosing or treating patients requiring physician follow-up; and
(iii) verifying that patient care is provided by the clinic in accordance with a written quality assurance plan on file at the clinic, which includes a random review and countersignature of at least 10% of the patient charts by the physician;

Such an action would automatically make you non-complaint and place both you and your supervising physician at risk for TSBME action should it be discovered.

 Can a physician Assistant in a non-designated medically underserved area write presciptions when the supervising physican is not in the building?

 First, to have the designation of a medically underserved area for the purpose of Chapter 157 Physician Delegation and Chapter193 Standing Delegation Orders -- the area must be designated by either the federal or state goverment and appear on one of the official listings as such.  It appears from your statement that this is not an officially designated medically underserved area.
As such, you must use the primary practice site rules which allows you to prescribe when the physician is not present, because the physician's constant presence is not required.  However the physician must practice at that location at least 51% of the total time that he practices weekly to be designated as a primary practice site.

 What items should be evaluated when credentialing a physician assistant?

 The recently passed and signed HB 1095 requires that PAs and APNs use the same credentialling form as physicians and this form should be the start point for any credentialling activity.

As a minimum, you should verify their professional education, licenses (Texas PA, DPS Controlled Substance Registration number, DEA #),  whether their supervising physician and alternates are currently enrolled providers
in the managed care plan, whether the National Commission on Certification of Physician Assistant certification is current (not required for PAs who graduated before 1994), Medicare Provider Number (if participating), Hospital affiliations (if any). Professional Liability Insurance Coverage, and practice location(s). 

Cross checking with the TSBPAE (Texas State Board of Physician Assistant Examiners) and the National Practitioner Data Bank should pretty much cover any sanctions or malpractice areas that were not previously disclosed on the standardized credentialling form..

 The pharmacist will not accept a phone order for a controlled substance when my supervising physician is out of the office. Why?

 In the definition part of the Controlled Substance Act it stipulates the the agent must be in the presence of the practitioner when the phone call is made.  In your particular situation, since the pharmacist can see the supervising physician entering and leaving the premise, the pharmacist is simply complying with the law.  It would not matter whether you are a physician assistant, APN, RN or LVN at that time.
There is often some confusion regarding this issue because both the Dangerous Drug Act and the Controlled Substance Act contain many similiar terms with almost identical definitions.  And both acts use the same mechanism for identifing agents or designated agents, which can add further confusion.
With the passage of HB 1095, this problem should be resolved once the State Board of Pharmacy, in conjuction with the Department of Public Safety and the State Board of Medical Examiners, have updated the pertinent rules that were affected and distributed them.

Job Title: Physician Assistant, Family Practice
POSITION SUMMARY: Operating in concert with and under the direction of a licensed physician, the graduate physician assistant performs a broad range of medical services, including, but not limited to the following:
SIGNIFICANT DUTIES AND FUNCTIONS
1. Admission History and Physical including pelvic examination
2. Discharge Summaries
3. Progress notes
4. Write or give verbal orders for any of the following:
      a) Routine admission, Laboratory, Diagnostic studies.
      b) Routine Diagnostic Radiologic Examination.
      c) General patient care measures, including diet, activity, intake
      & output, routine vital signs.
      d) Precautions such as Allergies and Isolation.
      e) Various preps such as required, i.e. NPO, enemas, etc.
      f)  Symptomatic treatments including physical therapy, inhalation therapy, etc.
     g) Medications may be prescribed as provided in state and federal law,
The following documents are required and attached: (If none, so  state): 

5.  Counsel the patient as to preventative care, medical problems, exercise, and the use of prescribed treatments and drugs.
6.  The physician assistant may assist or initiate care in life- threatening emergency situations.
7.  The Physician's Assistant may perform standard clinical procedures such as venapunctures, (to include IV therapy) arterial gases, catheter placement, intradermal tests, IM& Sub Q injections, EKG control of external hemorrhage, application of dressings, wound care, suture uncomplicated superficial lacerations, not involving major nerves, arteries or tendons, removal of sutures, nasogastric intubation, tracheal suction, collection of specimens for culture. Apply casts to simple fractures not requiring reductions, and removal of casts and replace casts for older fractures. 
9) Incise and drain superficial abscesses.
10) Remove superficial foreign bodies.
11) Assist the supervising Physician in technical and surgical hospital procedures per hospital credentialing guidelines.
12) In the absence of the supervising physician, the physician assistant is responsible to the alternate supervising physician (s) as designated.
13) Written and dictated Progress, History and Physical, discharge notes, and medical orders will be reviewed and signed as directed in institution bylaws. 
14) Teaching of Family Practice residents, nursing staff and office personnel.
QUALIFICATIONS
1) Current certification from the National Commission on the Certification of Physician Assistants and all associated requirements for medical education, logging of class time, and retesting. 
2) Membership in state and national physician assistant professional organizations
3) Participate in available hospital medical education programs.

