Ophthalmology practices may find advantages in incorporating physician assistants
A board-certified PA can decrease patient wait times, increase practice efficiency and revenue, and allow flexibility for surgeons.
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Incorporating a board-certified physician assistant, or PA-C, into an ophthalmology practice can be an alluring idea for a proficient practice. However, it is often met with uncertainty regarding the necessary steps for successful implementation. Historically, PAs have been an integral part of the health care team, both in a primary care setting and other specialties including orthopedics, emergency medicine, dermatology, neurology and ENT, to name a few. Yet, few have been integrated into ophthalmology. Let’s examine some data to help explain this.
The National Commission on Certification of Physician Assistants provides an annual report on PA-Cs. According to the 2018 Statistical Profile of Certified Physician Assistants, there were 131,152 PA-Cs at the end of 2018 in the United States; 74 of these PA-Cs worked in ophthalmology. Indeed, these data confirm a PA-C in ophthalmology is rare but possible. Therefore, to help reconcile the lack of information regarding a practice model that includes PAs, the following are five tips from two ophthalmology PAs on how ophthalmologists might consider incorporating a PA into their practice.
First, just as medical school students have a limited exposure to ophthalmology until residency, the same is true of most PA students. As a result, much of the training for a newly graduated PA happens on the job. Therefore, on average, plan on 4 to 6 months of on-the-job training and shadowing before the PA begins to feel comfortable seeing their own full panel of patients. This length of time is not much different than a newly graduated PA entering dermatology or emergency medicine, for example. It is also similar to the amount of time it takes for a resident to get started in ophthalmology.
Second, PAs are trained in both clinical and surgical medicine — use a PA to their well-trained capacity. PAs can assist in surgery (eg, oculoplastics and vitreoretinal) and can manage chronic eye diseases with their own panel of patients. They are also able to help by seeing pre- and postoperative patients; performing surgical clearance history and physical examinations; performing a variety of clinical procedures such as intravitreal injections, incision and drainage of chalazia, slit lamp exams, fundoscopy and biopsies; prescribing medications; ordering and interpreting testing; and taking call. In short, PAs are natural team players and can bill for both their surgical and clinical services.
Third, consult with ophthalmology groups that are using PAs. Ophthalmology is a world full of colleagues who know each other and who are willing to collaborate on the model of PA practice integration. Reach out and you will connect with someone who is more than willing to share their personal experience and recommendations.
Fourth, check your state laws and regulations to see if there are any limitations in a PA’s scope of practice within ophthalmology. The majority of what a PA will be able to do clinically and surgically is determined by whatever their supervising physician agrees for them to do. In other words, a PA has a wide course and scope of practice. However, for example, in some states a PA is not allowed to write a prescription for glasses or contact lenses. Even if a PA gets trained in refraction and their supervising physician agrees for them to perform this, in some states they will not be able to provide this service.
Fifth, be patient with the learning curve, and this applies for both the PA and the practice. If both parties recognize from the beginning that neither one of them has likely done this before, they will be able to power through the inevitable hurdles that arise. In our experience, once the feeling of smooth sailing occurs and things start clicking, you will look back and see that it was all worth it. You will have another patient medical provider functioning to the level of capacity that you choose, and they will be able to bring in revenue with their own panel of patients. And, if you decide to hire on another PA, with what you have already learned the transition will be much smoother and more efficient.
Identifying your practice’s needs and incorporating a PA can decrease wait times for patients, allow coverage when other providers are unavailable, increase practice efficiency and revenue, and allow surgeons more flexibility while having clinics covered. The American Academy of Ophthalmology said that it is “experiencing or will experience an overall shortage of ophthalmologists.” With the need so great in our rapidly aging baby boomer population and ophthalmology practices, bringing aboard a PA-C may be the solution you, your practice and your patients are seeking.
- References:
- 2018 Statistical Profile of Certified Physician Assistants. https://prodcmsstoragesa.blob.core.windows.net/uploads/files/2018StatisticalProfileofCertifiedPhysicianAssistants.pdf. Accessed Feb. 15, 2020.
- Supply of ophthalmologists. https://www.aao.org/focalpointssnippetdetail.aspx?id=3df1324e-8154-4cd3-b1d5-721e0c941ab9. Accessed Feb. 15, 2020.
- Washington State Legislature: RCW 18.71A.060. Limitations on health care services. https://app.leg.wa.gov/RCW/default.aspx?cite=18.71A&full=true#18.71A.060. Accessed Feb. 15, 2020.
- For more information:
- Stephanie Schick, PA-C, can be reached at Schick Ophthalmology, 436 E. Yosemite Ave., Merced, CA 95340; email: sschick@westmont.edu.
- Joel Ciolek, PA-C, can be reached at Kaiser Permanente Vision Essentials – Ophthalmology, Building B, 3553 Whipple Road, 1st Floor, Union City, CA 94587; email: ciolekj@heritage.edu.
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