The proposed Master of Health Sciences-PA Program is consistent with the missions of UNC-Chapel Hill, the School of Medicine (SOM), and the Department of Allied Health Sciences (DAHS).6,7,8
Multiple key points contained in the 2009 UNC-Chapel Hill mission statement are echoed in the
• To teach a diverse community of undergraduate, graduate and professional students to become the next generation of leaders (UNC-Chapel Hill mission statement)
Through a commitment to educating military medics, The UNC-Chapel Hill PA Program will increase diversity of the healthcare workforce by inclusion of veterans. Many military medics are already experienced leaders who may be expected to continue leading in the civilian sector of healthcare provision. The addition of PAs to the current mix of students studying health professions, including medicine, nursing, nurse practitioners, and the many students enrolled in programs in the Department of Allied Health Sciences (DAHS) will increase diversity within the Division of Health Affairs. Disciplines in the DAHS include occupational and physical therapy, clinical laboratory science, speech language pathology, audiology,
rehabilitation counseling, and others. The new PA Program will also increase diversity among the healthcare providers that are available to citizens of North Carolina.
A focus on education through “exemplary teaching” is also found in the mission statements of the DAHS and in the SOM’s focus on “excellence in educating tomorrow’s health care
professionals”.
• To enhance access to learning and to foster the success and prosperity of each rising generation. (UNC-Chapel Hill mission statement)
Access to an affordable PA Program will help enhance entrance to this professional field to students who may not have otherwise been able to afford the costs of attending a private institution. Six of the seven accredited PA programs in North Carolina are located in private institutions. The sole public institution offering a PA program, ECU, admits only 35 students per year, and our research suggests there is unmet demand which the proposed program will help to address. (See section on Student Demand that follows.)
• To extend knowledge-based services and other resources of the University to the citizens of North Carolina and their institutions to enhance the quality of life for all people in the State. (UNC-Chapel Hill mission statement)
Preparing students for the PA profession offers the potential for increased access to primary care for the citizens of North Carolina. As many as 1 million residents lack access to primary care, a problem that is especially acute in rural areas. Currently 6% of North Carolina counties have no active PAs, and 33% of counties report having fewer than two PAs per 10,000 residents. PAs are capable of providing primary care health services, and PA students will be assigned to at least one clinical site in an underserved area during the clinical year of the program. North Carolina also faces an increasing shortage of
physicians practicing primary care, especially in rural areas of the State. Increasing the supply of PAs who have had clinical rotations in rural area practices will help address this challenge.
Given the existing shortage of health care providers in NC and the anticipated increase in demand due to an aging population and implementation of the affordable care act we predict NPs, DNPs and PAs playing complementary and synergistic roles resulting in an increased supply of both types of practitioners to help alleviate a shortage of primary care physicians. Furthermore as the UNC DNP program is preparing nurses both for direct clinical practice and for executive roles in areas that support clinical practice such as administration, organizational leadership, and health policy, we anticipate that a
The table below provides information about the PA and NP professions.
CATEGORY PHYSICIAN ASSISTANT NURSE PRACTITIONER
Definition Health care professionals licensed to practice medical care with physician supervision.
Registered nurses with advanced education and training in a clinical specialty who can perform delegated medical acts with physician supervision.
Philosophy/ Model
Medical/physician model, disease centered, with emphasis on the biological/pathologic aspects of health, assessment, diagnosis, treatment. Practice model is a team approach relationship with physicians.
Medical/Nursing model, Biopsychosocial centered, with emphasis on disease
adaptation, health promotion, wellness, and prevention. Practice model is a collaborative relationship with physicians.
Education Affiliated with medical schools. Previous health care experience required; most require entry-level bachelors degree. The program curriculum is advanced science based. Approximately 1000 didactic and over 2000 clinical hours. All PAs are trained as generalists- a primary care model and some receive post-graduate specialty training. Education is
procedure and skill oriented with emphasis on diagnosis, treatment, surgical skills, and patient education. Currently, more than 80% of
programs award Masters degrees and all are currently transitioning to the master’s level.
Affiliated with nursing schools. BSN is prerequisite; curriculum is bio-psycho-social based, based upon behavioral, natural, and humanistic sciences. Approximately 500 didactic hours and 500-700 clinical hours. NPs choose a specialty training track in adult, acute care, pediatric, women’s health or gerontology. Emphasis on patient education, diagnosis, treatment and prevention.
Generally not trained for surgical settings and are not taught procedural skills. NPs generally have Masters degrees.
Certification/ Licensure
Separate accreditation and
certification bodies require successful completion of an accredited program and NCCPA national certification exam. NCCPA certification is the gold standard.
Nursing accreditation and multiple nursing certification agencies. Master’s Degree required to sit for exam. The national certification is voluntary and utilized for advanced nurse prescribers within their specialty training.
Recertification Recertification requires 100 hours of CME every 2 years and exam every 6 years with transition to 10 years. Recertification is comparable to family
Recertification requires 75 CEUs every 5-6 years. No exam is required. NP’s practice under their basic RN license under the Nurse Practice Act.
their State Medical Board and the Medical Practice Act provisions. Scope of Practice The physician assistant scope of
practice is defined by education and experience, state law, facility policy, and physician delegation. State laws allow physicians broad delegatory authority. This allows for flexible, customized team care. Any service the PA provides should be within their skill set, and within the skills of the supervising physician. A summary of State Laws and Regulations can be found at
http://www.aapa.org/PAlaws.
As Registered Nurses, NPs hold independent licenses to practice nursing. Individual state practice acts generally govern the rules and regulations under which NPs practice. Because practice acts are state specific, regulations for NP practice vary considerably from state to state. Thirteen states and the District of Columbia require no formal practice relationship between NPs and physicians. Other states require either a collaborative or supervisory relationship between NPs and physicians. To find out the specific rules contact the state’s Board of Nursing. Contact information can be found at the American Academy of Nurse
Practitioners’ website, www.aanp.org or www.acnpweb.org, under regulatory information
Third Party Coverage and
Reimbursement
PAs are eligible for certification as Medicaid and Medicare providers, Commercial payer reimbursement is currently variable.
NP’s are eligible for certification as Medicaid and Medicare providers, and generally receive favorable reimbursement from commercial payers.
The SOM mission statement includes, “provide superb care to North Carolinians and others we may serve” and “maintain our strong tradition of reaching underserved populations”. Furthermore, reference to “patient-centered clinical practice” is a key part of the DAHS mission. The addition of the PA program to the SOM and DAHS will
enhance the ability to provide health care services that are focused on direct patient care. Primary care services in underserved rural and urban areas of North Carolina will be enhanced through the placement of PA students in clinical rotations.