GENERAL SUMMARY
The P.A. in Cardiovascular Surgery assists the supervising surgeon in the management of patients, and performs diagnostic and therapeutic procedures under the supervision of the surgeon. The P.A. works closely and assists the surgeon in providing quality, efficient and continuous and cost-effective care during the patient's hospitalization. 

PRINCIPLE DUTIES AND RESPONSIBILITIES 
• Preoperative Care
• Perform and record history and physical examinations.
   a. Write appropriate admission orders (including nursing care, medication orders, laboratory and radiological examinations, and obtain consultations approved by the surgeon).
   b. Review pertinent abnormal findings in the patient's history, physical examination, radiological and laboratory data with the surgeon, and obtain appropriate consultation, additional laboratory or radiological studies as needed, and initiate appropriate medical intervention.
   c. Record in progress notes pertinent findings from history, physical examination, laboratory studies, and radiological examination.
   d. Evaluate unstable patients and initiate emergency management (of conditions such as unstable angina, evolving myocardial infarction, arrhythmia, cardiac arrest, hypothermia, hypertensive crisis, hemorrhage, chest trauma, etc.).
   e. Conf irin operating room schedule, adding urgent or emergency cases as needed.
   f. Patient education as needed.
• Intraoperative Care
   a. First and second assist the surgeon in the operating room.
   b. Saphenous vein harvest.
   c. Place indwelling catheters, such as Foley, intravenous, and arterial catheters.
   d. Assist in preparation of patient for procedure.
   e. Closure of chest as delegated by the attending surgeon.
   f. Monitoring and transport of patient to ICU. 

Postoperative Care
   a. Write appropriate postoperative orders including general and specific nursing care, respiratory therapy and ventilator settings, medications, including inotropes, parenteral vasodilators and controlled substances for analgesia and sedation, laboratory and radiological studies.
   b. Attend the patient in the early postoperative period reviewing laboratory and radiologic data and making appropriate interventions.
   c. Initiate treatment of postoperative complications such as hemorrhage, hypovolemia, hypotension, hypertension, arrhythmia, cardiac arrest, seizures, stroke, pneumothorax, hemothorax, cardiogenic shock, renal failure, etc.
   d. Advise the attending surgeon of unexpected events, providing an accurate synopsis of events related to a major change in the patients condition and describing corrective measures already taken.
   e. Daily assessment of patients postoperative course, write note of patients progress in chart as it pertains to the supervising physician- and implement indicated therapy as determined by the supervising physician.
   f. Complete discharge summaries. 

The P.A. assistant shall have the knowledge and competency to perform the following functions, and may perform them with appropriate supervision:
   a. Insert and remove intravenous lines
   b. Insert and remove Foley catheters
   c. Pass and remove nasogastric tubes
   d. Placement and removal of chest tubes
   e. Remove monitoring lines
   f. Irrigate chest tubes and Foley catheters
   g. Apply dressings and bandages
   h. Control external hemorrhage
   i. Cardiopulmonary resuscitation
   j. Carry out aseptic and isolation techniques
   k. Venipuncture
   l. Draw arterial blood gases
   m. Place indwelling arterial lines by percutaneous or cutdown technique
   n. Evaluate CXR for catheter placement, and make appropriate changes
   o. Assist in placement of IABP catheter, and adjust LKBP for timing
   p. Remove IABP catheters
   q. Perform thoracentesis
   r. Drain, debride and culture wounds
   s. Placement of central lines
   t. Perform pleurocentesis

MISSION and SERVICE: The Physician Assistant’s mission serves in all medical and surgical specialties, operating as established medical authorities through collaborative care agreements with their physician colleagues, hospitals, practices, and clinics. PAs are extended Hospital medical credentials and privileges. 

MEDICAL COMPETENCY: Physician Assistants are trained in the same medical model as are physicians. PA's medical training advances their expertise in all areas of medicine in a condensed time frame-training is roughly two-thirds the length of medical school with 108 weeks of general primary care education. PAs further enhance their chosen medical specialty in a structured residency program and/or hand in hand with their physician colleagues. Physician Assistants must also pass a national medical certification board and recertify every six years. In many cases, experienced PAs bring their patients a level of experience and care that often exceeds that of medical residents and less experienced physicians.  Frequently MDs in one area of medicine defer judgment to a Physician Assistant in another specialty. 

