Physician Assistants: A Literature Review - Health Professions ...

more patients for whom they were the principle provider (Martin, 2000, as cited by Henry et al.,2011). Rural PAs were found to: Commonly perform prenatal/postnatal care, house and night calls, nursing home roundsand athletic team coverage Also perform follow-up care, routine administrative duties, the ordering of routine laboratorytest and radiological studies, the recording of patient histories, patient education andcounselling, routine physical exams, the diagnosis of common illnesses, and minor surgicalprocedures Within rural hospitals, to provide services in emergency departments, surgeries, and duringinpatient rounds, and have admitting/discharge privileges (Henry et al. 2011).A 2002 survey of 34 rural hospital administrators in Montana found that only 7.5% of PAs wererequired to have direct physician supervision, while the other 92.5% met their supervisionrequirements through site inspections and telephone communication. In the most autonomousscenario in that state, a PA operating in a remote site may be granted the authority to maintain anoffice separate from the supervising physician, and the physician would be required to inspect theremote site and review patient records and office procedures at least once every 30 days (Larsson& Zulkowski, 2002). ††††A third study included in the above-mentioned review found that PAs practicing in rural settingsrated skills specific to women’s health (e.g., cervical cytology smears, breast examination) asamong both the important and most commonly used skills that they possessed (Asprey, 2006).Hutchinson et al. (2001) describe a family medicine clinic located in an underserved rural region ofMichigan that is routinely staffed by an APN and a PA. These MLPs provide medical care for theentire range of outpatient conditions (e.g., checkups, emergency treatment of myocardialinfarctions and surgical conditions before transport to hospital). A general practice doctor is on sitefor a day and a half each week and otherwise available for consultation via email and telephone.D. PA Autonomy in Other SettingsThe search for this rapid literature review identified articles describing PA autonomy of practice inother settings, including primary care, endoscopy, and interventional radiology.Primary careA 2002 survey of 1,363 primary care physicians examined the use of MLPs as providers of cancerprevention and screening services (Oliveria et al., 2002). PAs were employed in 382 (28%) ofthese practices. Overall, among the practices that employed them, it was reported that PAsperformed: complete body skin exams in 78.3% of practices digital rectal exams in 86.9% of practices clinical breast exams in 84.8% of practices Papanicolaou (i.e. “Pap”) testing in 82.7% of practices†††† Or another interval specified by the Board of Medical Examiners.Page 9 of 74