David Serbousek

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Physician Assistants In The UK
David Serbousek AS, BSN, RN, BM, PA-C Helen
Serbousek AS, RN, BM, PA-C
1st November 2006
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OBJECTIVES
REQUIREMENTS TO WORK IN THE US
REQUIREMENTS TO WORK IN THE UK
THE UK EXPERIENCE
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Where were coming from
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A quick Primer on Physician Assistant Practice
in the US
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• Over 50,000 Physician Assistants practicing in
  the US
• Over 30 employed in a Family Practice setting.
• The remaining are employed in

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To Practice in the US

• Must have a 4 year college degree
• This will allow you to apply to an accredited
  Physician Assistant Program
• Must be graduate of an accredited Physician
  Assistant Program
• This will allow you to apply to take the
  National Certifying Exam
• Must pass the National Certifying Examination

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IN THE US THERE IS NO NATIONAL MEDICAL LICENSE

• Must apply for licensure to practice medicine
  with the Board of Medicine in each state intend
  to practice
• Must apply for prescription privileges to the
  Pharmacy Board in each state intend to practice
• Must apply to the Federal Drug Enforcement Agency
  to prescribe controlled substances

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In Practice

• Employed by an institution or private practice
• Must have a designated supervising physician
• He doesnt necessarily have to be on site
• Must have a scope of practice on file with either
  the institution of hire or with the supervising
  physician

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SCOPE OF PRACTICE

• The scope of practice is established by sitting
  down with the the supervising physician and
  agreeing on what he needs done and what the PA-C
  feels comfortable in doing.
• The scope of practice is usually a mirror of
  the practice of the supervising physician.
• As a midlevel provider--a physician extender--the
  PA is there to provide the services of that
  particular practice

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And Remember

• Must renew state and local licenses at a one or
  two year interval
• Must log yearly Continuing Medical Education
  Requirements
• Must take the Physician Assistant Recertification
  Exam every 6 years

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• Physician Assistant training is a general
  medicine training.
• Certification and Recertification exams are
  general medicine examsno matter what area of
  medicine the PA is in actual practice.

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To Practice in the UK
Current US certification, and be able to maintain
that certification Must have a employer, or the
offer of employment Passport Work Permit Work
Visa
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Malpractice Insurance (Medical Protection
Society) Develop scope of practice Maintain
CMEs Local Online Mail National Meeting
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I dont think were in Kansas anymore Toto
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Since youre here A few things to think about
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I dont think they exist
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Food Shelter Clothing
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Helens Hierarchy
Shoes Jewelry Cute dress Diet coke Food
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The 2 Biggies

• The 2 most important things that you need
• when you get off the plane (other than the
• Airport restroom) is a place to live, and a way
  to pay for it.

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Taxes Council Tax This one can
throw your budget for
a loop
TV Tax I didnt watch
it when I didnt
have to pay for it Road Tax Only if
you have a car
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Sticker Shock
Everything is sooo expensive
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You Say Tomato
I say tomato
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England and America Two countries separated By a
common language
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Thats not what I thought you saidHow we
communicate

• Everyday greetings You all right?
• Common objects
• Slang
• Local Colloquialisms

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Medical Terminology

• ASA ASAP
• Hep Lock
• Nitro Drip
• 10 MS IV Now
• Cardiac Labs
• EKG

• Aspirin is Aspirin
• Cannulate
• GTN Drip
• Diamorph
• Bloods
• ECG

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Use of the Generic name rather than the Trade
name for medications Tylenol isnt even
acetaminophen So how high was that BM? Now
that was some BO! CervicalIs that like a
bi-cycle?
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• At the moment, we are working in
• Family Practice and AE
• We are able to be plugged directly into
• any medical specialty
• We can work anywhere you have the need

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In the US

• The PA performs Hx and Px
• Orders and interprets lab tests and diagnostic
  studies
• Makes referrals
• Admits and discharges from the hospital
• Follows up after discharge

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• Diagnose and initiate Tx
• Perform minor surgery in the office
• Assist with major surgery in the
• hospital

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• Carry a full patient load
• Patients are not screened for acuity
• The next one on the list is the next one seen

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In the UK

• The PA performs Hx and Px
• Requests and interprets lab tests and
• diagnostic studies
• Makes referrals
• Admits to the hospital
• Follows up after discharge
• Performs minor surgery in the office

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• Patients are not screened for acuity
• See the next one on the list
• And we carry a full patient load

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Current Situation for PA Practice
33 months on and we are still an unregistered
profession. Working under Article 46, The
Delegation and Referral Clause, from the General
Medical Council's Guide To Good Medical
Practice No prescriptive privileges--All
prescriptions must be Signed by a
physician Family Practice Physician Assistants
cannot request X-rays or many other diagnostic
tests
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Family Practice
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This is how Helens day begins
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Sample Morning and Afternoon Appointment Schedule
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All these open Slots before 8AM
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The phone begins to ring, and
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• This is in addition to filling out forms for
  insurance companies, social services, police,
  etc
• Home visits
• Office procedures

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AE
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PA Practice in the AE

• Practice as a Clinical Assistantwith
• all that entails
• Can request routine X-rays (and
• stand in line like everyone else for
• other diagnostic studies
• Not able to sign prescriptions

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Comparing Practice in the USand the UK

• In the USER and Family Practice tends to Tx 1st
  and refer as the disease progresses, or does not
  respond to Tx
• Most minor procedures such as toe nail
  excisions, wart removals, vaginal exams,
  endometrial Bx, etcare done in the ER or the
  office at the time of the visit by the Family
  Practice provider

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In the UK

• AE and Family Practice tends to rely on the
  consultants for management of the Dz
• The Dz is managed by the consultants and the
  practice nurses in their various clinics
• Conditions that are found to require a minor
  surgical procedure are usually deferred for
  another visit or to
• a consultant

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• In the NHS, time constraints and targets would
  not allow the AE or the GP to practice in a US
  style
• Very difficult to fit complete patient care into
  a 7-10 minute visit.
• Many surgeries do not have the space
• to allot for a dedicated procedure room all the
• time
• It makes sense to divide the patient care into
  managed bits such as to the consultant or the
  practice nurse, or a certain day of the week set
• aside for surgeries

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The past 33 months have been a very positive
experience for every one involved in the
process Have integrated well with
doctors, nurses, and patients
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Patient feedback has been very positive Physician
Assistants do a good hands onPhysical exam A
lot of patient teaching concerning patient
illness, medications, and prognosis
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Why use Physician Assistants?

• If you cant get enough Docs to do the job then
  Pas
• can extend the services
• Broad base of General Medicine covering all the
  areas of medicine.
• Trained to practice medicine
• Cost effective

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Thank you for your attention, and as my friend
Groundskeeper Willie says
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If it's not Scottish It's Crrrap!!!
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Think outside the box
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Website www. ukapa.co.uk
Helen Serbousek PA-C Mobile [phone] Home
01384 296 182 Email hserbousek_at_yahoo.com
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Questions???