PHYSICIAN ASSISTANTs: Are rigorously medically trained and are licensed medical professionals as advanced medical providers who establish and build a medical practice diagnosing and treating their own patient roster, serving in a variety of clinical settings, such as specialists in Cardiac care, Orthopaedics and Sports medicine, Pediatrics, Internal Medicine, Emergency Medicine, Occupational Health, Pulmonary Care, Neurology, Gastroentology, Neonatology, Family Medicine, Urology, Obstetrics and Gynecology, in primary care practices, geriatric long-term care facilities, hospitals, correctional institutions, Federal and community-based clinics. In short, PAs are trained and certified advanced medical practitioners giving complete and outstanding patient care. 

DEGREES OF AUTONOMY: Physician Assistants are generally excellent team builders respecting the limits of their Physician colleague’s medical professional relationships and state laws.  It's vitally important that the PA and MD are similar in their team approach!  This successful continuum includes Physician Assistants practicing significant autonomy in their medical practice, exclusive of a physician's presence, while other PAs want a much closer professional relationship with a consulting MD who is more, often than not, physically present for practical direction and oversight. 

PHYSICIAN ASSISTANT'S MEDICAL PRACTICE includes: 

Physician Assistants Give comprehensive physical assessment. 
Physician Assistants Evaluate, diagnose, and treat new and existing patient's medical and surgical conditions. 
Physician Assistants Initiate and interpret labs and x-ray studies including CTs & MRIs. 
Physician Assistants Perform medical and surgical procedures. 
Physician Assistants Prescribe and refer patients for specialized consultation. 
Physician Assistants Assist Physicians in medical and surgical procedures. 
Physician Assistants Use prescriptive authority to write prescription medicines for patients. 
Physician Assistants Write/Dictate medical notes in patients' charts indicating patient status, treatment & procedures. 
Physician Assistants Conduct follow-up patient care. 
Physician Assistants Provide health education to patients and families. 
Physician Assistants Supervise and/or coordinate the activities of patient care and support staff within the clinic. 
Physician Assistants Train and supervise medical residents engaged in specific clinical activities. 
Physician Assistants Teach and train illness prevention. 
Physician Assistants Actively participate in community health education. 
Physician Assistants Perform emergency life saving procedures including cardiac arrest, respiratory arrest, massive hemorrhage. 
Physician Assistants Are among front line medical providers in emergency disaster services. 

PATIENT'S EVALUATION: Patients highly value Physician Assistants for their exceptional people skills in uniting their advanced medical expertise with outstanding quality patient care by: 
Physician Assistants have Excellent interpersonal and communication skills. 
Physician Assistants Give the patient quality compassionate and empathetic caring. 
Physician Assistants Give the patient more time through Active listening. 
Physician Assistants Give the patient more easily understood feedback and instructions, 
Physician Assistants Promote greater patient health and wellness. 
resulting in patients often preferring medical treatment by physician assistants-associates... 
"Consumers seek a broader array of health services than physicians have time, inclination, or expertise to address. Interdisciplinary care is a more efficient and effective strategy for providing care of high quality since all providers contribute what they do best." Linda H. Aiken, PhD, RN Jan. 14, 2002 http://www.medscape.com/viewarticle/447839 

For patients with chronic illness, treatment by a multidisciplinary team represents the state of the art, with nonphysicians providing most of the routine care and ancillary services while physicians and PAs manage more acute and complex problems.

Physician Assistants KNOWLEDGE, SKILLS and ABILITIES INCLUDE: 
Physician Assistants have the ability to perform medical examinations using standard medical procedures. 
Physician Assistants have knowledge of drugs and their indications, contraindications, dosing, side effects, and proper administration. 
Physician Assistants have expertise in clinical operations and procedures. 
Physician Assistants have expertise in primary care principles and practices. 
Physician Assistants have expertise in patient care charts and patient histories. 
Physician Assistants have expertise in Surgery, pre-op and/or post-op procedures. 
Physician Assistants have expertise in CPR and emergency medical procedures. 
Physician Assistants have expertise in current and emerging trends in technologies, techniques, issues, and approaches in area of expertise. 
Physician Assistants have expertise in clearly communicating medical information to professional practitioners and the general public. 
Physician Assistants have expertise in  maintaining quality, safety, and/or infection control standards. 
Physician Assistants have expertise to observe, assess, and record symptoms, reactions, and progress. 
Physician Assistants have expertise to make administrative and procedural decisions. 
Physician Assistants have expertise in related accreditation and certification requirements. 
Physician Assistants are professionals in reacting calmly and effectively in emergency situations. 
Physician Assistants have expertise in supervising and training staff, including organizing, prioritizing, and scheduling work assignments. 
Physician Assistants have expertise in preparing and maintaining patient records. 
Physician Assistants have expertise in educating patients and/or families as to the nature of disease and to provide instruction on proper care and treatment. 
Physician Assistants believe when each medical team member is honored and celebrated for their skills, abilities, and love of medicine and patients, the whole team benefits and patients received the best available medical care making the whole health cares system fundamentally sound.© 

