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Physician assistant past present and future -2013

Jun 02, 2015


  • 1. Physician Assistant Past, Present and Future Ashish Gaur BS(BITS),M.D(AM),PG Dip PPHC

2. ITS 1650. The first documented not a nurse, neither a doctor position was in Russia in 1650 with the feldshers who provided healthcare in rural locations throughout the country. During the French Revolution, there was officer de sant who worked in the battlefield providing healthcare since many doctors and nurses were being killed along with the soldiers. China-1966 Bare foot Doctor. Know your past and learn for present to improve your future 3. Dr Eugene Stead innovated. Kenneth Farewell-First qualified Physician Assistant (PA) India-Started in 1991 History 4. First PA graduated from Duke University in 1967. John Kirklin initiated the first formal educational program for training PA. His wife was the program coordinator. John Byrnes founded APACVS in 1981. APACVS recognition by AATS.(IAPA by MCI?) History 5. Among the most famous PA (1970) Was assistant to Dr. Blalock who devised BT shunt. Later was teacher to Dr. Denton Cooley in Blalocks unit. During the first live human child heart operation he looped and anastomosed for Dr. Blalock. Was recognized despite being BLACK Movie-Something the lord made.---A Must watch Vivian Thomas 6. Wanted to be a doctor---missed a seat. Enthusiasm and zeal towards patient treatment and care. Best profession which takes you to nearest to patient (excluding doctors ) in comparison to all other paramedics. DID YOU BECOME A PA 7. Recognition-Only in parent institute Confusion- As nurse and unqualified Salary-Meager Job-Not defined job profile and difficult placements. Future-Not defined. Migrated to USA. Past-Problems 8. Defined job profile. Descent starting salary. Numbers-700 till date? North and central India is open for jobs. Escorts, Medanta, Narayana, Asian Heart, Kokilaben, Fortis and Wockhardt. Present 9. Job Profile-harvesting vein ,radial artery, opening and closing of sternum, assisting as first /second assistant. ICU-IABP and ICD insertion and removal. Hemodynamic management. Rounds and wound management. Present 10. Harvesting vein, radial Graduate to IMA Opening and closing of sternum. Assisting as first/second assistant. Operation Theater booking/scheduling cases. Job Profile-OT 11. Hemodynamic monitoring Diagnose the problem before it arises. Procedures-ICD, IABP, Intravenous, arterial lines (in association with Surgeon). Rounds. Job Profile-ICU 12. Initially a surgeon assisted another surgeon. This team doesnt exist now in any part of the world. Because assistant surgeon wants to create his own team. Did not pursue for long as need for independence and identity arises. A PA/SA is anchor to the team. Together with a surgeon, PA can build the team under trust and mutual understanding which can last permanently. Both can grow independently and interdependently. Symbiotic Relation. Anchor and Team Builder 13. Approach APACVS. Approach MCI. Open branches and encourage PAs working in those respective areas to be members and help to groom future of PA s in those respective states. Journal-Need to go online. Induce more hospitals for training. Approach central health government body. Future 14. Training-Should be practical but theoretical is must. More emphasis on theory. Courses less than 4 years should be discouraged. Conduct campus interviews for jobs post completion of the course. Involve senior PAs working in different states and hospitals in job interviews. Massive demand in hospitals in north and central India but due to unavailability of qualified PAs they opt for quacks. Future 15. Student Union/Group. Active participation in association. Senior PA to be approachable, to come back to association. PAs should help the juniors for fetching job CME-twice a year and alumni meet once a year. Future 16. IAPA to associate with other universities rather than hospitals to start PA courses. IAPA should open more branches. IAPA to conduct regular training sessions in form of CMEs UNITY. Future 17. Develop endoscopic program. (Future) Minimally invasive training .(An assistant should know what his boss is looking at and approaching ) In ICU-Train on IABP insertion and central line and intubation. Wound management clinic should be manned by PA As they close wound and should graduate to better management techs (VAC). TEE -Developing scenario in Intraoperative(we have started doing it)-Centers-Pune and Bangalore. Diversify-Interest based. Huge demand in neurosurgery and general surgery too. Goals 18. Where are wewhere we should be? Present Knowledge Unidimensional job profile Recognition by Unit Self or Pear recommendation BHMS, BAMS,unqualified also work as PA. Central IAPA Aim Growth. Multidimensional MCI Defined profile BAN by association Decentralize the body. Open more branches 19. Untrained Unqualified Homeo, Ayurs and Bsc Graduates. Association ban . Letter to hospitals employing them. Quacks 20. Assistant name does not adequately represent all that a PA does. Worldwide PA- Physician associate or Surgical Associate. PA name drives confusion in patients and staff (often mistaken as medical assistant). In USA AAPA has passed a bill to rename PA to physician associate. Easy to do in India as still controlling body is one and numbers are limited. Should be done to avoid confusion. Misnomer 21. IAPA to associate with IACVTS. IACVTS to conduct regular exams only after passing out the degree. To certify the Surgical associate that he can perform. It will help eliminate QUACKS and will give platform . Further IAPA meet to be held with IACVTS meet. It will regularize the forum and then we can take it from there (example- Perfusionist). Should speak to Dr Suresh Rao and Dr Rajan and get it done. IAPA ---IACVTS 22. If an Indian surgeon wants to give USMLE/MRCS to migrate to US/UK for bigger and better fortunes. What needs for an Indian PA to do the same in US/UK. NEED HOMEWORK and Logistical planning . Should be discussed and shared in fraternity. On priority basis and can take help from PA s working in USA and cardiac surgeons worked in US/UK. Migration To Western World 23. Approach MCI Via senior doctors Via Local MCI body Approach Health Ministry Political approach Write Letters Articles Newspaper Camps Recognition By MCI 24. Yearly Elections. Please dont retain presidentship for long. Recruit youngsters from class level as CR. Responsibility of office bearers to approach MCI and conduct regular meets. Journal Club where very PA can publish online atleast triyearly. PA working in other states and hospitals to take lead in organizing future IAPA meets. IAPA 25. A BIG ISSUE Should open MS PA Should train and start courses post BS . Can plan off campus. It can stop migration. Post Graduation 26. AAPA has included IAPA in their official website and has a link. GOOD NEWS 27. Involvement Dependence Training Protocol following Trust RECOGNITION 28. Cardiac surgery lures . Want to perform. Knowledge Train Trust Time Care