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Finding your niche

Introduction Physician assistant (PA) education is modeled on the broad, generalist design of physician education. PA students learn each organ system and how they interrelate as a whole body system to promote health and well-being or to cause alterations in function. Students also learn about population-based and systems-based delivery of health care. Most PA students spend their clinical experiences “rotating” through selected medical and surgical specialties…

Transition to professional practice

Learning outcomes At the conclusion of this chapter, the reader should be able to: 1. Describe the transition from physician assistant (PA) student to early career PA. 2. Discuss how reflection-in-action assists the novice PA in recognizing learning needs. 3. Outline the self-directed learning process used by the new graduate PA to address gaps in knowledge and skills. 4. Discuss tips for maximizing a successful student-to-clinician…

Mass casualty natural disaster

Introduction Mass casualty incidents (MCIs) can result from both natural disasters, such as hurricanes, and human-made disasters, such as terrorist attacks. MCIs tax medical infrastructures and require urgent responses from medical personnel from many different disciplines. Physician assistants (PAs) are being called on to respond to the urgent medical needs more frequently than in the past. Many times, PAs are first on the scene and take…

Patients with disabilities

Learning outcomes After reading this chapter, the student will be able to: 1. Recognize the existence of health inequities in people with disabilities. 2. Identify their responsibilities for ensuring patients with disabilities receive comprehensive health care services, including acute, chronic, preventive, and wellness care. 3. Create an accessible environment in the care of patients with low vision, deafness/hardness-of-hearing, cognitive disability, and mobility disability. Introduction In July…

International health care

Introduction The opportunity to work abroad, whether that means updating the skills and knowledge of local providers for a couple of weeks or committing to a longer-term stay of months to years and providing essential health care to displaced populations suffering from the ravages of war or natural disasters, is attractive to many physician assistants (PAs). For some, it is simply a heightened sense of adventure…

Rural health care in the united states

Introduction Rural health care is an often-overlooked area of clinical practice that is essential to the well-being of millions of Americans. The 2010 U.S. Census calculated that about 59.5 million people, or 19.3% of the population, are “rural” (see definitions in the following section); however, the ratio of patient to primary care physicians in rural areas is only 39.8 physicians per 100,000 people, compared with 53.3…

Urban health care

Introduction According to the 2010 U.S. Census, 80.7% of the population lives in urban areas. This large percentage is due, in part, to the inclusion of not only those who live within the city limits but also those who live in the increasingly dense “outer city,” the suburbs surrounding urban areas. Although the population and physical geography of a city can contract and expand over time,…

Military medicine

The U.S. Military is us. There is no truer representation of a country than the people that it sends into the field to fight for it. The people who wear our uniform and carry our rifles into combat are our kids, and our job is to support them, because they’re protecting us. Tom Clancy Introduction It is appropriate that any physician assistant (PA) textbook include a…

Correctional medicine

Learning outcomes Readers of this chapter will learn how to: 1. Describe unique aspects of providing care in correctional health settings. 2. Define deliberate indifference and responsible health authority (RHA). 3. Discuss clinical situations in correctional health settings that may require negotiation among medical, custody, and security staff. 4. Explain challenges associated with managing communicable and chronic diseases in correctional health settings. 5. Discuss conflicts that…

Health care for the homeless

Learning outcomes In this chapter, readers will learn to: 1. Describe the connection between health and homelessness. 2. Explain challenges that people experiencing homelessness face trying to access health care and comply with medical recommendations. 3. Identify health conditions that are common among people experiencing homelessness. 4. Discuss strategies that health care providers can use to optimize care delivery to patients who are homeless. Introduction In…

Population health

Learning outcomes By the end of this chapter, readers will be able to: 1. Describe the United States health care evolution to population-based health. 2. List the core functions of public health, including primary, secondary, and tertiary prevention. 3. Discuss agencies and programs that assist physician assistants (PAs) in implementing and promoting disease prevention, including the Centers for Disease Control, the United States Preventative Services Task…

Postacute care, rehabilitation, and long-term care systems

Introduction The physician assistant (PA) profession is rooted in primary care; however, increasing numbers of PAs are choosing specialty areas. According to the 2018 American Academy of Physician Assistants’ salary report, 34% of PAs reported practicing in a hospital setting, whereas 56% remained in an outpatient setting (family and general medicine, internal medicine, pediatrics, and other specialty clinics or facilities). Although most medical care continues to…

Health and health care delivery systems

Learning outcomes After carefully reading this chapter, the physician assistant student will be able to: 1. Define health systems and list the key elements of a health system. 2. Describe health systems in the United States (U.S.), United Kingdom (UK), and Canada. 3. Compare and contrast horizontal, vertical, and virtual health system integration. 4. Discuss the four levels of the U.S. health care system. 5. Discuss…

Patient safety and quality of care

Introduction In late January 2001, 18-month-old Josie King turned on the hot water and climbed into a scalding-hot bathtub. She sustained second-degree burns on 60% of her body and was admitted to Johns Hopkins Medical Center. On February 22, 2001, 2 days before her planned discharge home, Josie’s parents held their brain-dead daughter for the last time as she was disconnected from the ventilator. Her death…

Health disparities

What are health disparities? According to Unequal Treatment, health disparities are the differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups. Disparities in health care exist even when controlling for gender, condition, age, and socioeconomic status. After decades of improvements in preventive health care and significant declines in disease mortality for many Americans, disparities…

Research and the physician assistant

Introduction Most physician assistant (PA) students choose to study to become PAs because they want to care for patients. If they had wanted to study for a research-oriented degree, they would have applied for MS or PhD programs in biochemistry, biology, public health, or experimental psychology. Nevertheless, PAs cannot avoid research. To provide high-quality, evidence-based patient care, PAs need to consult research daily. PAs who are…

Evidence-based medicine

Learning outcomes After carefully reading this chapter, the physician assistant student will be able to: 1. Provide an overview of the history of evidence-based medicine. 2. Describe the steps to evidence-based practice. 3. Write a foreground (“PICO”) question for a given clinical vignette. 4. Differentiate experimental from observational study designs. 5. Describe the key design elements of randomized controlled trials, cohort, case control, and cross-sectional studies,…

Interprofessional practice and education

Introduction Physician assistant (PA) students who train in the early 21st century are being prepared as never before for interprofessional practice (IPP) via interprofessional education (IPE) ( Box 40.1 ). IPE is a newer concept in medical education; therefore PAs who graduated a decade ago may not have had the same experience in IPE as current students and physicians. Working as part of a team with…

Stress, burnout, and self-care for physician assistants

Learning outcomes The reader of this chapter will be able to: 1. Describe the concepts of burnout, resilience, compassion fatigue, depersonalization, wellness, and self-care. 2. Understand the current models of burnout and wellness, including the individual and external factors that affect clinician wellness. 3. Describe the effects of burnout as it relates to the physician assistant student, practicing clinician, and patient. 4. Discuss potential strategies for…

Postgraduate clinical training programs for physician assistants

Introduction Employment opportunities and clinical roles for physician assistants (PAs) have rapidly expanded to include positions in a wide variety of specialty areas. Postgraduate curricula are designed to build on the knowledge and experience acquired in PA school, enabling individuals to assume roles as well-prepared PAs on specialty health care teams more rapidly than those without formal training or prior specialty experience. Many postgraduate programs have…