GENERAL: Physician Assistants (PA) are health professionals who are qualified by formal training, experience, and certification to perform clinical duties. These duties encompass primary or specialty  medical care under the cognizance/ supervision of a physician or physician specialist; coordination of patient care; instruction/ supervision of other health care personnel; administrative duties as required. The clinical activities of each Physician Assistant will be supervised by a qualified physician or physician specialist (MD or DO). The Physician Assistant / Physician will both maintain current license / certification with either the Maine state Board of Osteopathy or Board of Medical Registration. 

SUPERVISION:
 Medical   - designated physician(s).

ROUTINE DUTIES: The duties listed below are included as an outline of, but not a limit to, the clinical activities to be performed by Physician Assistants providing care in the Jail:
a.  Obtain, evaluate, and record mental health histories;
b.  Perform physical examinations and mental health assessments;
c.  Order necessary testing (Lab, X-Ray, EKG, etc.) for routine and acute mental health care;
d.  Collect specimens, when necessary, for test and / or examinations;
e.  Analyze and interpret data, formulate problem lists, and establish appropriate plans for management of clinical problems;
f.  Initiate necessary consults to specialists and other health professionals;
g.  Establish eligibility / limitations for inmates with mental illness participating in jail programs;
h.  Counsel inmates regarding mental health related matters: treatments, medications, diet and other issues as required;
i.  Provide management for acute and chronic mental illness in the inmate population;
j.  Prescribe necessary medications, as authorized by law, to remit / resolve patient mental health problems;
k.  Provide consultative services to the Administrator and assistants on issues pertaining to the mental health status of inmates;

EMERGENCY DUTIES: The activities listed below are intended to outline duties during mental health emergency situations:
a.  Assess patient condition and institute emergency treatment for non – life threatening conditions;
b.  Institute initial therapy to stabilize life threatening conditions and activate EMS response;
c.  Coordinate care with EMS responders;

ADMINISTRATIVE DUTIES:

a.  Assist with preparation of health reports, health service financial requirements and budget data;
b.  Assist in development, coordination, revision of health service policy;
c.  Coordinate inter(intra)- departmental activities;
d.  Evaluate effectiveness and efficiency of mental health procedures, risk management, and quality assurance;

QUALIFICATIONS:

a.  Individual must have ability to work in team environment.
b.  Must demonstrate a deep concern for the mental health and well being of others.
c.  Must be able to interact with co-workers, patients, inmates, staff, and correctional officers to instill confidence and facilitate communication.
d.  Must possess sufficient training / experience to qualify for Maine State Board of Osteopathy or Medical Registration.
e.  Must be certified by the National Commission on Certification of Physician Assistants and the appropriate Maine State Board(s).

Additional training / qualification is desirable:
a. Experience in correction health settings.
b. CCHP Certification

GENERAL: Physician Assistants(PA) are health professionals who are qualified by formal training, experience, and certification to perform clinical duties. These duties encompass: primary medical care under the cognizance / supervision of a physician; coordination of patient care; instruction / supervision of other health care personnel; administrative duties as required. The clinical activities of each Physician Assistant will be supervised by a qualified physician (MD or DO). The PA / Dr. will both maintain current license / certification with either the Maine state Board of Osteopathy or Board of Medical Registration. 

SUPERVISION:
 Medical   - designated physician(s).

