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Are hospitalist physician assistants the answer to shortages?


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It's no secret that hospitals across the country struggle with many challenges. Among them is a pressing shortage of hospital physicians and restrictions on resident duty hours that can sometimes leave a vacuum of care providers. That's where the hospitalist physician assistant (PA) can help fill the void.

Mayo Clinic Arizona announced the first post-graduate PA fellowship dedicated to hospital medicine in the country, according to the paper, "A hospitalist postgraduate training program for physician assistants," published in the January issue of Journal of Hospital Medicine.

Unlike traditional PA training programs, this optional post-graduate program focuses on the inpatient setting.

"We found it difficult to recruit and find people who had training in hospital medicine," said Kristen K. Will, MHPE, PA-C, Mayo Clinic program director of the post-graduate PA fellowship in hospital internal medicine in Arizona. "PAs are trained in primary care. If PAs have hospital experience, most of it is in the subspecialty area. And that doesn't necessarily carry over in knowing how to take care of general medicine patients in the hospital."

Using a combination of clinical rotations and didactic training, the Mayo program catapults PAs to be effective and efficient, according to Will. PAs go through a 12-month training based on the Society of Hospital Medicine's Core Competencies to learn about hospital systems and operations. Upon completion, the PAs receive a certificate. Currently, in its third year, the program has since graduated two PAs, who were later hired at Mayo.

The history of the PA in the hospital

The PA role in the hospital isn't a new one. Since the 1950s, PAs have assisted in providing care in the OR and in other medical subspecialties. Decades later, the hospitalist PAs numbers have grown. Currently, 37.5% of all PAs work in the hospital setting, according to the latest data from the American Academy of Physician Assistants 2009 Census.

Although duties vary by individual, institution, and even state, PAs typically round daily, admit patients, plan discharges, and lead end-of-life discussions with patients.

"As the PA role is more understood and there are more PAs demonstrating that they do provide very good, cost-effective, quality healthcare for patients who are hospitalized, it will lead people to understand how to better utilize them in the hospital," Will said.

In addition to helping with the physician shortage and duty hour limits, proponents say the hospitalist PA movement is supported by a growing body of evidence that PAs provide equal, if not better care, than traditional house staff services.

For instance, a study published in the Journal of Hospital Medicine in September 2008 stated that hospitalists and PAs produce equivalent outcomes as traditional house services. When compared, length of stay, mortality, ICU transfers, readmissions, and patient satisfaction were essentially the same.

Another study in the March-April 2009 issue of American Journal of Medical Quality stated that hospitalists and PAs even save more patient lives than in the resident model.

Benefits of hospitalist PA training

The Mayo program also touts advantages, such as a shorter learning curve.

"After one year of our program training, the PA functions at the level of someone who would have been working, learning on the job, at the three- or four-year mark. Essentially, more time and investment upfront makes them better, effective healthcare providers at the end, in a shorter time period," Will said.

No only do the Mayo PAs advance faster, they are more likely to stick around and take on more leadership roles, said Will about the retention and committee work that in which PAs participate.

A worthwhile investment

For hospital administrators who may be wondering if this PA program would work in their own institution, the Mayo PA program could be replicated in other institutions.

"This simple, yet diverse and comprehensive curriculum could definitely be implemented in any type, community hospital, large academic institutions. It's a relatively inexpensive type of program to run. The curriculum could be easily implanted in any type of medical system," she said.

In addition, hospital medicine nonphysician training could expand to nurse practitioners. "It's a good return on investment from a business standpoint," Will said.