Editorial Open Access
Practicing Orthopedic Medicine by Physician Assistants
Wei Li *
School of Health & Rehabilitation Sciences, Indiana University Purdue University Indianapolis, Indianapolis, USA
*Corresponding author: School of Health & Rehabilitation Sciences, Indiana University Purdue University Indianapolis, Indianapolis, USA, Tel: 317- 278-9575; Fax: 317-278-9555; E-mail: @
Received: January 09, 2015; Accepted: January 21, 2015; Published: February 05, 2015
Citation: Li W (2015) Practicing Orthopedic Medicine by Physician Assistants. J Exerc Sports Orthop 2(1): 1-2.
The Trend of PA Practicing in Orthopedics
Since Physician Assistant (PA) originated in the 1960s from the Duke medical center [1], it has been continuously growing as a health care profession and delivering care to general populations together with other medical professionals. The intention for creating the PA profession was to deal with the shortage problem of primary care workforce. Although the PA profession has become a vital part of the primary care, the percentage of PAs practicing in the primary care had declined from 50.2% in 1995 to 32.1% in 2013. On the other hand, the number of PAs has grown so quickly in subspecialties of both internal medicine and surgery [2]. As a surgical subspecialty, orthopedics has become the second most common specialty practiced by PAs following only to the primary care. The orthopedics employed 10.9% of the total PAs in 2013 as compared with a 6.5% in 1997. The percentage of PAs practicing in orthopedics had increased steadily from 1997 to 2006 and then maintained around the 10% level (Figure 1).

The absolute number of PAs in orthopedic practice is growing more dramatically, as the total number of PAs eligible to practice medicine has been increasing almost in a linear manner in the past decade (Figure 2). With the influence of the Patient Protection and Affordable Care Act (PPACA), new PA education programs has sprang up all over the country [3] and the number of PAs are predicted to see an enormous growth in the near future. In 2002, there are 5069 PAs practicing in the orthopedic specialty, whereas the number doubled in the year of 2013 (Figure 2). By contrast, the percentage of PAs practicing in the orthopedic medicine only has a 2% increase from 8.9% in 2002 to 10.9% in 2013 (Figure 1).
Why PAs are popular in the Orthopedics?
Contributions of PAs to the orthopedic medicine can be seen in both inpatient and outpatient settings [4]. They provide pre- and post-operative services to patients by working closely with physicians, nurses and residents [5]. Most orthopedic PAs operate on a variety of surgical procedures routinely, although their common roles are working as first assistants [6]. Overall, PAs have earned good reputations in the orthopedic medicine, which reflects they had been well trained in the first place. As lots of PA programs have close relationships with medical schools or hospitals, PA students are often trained together with medical students, residents, and fellows. As general health care providers, the PAs are flexible with their specialty choices and they also can easily switch to a new specialty.

Employing PAs in the orthopedic medicine has many obvious advantages. Firstly, utilization of a PA does not cost more than hiring a surgical assistant [7]. Although the direct collections could not cover their compensations [8], PA related services have impacted the orthopedic care significantly by decreasing wait
Figure 1: Percentages of PAs practicing in orthopedics were shown from 1995 to 2013. Data was from the American Academy of Physician Assistants (AAPA) PA Censuses (1995-2013).
Figure 2: The PAs practicing in orthopedics are shown from 2002 to 2013. Data was from the annual AAPA PA Censuses (2002-2013).
time, lowering post-operative complications and shortening postoperative stay [7,8]. Secondly, PAs in orthopedic medicine can free physicians from both the operating room and some pre- and post-operative services. For physicians, the saved valuable time can be used for other purposes such as administration, research and other clinical activities. Last but not least, the orthopedic care is more efficient as a result of employing PAs in the orthopedic medicine. The increased pull through rates in both emergency room and operating room benefits both the hospitals and the patients [7,8].

There are many factors for attracting PAs to the orthopedic medicine, in which financial incentives and employment opportunities probably have the strongest influences [9]. With cardiovascular/thoracic surgery, neurosurgery, emergency medicine and dermatology, the orthopedics was one of the five specialties offering the highest salaries on average to PAs in the year of 2005 [2]. The physicians in orthopedics are also willing to hire PAs as they could have excellent assistants by paying a much lower level of compensations than what they have. So this is a win-win situation from all involved parties for getting PAs involved in the orthopedic medicine. The number of PAs practicing in the orthopedic medicine is predicted to keep going up until the market is saturated by the rapid growth of PAs later.
References
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  8. Althausen PL, Shannon S, Owens B, Coll D, Cvitash M, Lu M, et al. Impact of hospital-employed physician assistants on a level II communitybased orthopaedic trauma system. J Orthop Trauma. 2013; 27(4):e87- 91. doi: 10.1097/BOT.0b013e3182647f29.
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