ROUTINE DUTIES: The duties listed below are included as an outline of, but not a limit to, the clinical activities to be performed by Physician Assistants providing care in the Jail:
a.  Obtain, evaluate, and record medical histories;
b.  Perform physical examinations;
c.  Order necessary testing (Lab, X-Ray, EKG, etc.) for routine and acute health care evaluations;
d.  Collect specimens, when necessary, for pathologic examinations;
e.  Analyze and interpret data, formulate problem lists, and establish appropriate plans for management of clinical problems;
f.  Initiate necessary consults to specialists and other health professionals;
g.  Establish physical eligibility / limitations for inmates participating in jail programs;
h.  Counsel inmates regarding health related matters: treatments, medications, diet and other issues as required;
i.  Provide management for acute and chronic illness in the inmate population;
j.  Prescribe necessary medications, as authorized by law, to remit / resolve patient health problems;
k.  Provide consultative services to the Administrator and assistants on issues pertaining to the health status of inmates;

EMERGENCY DUTIES: The activities listed below are intended to outline duties during medical emergency situations:
a.  Assess patient condition and institute emergency treatment for non- life threatening conditions;
b.  Institute initial therapy to stabilize life threatening conditions and activate EMS response;
c.  Coordinate care with EMS responders;

ADMINISTRATIVE DUTIES: 
a.  Assist with preparation of health reports, medical financial requirements and budget data;
b.  Assist in development, coordination, revision of medical department policy;
c.  Coordinate inter(intra)- departmental activities;
d.  Evaluate effectiveness and efficiency of medical procedures, risk management, and quality assurance;

QUALIFICATIONS:

a.  Individual must have ability to work in team environment.
b.  Must demonstrate a deep concern for the health and well being of others.
c.  Must be able to interact with co-workers, patients, inmates, staff, and correctional officers to instill confidence and facilitate communication.
d.  Must possess sufficient medical training / experience to qualify for Maine State Board of Osteopathy or Medical Registration.
e.  Must be certified by the National Commission on Certification of Physician Assistants and the appropriate Maine State Board(s).
f.  Additional training / qualification is desirable: Advanced Cardiac Life Support, Advance Trauma Life Support, Primary Care Certification, as is experience in correctional medicine.

Scope of Practice/Protocols: [note: unfortunately this model appears to reflect a misunderstanding of the advanced medical competency, level of medical professionalism, and the high achievement of medical skills of the Physician Assistant  and confuses some duties contributed by medical assistants.] 

Orthopaedic Surgical Physician Assistants

Orthopaedics & Sports Medicine Clinic Duties ( 30%)
Participate in medical history taking, H&Ps, physical examination, image interpretation, documentation, coding, and patient evaluation/care 
Participate at outreach clinic sites in capacity similar to the clinic setting described above 
Perform arthrocentesis, trigger point injections, subacromial injections, suture removal, and simple fracture management/cast application on a routine basis as expertise dictates 
Participate in our in office GE MRI training, and subsequent day to day functions/maintenance of the GE MRI machine 
Participate in teaching for patients and staff within the department 
Organize orthopaedic library books, journal, educational presentations and technical equipment related to our clinic floor 
Participate in day to day functions/maintenance of the GE 6800 fluoro unit 
Participate in patient telephone call backs and prescription refills 
Maintain good, professional relationships with clinic staff

Surgery Center OR Duties ( 25%)
Organize patient clinic notes, plain films, MRI scans, and CT scans pre-  and post- operatively 
Participate in all surgical procedures intra operatively Assist with pre-  and post- operative notes 
Participate in pre-  and post- operative patient and family education 
Participate in pre-  and post- operative anesthesia where Orthopaedic expertise is warranted 
Participate in teaching for OR staff 
Assist with patient care throughout the course of inpatient and outpatient surgery 
Maintain good, professional relationships with OR staff

ER Duties ( 15%)
Participate in call responsibilities for orthopaedic ER coverage Participate in history taking, H&Ps, physical examination, image interpretation, documentation, coding, and patient evaluation/care in the ER Perform arthrocentesis, trigger point injections, subacromial injections, suture removal, and simple fracture management/cast application in the ER as expertise dictates Participate in ER procedures where Orthopaedic expertise is warranted
Participate in ER patient and family education
Participate in teaching for ER staff
Assist with patient care throughout the course of the emergency room visit
Maintain good, professional relationships with ER staff

  Hospital Duties ( 15%)
Perform daily rounds of inpatients
Participate in daily progress notes on hospital floor inpatients
Participate in history taking, H&Ps, physical examination, image interpretation, documentation, coding, and patient evaluation/care for inpatient consultations
 Perform arthrocentesis, trigger point injections, subacromial injections, suture removal, and simple fracture management/cast application on the hospital floor as expertise dictates
 Participate in hospital floor procedures where Orthopaedic expertise is warranted
 Participate in hospital floor patient and family education
 Participate in teaching for hospital floor staff
 Assist with orthopaedic patient care throughout the course of hospital stay
 Maintain good, professional relationships with hospital floor staff

   Orthopaedics & Sports Medicine Miscellaneous Duties ( 15%)
 Participate in Public Relations functions for Orthopaedics & Sports Medicine
 Participate in all pre  and post operative departmental conferences
 Participate in all morbidity and mortality conferences
 Organize orthopaedic industry representatives and literature for accurate dissemination of medical information and implants
      Maintain good, professional relationships with industry representatives

PBYSICLAN ASSISTANT, LICENSED, SURGERY

Job Summary:

Provides inpatient and outpatient medical and surgical services, including patient histories and physicals, treatments, medications, surgical procedures, pre operative and post .operative care, etc. to patients, under the supervision of a licensed physician.

