This information page is designed to answer some of the questions you may have as you consider bringing a PA into your practice. The topics include:

• Benefits of Hiring a PA
• Is a PA Right for Your Practice?
• Preparing to Hire
  • Create a Job Description
  • Read the Idaho PA Practice Act
  • Summary of PA qualifications
  • Develop an Employment Package
  • Understand PA Credentialing and Privileging
  • Check with Local Hospitals
  • Create a Delegation Agreement
  • Get Help with Questions
• Finding a PA
  • Reaching PAs in Idaho
  • Reaching PAs Nationally
• Building a Successful Physician-PA Team

The physician-PA team enhances medicine because PAs are educated as clinical partners to provide physician-directed medical care. PAs provide a broad range of diagnostic and therapeutic services, from primary care to surgical procedures. In their work with physicians, PAs routinely perform physical exams and take patient histories, order and interpret laboratory tests, manage and treat illnesses, repair lacerations and perform office procedures, assist in surgery, write prescriptions, and provide health education and patient counseling.

One of the most valuable attributes of the PA profession is flexibility within the dynamic model of the physician-PA team. PAs can provide versatile medical care in all settings and specialties because of their broad general medical education. Hiring a PA means gaining an extra set of skilled hands, eyes, and ears. PAs offer an array of benefits to practices and physicians, including higher revenues, improvements in patient satisfaction via accessible care, and more flexibility in the schedules of their employers.

Knowing what your practice or institution needs is the first step in making the most of the physician-PA team. Where would your practice most benefit from this assistance? A thorough analysis of your current practice needs and your patient population will help you find a PA who will be the perfect fit.

Begin by developing a detailed job description that reflects the needs of your practice. Be sure to involve the physicians who will be supervising the PA and consider the supervisory style and specialties of your practice or institution. Are you seeking a new graduate or a practiced veteran? Newly graduated physician assistants usually require mentoring for the first few months of their employment. The job description should address the following issues:

• Will the PA see all patients, follow-up patients, or all first-time patients? Will they establish their own patient panel? Would you like the PA to make hospital rounds? Assist in surgery? Take call?

As you create your job description, familiarize yourself with Idaho’s PA practice act — especially its provisions concerning supervision, prescribing, and delegation. A link to the full Rules for the Licensure of Physician Assistants for Idaho is available at www.bom.state.id.us. In addition, the Idaho Academy of Physician Assistants (IAPA) staff is ready to assist you with specific questions.

• Qualifications: Graduation from accredited PA program, baccalaureate degree, and NCCPA examination.
• Application: By PA for license. Delegation of Services agreement with supervising physician required for practice. Personal interview of PA, supervising physician, or both may be required.
• Scope of practice: PA may take histories, do physical examinations, initiate and interpret laboratory and diagnostic tests, and perform other duties that are included in the supervising physician's scope of practice and are delineated in the Delegation of Services Agreement.
• Prescribing/dispensing: PA may apply for approval to prescribe Schedules II-V and non-controlled medications. Application to prescribe must include documentation of all pharmacology course content completed (at least 30 hours). PAs who are authorized to prescribe controlled medications must register with the DEA and Idaho Board of Pharmacy. Dispensing limited to times when pharmacist is not available. PAs in family planning, communicable disease or chronic disease clinics under government contract or grant may also dispense medications.
• Supervision: Supervising physician must conduct on-site visit at least monthly. Must be available by phone or in person; hold regularly scheduled conferences; review sampling of charts. Supervising physician must designate an alternate supervising physician in his or her temporary absence.
• Participation in regulation:Three PAs serve on PA advisory committee.
• Idaho State Board of Medicine, P.O. Box 83720, Boise, ID 83720-0058; (208)327-7000. www.bom.state.id.us

The IAPA and American Academy of Physician Assistants (AAPA) can assist your practice as you devise a PA employment package. Visit the Academy’s website for national data on PA salaries and benefits: www.aapa.org

Contracts are an essential element of the employment package. Contract negotiation lays the foundation for a fair and mutually beneficial professional relationship. AAPA features guidelines for creating contracts.

Perform a thorough credentials check on the candidate. One excellent way to verify credentials is through AMA Physician Profile. It provides all the necessary information on a PA’s education, graduation, national certification status, current and historical state licensure information, legal name, address, and date of birth. This information meets the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) primary source requirements.

During the hiring process, request the following from the PA
• A copy of his or her current state license (with license number, DEA number if applicable, and expiration dates)
• A copy of current certification from the National Commission on Certification of Physician Assistants (NCCPA). PAs will get a certificate each time they recertify. This will have the NCCPA #, issue date, and expiration date.
• Letters of reference from previous employers and colleagues — particularly peer recommendations and physician evaluations regarding the performance of specific responsibilities (i.e., surgical skills or other special skills).
• Documentation of CME records or additional training the PA has received, e.g., current ACLS, BLS, PALS, or other certificates.
• A copy of any recent hospital privileges. If the PA has a log documenting specific procedures, request a copy.

Ask the local hospital(s) about their policies regarding PA practice. Have PAs worked in the hospital before? Have they been privileged? If so, what are the procedures for privileging? How long will it take? Are there any physician co-signature requirements? Are competency measures used for any procedures the physician may want to delegate to the PA? What are the admission policies of the hospital? What are the policies on initial consultation in the hospital? Knowing the institution’s policies on PA utilization in advance will save time and prevent surprises and frustration.

Once the PA is on board, the PA and supervising physician(s) together should create a delegation agreement that flexibly defines the clinical partnership, taking into account the state laws and regulations. This is an opportunity to think through the ways in which you will work as a team. The physician and PA should discuss this document at least once a year and revise it as needed.

AAPA’s Professional Affairs staff can help with a template delegation agreement. Contact Jennifer Anne Hohman for more information at 703/836-2272, ext. 3220; jhohman@aapa.org.

If you have made the decision to hire a Physician Assistant, there are many ways to find one suitable for your practice.

• Advertise the position on the Idaho Academy of Physician Assistants’ website and list serve. Our online job list is extremely popular and a primary source of PA jobs available in Idaho. Our list serve includes every PA in Idaho who is a member of IAPA. Please contact Molly Steckel at (208) 343-4818 or mollysteckel@gmail.com for more information. The one-time cost for advertising on the site is $50. Send us your ad by contacting IAPA.
• Post your position on the Idaho State University PA Program’s website.
• Place an ad in your local or regional newspaper classifieds.
• Place an ad with the Idaho Medical Association.
• Use word of mouth; if you know a PA, ask them if they know anyone looking for new opportunities.

• The American Academy of Physician Assistants works nationally with HealtheCareers.com in posting openings for PAs.

More information about hiring a PA can be found at The American Academy of Physician Assistants.

The front office staff sets the tone for patient perception of providers. It is important that they understand that the PA is your medical partner. Educate staff to present the option of seeing a PA as a positive one. For example, they could explain that PAs allow for quicker appointments and that PA care is closely coordinated with the physicians. We suggest visiting the AAPA website for some information that is perfect for educating all members of the practice or institution, from front office staff to fellow physicians, about the education, qualifications, and unique role of PAs.

Consider sending a letter to patients introducing the new PA, explaining the PA’s background, and generally describing how the physician and PA will practice together. In addition, printed information about PAs should be available in the office for patients to read and take with them. AAPA produces brochures about PAs designed for waiting rooms. To order them, visit AAPA’s on-line store. Here you will also find AAPA’s publication Hiring a PA, which features sample letters of introduction for use with patients and advertisement ideas for use in local newspapers.