Specific Duties and Responsibilities:

1. Conducts oneself in a manner which promotes quality and' service excellence for patients, physicians, staff, and visitors and contributes to the spirit of teamwork within the Clinic.

2. Sees adult, pediatric, and geriatric patients in a clinic setting, performing routine medical assessments and treatments i.e., obtains medical histories, performs physical examinations, counsels patients, etc. Performs outpatient surgical procedures in clinic setting i.e., removes cysts and skin lesions, etc. Performs and documents all activities in accordance with established policies and protocols.

3. Performs patient pre operative hospital and Clinic day surgery admission histories and physicals for surgical patients i.e., obtains statement of chief complaint and present illness, past medical history, social history, and family history; records vital signs; reviews systems, including respiratory, neurologic, circulatory, lymphatic, head/ears/eyes/nose/throat (HEENT), skin, musculoskeletal structure, etc. Forms patient assessment and develops preliminary patient care plan. Performs and documents all activities in accordance with established policies and protocols.

4. Acts as First Assistant Or Second Assistant to surgeon

during surgical procedures i.e., holds retractors, ties off vessels and tissues, repairs incisions and lacerations, cuts and cauterizes tissues, etc., as needed and as directed for wide variety of surgical cases i.e., general medical, vascular, etc. Performs  complex surgical techniques as needed and as directed by physician.

5. Provides post operative care to patients on an as necessary basis i.e., evaluates patient's physical
condition to ensure no secondary complications have occurred due to surgery, removes sutures and/or staples,
aspirates wound fluids, provides specific patient care as needed, etc. in accordance with established policies and
protocols. 

6. Dictates discharge summaries for patient's medical record and for billing purposes, including final diagnosis,
operations and/or procedures performed, complications (if any), discharge needs, discharge instructions, and a
narrative summary of patient's stay as well as pertinent laboratory and pathology findings, in accordance with
established policies and protocols.

7. Performs Doppler vascular studies on patients in hospital and clinic settings to help determine conditions of
vascular flow to the lower extremities.

8. Occasionally makes hospital patient visits (rounds), with physician and/or independently, to monitor patient's
current physical condition i.e., reviews patient's medical record, talks to patient, performs appropriate
physical examination, assesses changes in patient's condition, adjusts patient's care plan accordingly,
writes new patient orders for medications, lab/x ray tests, etc., and documents all of the above in patient's
medical record. Performs all activities in accordance with established policies and protocols i.e., all orders
supervised and countersigned by physician, etc.

9. occasionally conducts and coordinates patient's hospital discharge process i.e., informs and instructs patient on
current condition and follow up care including outpatient, therapy and services, usage of medications, etc.;
interacts with family members and/or other health care professionals relative to patient needs,. etc.; all in
accordance with established policies and protocols.

10. Documents all procedures and/or services to patients on charge (route) slips and processes route slips in
accordance with established procedures to ensure accurate billing to patient accounts

11. Performs other duties as assigned.

Oualifications:

Education: Completion of a physician assistant  educational program approved by the American  Medical Association. Licensure as Physician Assistant by Medical ' Examining Board of the State of Wisconsin. Certification by National  Commission on Certification of Physician  Assistants (NCCPA).

Experience : Learns job in 2  4 years.
Other: Ability to obtain appropriate practice privileges at area hospitals.

Supervision Relationships :

Reports To: Administratively reports to Clinic Manager. Medically reports to Surgical Supervising Physician(s).

Supervises: No one.
Advises and gives direction to surgical team members including Day Surgery Center staff and department nurses and clerical staff.

This job description Is presented to guide Physician Assistants and Neurosurgeons. It Is only a guideline In which to adapt the Physician Assistant to a Neurosurgery practice under the supervision of a Neurosurgeon, as directed by the state laws in which the Physician Assistant practices. Physician Assistants are licensed healthcare professionals trained in the same format, as are physicians. The average physician assistant has a bachelor's degree and 4 1/2 years of healthcare experience before entering a PA program. This job description for Physician Assistants in Neurosurgery includes but is not limited to:

1. General duties: Performing comprehensive and problem focused histories and physical examinations, interpret laboratory and diagnostic tests. Interpret and correlate subjective and objective data. Formulate a differential diagnosis establish and a working diagnosis. Develop a treatment plan for neurosurgical conditions within the scope of practice and in conjunction with the neurosurgeon. Implement therapeutic intervention for specific conditions were appropriate. Exercise judgment on conditions requiring consultation, referral, or evaluation by the supervising neurosurgeon or other healthcare professionals.

2. Hospital duties: first assistant in surgery, closure of a deep and superficial wounds to assist with all neurosurgical procedures to include craniotomies, spinal procedures including instrumentations, microscopic procedures. Conduct hospital rounds on a daily basis of all patients including intensive care units, write orders, progress notes, perform all admission history and physicals, order appropriate laboratory and radiographic tests such as MRI's, myleograms, bone scans, and other radiographic studies as needed or indicated. Perform appropriate laboratory and diagnostic studies, such as Lumbar punctures, ventriculostomies, myleograms, placement of tong traction, halo fixation devices. Evaluate and clarify clinical conditions, formulate an implement a treatment and therapeutic plan for hospitalized patients, discharge planning, dictate discharge summaries.

3. Office duties: to see all new office patients and complete a thorough history and physical examination that is problem oriented for neurosurgical conditions. Present that patient to the attending neurosurgeon's and then help formulate a treatment plan, order appropriate radiographic studies and perform office procedures such as local blocks. Evaluate postoperative patients and routine follow up visits. Be available to see those patients that require a same day office visits. Return phone calls of from patients, handle prescription refills, review radiographic reports laboratory reports for abnormalities. Review x rays MRIs CT scan's of hospitalized patients and office patients with the attending neurosurgeon.

4. Evaluate, screen and counsel patients on health maintenance and promote utilization of community resources. Design, conduct and or participate in research studies, manage databases, and perform quality assurance.

5. Training: For a physician assistant to have the necessary skills and expertise to perform the above procedures requires time and training. For a physician assistant who is a new grad, or without any neurosurgical experience there is a learning curve which takes approximately one year for a physician assistant to obtain the confidence in handling the day to day office and hospital routine. It will take time to adjust to the operating room environment. If a Neurosurgical practice hires a new grad they must understand that the Neurosurgeons must instruct and demonstrate to that individual their method of dealing with Neurosurgical problems conditions surgical techniques.

This is an education process that can be equally rewarding to the Neurosurgeon and the Physician Assistant. As the Physician Assistant grows in knowledge, education and skills this will benefit the Neurosurgeon and the Neurosurgical practice, by reducing the amount time the Neurosurgeon spends with small issues allowing the surgeon to handle the more seriously ill patients. As always, the Physician Assistant works under the supervision of the Neurosurgeon. It is the Neurosurgeon who should be the judge of the capabilities, skills and limitations of the Physician Assistant.

Physician assistants are licensed health care professionals trained in the same format, as are physicians. Their training is roughly two-thirds the length of medical school with 108 weeks of general primary care education. The average physician assistant has a bachelor’s degree and four and a half years of health care experience prior to entering a PA program. A job description for Physician assistants in orthopaedics includes but is not limit to:

1. Performing comprehensive and problem focused history and physical exams, interpret and correlate laboratory and diagnostic procedures. Interpret and correlate subjective and objective data to formulate a differential diagnose and establish a working diagnosis. Formulate a treatment plan for Orthopaedic problems within scope of practice. Implement therapeutic intervention for specific conditions when appropriate. Exercise judgment on problems requiring consultation, referral, or evaluation by the supervising Orthopedic surgeon or other health care professionals. 

2. Order, collect, and perform appropriate laboratory or diagnostic procedures, and studies including but not limited to blood and tissue specimens. Ordering or performing diagnostic studies such as but not limited to EMG, electrocardiogram, compartment pressure measurements, and x-ray examinations including special x-ray examinations CT, MRI, and bone scans etc. 

3. Performing procedures such as but not limited to, digital blocks, regional anesthesia, and minor outpatient surgical procedures such as but not limited to: tendon repair, wound closure, wound management, wound debridement, incision and drainage, needle biopsy, percutaneous pinning of fractures, k-wire removal and hardware removal. 

4. Perform diagnostic and therapeutic procedures including but not limited to joint and bursa aspirations, closed reduction of fractures and dislocations, injections of joints, tendons, trigger points and bursa, as well as brace, cast and splint applications. 

5. Assist in surgery to include but not limited to first assist, deep and superficial tissue closures, application of appliances and any other action delegated by the surgeon. Conduct hospital, rounds, write orders, and take call for the Orthopaedic surgeon. Evaluate and clarify clinical conditions, formulate and implement a treatment or therapeutic plan for hospitalized patients, dictate discharge summaries, histories and physicals. 

6. Order, prescribe, dispense, and administer Medication, orthosis, orthotics, braces and other Orthopaedic devices as may be allowed by state legislation. 

7. Evaluate, screen and council patient on health maintenance and promote utilization of community resources. Design, conduct and/or participate in research studies, manage databases, and perform quality assurance. 

source: http://www.paos.org/jobdescription.html

1. Practice Medicine with supervision by a Texas Licensed Physician.
2. Supervise nursing support staff.

[note:] In the past, we had a multi page job description including many facets of practicing medicine. When one of our physicians was named in a professional liability suite, the defense attorneys went over all our job descriptions
and advised toward simplicity and generalism. The reason was that the more detailed the job description and protocols were, the more likely that they could be misinterpreted and the plaintiff's attorney given ammunition to
fire at a jury.

Regarding Protocols, we use this:

The PA will practice medicine with physician oversight. Patients seen by a Physician assistant with Chest Pain, Abdominal Pain, Respiratory Distress, Fractures, LOC, and Dysfunctional Uterine Bleeding will be evaluated by a
physician prior to discharge from the ER.

The PA formulary will be that as listed in the Physician's Desk Reference.

Regarding any specific non-clinical duties, those are listed in the employment contract, such as expected work hours, required meetings, etc.

Function:

The Physician Assistant shall perform directed medical histories and physical examinations; assesses patients' medical/surgical conditions; administers treatments under physician orders and in conformity with the approved protocol; advises and counsels patients or legal guardian of patient problems; assists physician as directed.

Organizational Relationships:

Chairman, Department of Emergency Medicine Staff Emergency Department Physicians Physician Assistant

Requirements

A. Education: Graduate of an CAAHEP (Commission on Accreditation of Allied Health Education Programs) approved, Class A Physician Assistant Training Program. Must be certified by the NCCPA (National Commission on the Certification of Physician Assistants) or eligible to sit for the exam.

B. Experience: General experience as a Physician Assistant in the evaluation and management of patients with emergent, urgent and non urgent medical problems.

C. Other: Must be licensed or eligible for licensure by the Commonwealth of Virginia Board of Medicine. Prescription protocols required. Ability to work autonomously as a physician extender is required as is the ability to work well under pressure.

D.  Current ACLS Certified.

E. Protocol: He will work only within the protocol approved by the State Board of Medicine (the "Protocol"). A copy of the protocol executed by the Physician Assistant and his/her supervising physician and submitted to the Board of Medicine must be kept on file in the Chesapeake General Hospital Medical Staff Office, updated as necessary. Additional supporting documentation of training and current clinical competency may be required for requested invasive procedures that are included in the protocol approved by the State Board of Medicine. He will be expected to pay close attention to detail, coordinate varying tasks, and be accurate in all aspects.

F. Supervisory Controls: A physician assistant must be employed by a physician acting as his supervisor for the position; however, he will be able to think independently, work with the amount of supervision reflected in the Protocol and interact with all staff members.

G.  If prescriptive authority is requested as part of practice
 privileges, the Physician Assistant must provide evidence of
 prescriptive authority approved by the Virginia Board
 of Medicine in the protocol.

Duties and Responsibilities

A. Performs a directed history and physical examination pertaining to the patient's presenting complaint, reviews patient records to determine health status, and makes an assessment therefrom; records and presents pertinent data to the supervising physician for determination of final diagnosis and treatment plan.

1. Determines whether the patient's condition requires the immediate attention of the supervising physician.

2.  Executes standing orders.

3. Identifies normal and abnormal findings in history and physical exam. Orders appropriate laboratory and x ray studies.

4. After consultation with the supervising physician, may refer appropriate patients to specialist for consultation.

5. Writes prescriptions as permitted by the Protocol approved by the Board of Medicine.

B. Instructs and counsels patient or legal guardian regarding matters pertaining to their physical and mental health, such as diets, social habits, medications, and the nature and treatment of their injury or illness and required follow up.

C. May perform the following routine diagnostic procedures if made a part of the Protocol:

1.  Venipuncture
2.  Urethral catheterization
3.  Nasogastric intubation and gastric lavage
4. Collecti