History of the profession, PA organizations, certification & licensure, teamwork, clinical practice, professionalism, and difficult-conversation frameworks, condensed to the highest-yield facts.
| Topic | One-glance facts |
|---|---|
| 5 stages of development | Mnemonic "I Implement Every Important Maturation" → Ideology, Implementation, Evaluation, Incorporation, Maturation. Implementation era (frameworks, licensure, accreditation) ran 1966–1972; Evaluation stage produced HMO research showing a 76% "substitutability factor." |
| Dr. Eugene Stead | "Father of the profession"; Chair of Medicine at Duke. Had used a fast-track, competency-based physician model at Emory in the 1940s to staff Grady Hospital; founded the first PA program at Duke in 1965 with 4 former Navy corpsmen (2-year program). |
| Dr. Charles Hudson | NBME president; first introduced the PA "concept" in a 1961 speech to the AMA House of Delegates (published JAMA 1961). Envisioned corpsmen given 2–3 yrs college training as technical "externs" who would not make medical judgments. |
| 4 Pillars of the profession | (1) Professional association, (2) Educational organization, (3) National certification, (4) Program accreditation. |
| Key founding years | 1965 Duke's first PA program (same year Medicare & Medicaid created) · 1972 APAP founded (now PAEA) · 1973 first cert exam (NBME) & first AAPA meeting (Wichita Falls, TX) · 1974 NCCPA formed · 1975 first PANCE. |
| 2020s milestones | 2021 AAPA HOD changes name to Physician Associate; Hayley Arceneaux = first PA in space · 2023 NCCPA launches PANRE-LA · End of 2025: 201,038 PAs certified · 2026: 330 accredited entry-level programs · Licensure Compact adopted by 16 states. |
| PA History Society (PAHx) | Founded 2001; mission = share the history of the PA profession and show its societal impact; based at the Stead Center (NC), website pahx.org. Collections: oral histories, biographies, illustrated timeline, videos, photos, memorabilia. |
| Topic | One-glance facts |
|---|---|
| 4 pillars organizations | ARC-PA (accreditation) · PAEA (education) · NCCPA (certification) · AAPA (professional association). |
| ARC-PA | Created 2001; publishes Accreditation Standards for PA Education (6th edition, 9/2025); 322 accredited programs. Up to 30 Commissioners (2/3 PAs; remainder up to 6 physicians, 2 deans, 2 public). Also accredits Clinical Postgraduate Programs and Post-Professional PA Doctoral Programs (PPDP). |
| PAEA | Represents PA educational programs; mission = advance excellence in PA education. Administers CASPA (central application) and assessment tools PACKRAT, End-of-Rotation & End-of-Curriculum exams. |
| NCCPA | The only nationally recognized certifying body for PAs; established 1974; confers the PA-C designation. Administers PANCE, PANRE, PANRE-LA and 12 CAQs. Board: reps from AAPA/PAEA/FSMB + 7 PA directors-at-large, 2 public, 5 physician directors. |
| AAPA | Vision: PAs transforming health through patient-centered, team-based practice. 74,000+ members. House of Delegates (HOD) = policy-making body: 58 chapters, 27 specialty orgs, 15 caucuses, Student Academy (22 delegates). Student membership = $75 for entire enrollment. |
| SAAAPA (Student Academy of AAPA) | Comprised of AAPA student members; Student President sits on the AAPA Board of Directors. Largest single delegation in HOD at 22. Runs the National Medical Challenge Bowl (NSU Jax won 2012). |
| PAF & FAPA | PAF (Physician Associate/Assistant Foundation): mission = empower PAs to improve health through philanthropy; funds Impact Grants, Global Outreach, scholarships. FAPA (Florida Academy of Physician Associates): only FL PA org, established 1974; student membership $60. |
| Topic | One-glance facts |
|---|---|
| PANCE | 360 MCQs, six 60-min blocks of 60 questions, 6-hour exam day, 45 min total break time; ≥20% surgical content, ≤2% legal/ethical; covers 7 knowledge/skill areas + 13 disease/disorder categories. Eligible up to 6 years / 6 attempts (grads on/after 1/1/2003), retake limited to once per 90 days or 3×/year. |
| Recertification | CME: 100 hrs per 2-year cycle (≥50 Category I). Exam recert every 10 years via PANRE (Pearson VUE, 5 hrs, no reference material) or PANRE-LA (25 questions quarterly × 12 quarters, scored instantly). |
| Florida licensure | Regulated by Medical Practice Act 458.347 (Osteopathic 459.022), FS 456, FAC 64B8-30. License valid 2 years; requires 100 hrs CME/2 yrs or current NCCPA certification — continued NCCPA certification itself is not required to practice. |
| Credentialing vs. privileging vs. scope | Credentialing (mandated by Joint Commission & NCQA) = primary-source verification of education/training. Privileging = demonstrated ability for specific tasks, granted at the institution, renewed annually. Scope of practice set at credentialing via Medicare regs + federal/state law + hospital bylaws. |
| 7 PA competency domains | Mnemonic "Knowledgeable Interpersonal People Interact Professionally, Practicing for Society": Knowledge for Practice, Interpersonal & Communication Skills, Person-Centered Care, Interprofessional Collaboration, Professionalism & Ethics, Practice-Based Learning & QI, Society & Population Health. Last revised 2021. |
| Reimbursement | PAs generally reimbursed at 85% of physician fee. "Incident-to" billing pays 100% of physician fee (many restrictions). First-assistant surgery = 13.6% of primary surgeon fee. Since 2022, Medicare allows direct reimbursement to PAs if state law allows. |
| Optimal Team Practice (OTP) | Passed by AAPA HOD in 2017; primary goal = remove burdensome administrative constraints. Eliminates the legal requirement for a specific PA-physician relationship, creates a separate majority-PA board, and authorizes direct payment from all public/private insurers. |
| EMTALA (1986) | Hospitals must provide a medical screening exam (MSE) to anyone requesting emergency care. PAs can perform the MSE, certify false labor, and certify a stable patient may be transferred; an unstable transfer requires physician consult & signature. |
| Topic | One-glance facts |
|---|---|
| Interprofessional Collaboration (IPC) | WHO definition: multiple health professionals working together with patients, families, caregivers, and communities to deliver the highest-quality care. Benefits: reduces mortality, improves patient compliance, decreases professional burnout. |
| Barriers to IPC | Communication breakdown · hierarchical power structures · role confusion/scope-of-practice issues · organizational constraints · time & resources · cultural & attitudinal barriers · structural & systemic barriers · patient-related factors. |
| 4 tenets of patient-centered care | Dignity & Respect · Information Sharing · Participation · Collaboration. |
| Advanced-practice nursing roles | CRNA = RN + experience + master's, administers anesthesia (~$223K). CNM = RN + master's, labor/delivery & well-woman care. APRN/NP = RN + certificate/master's/doctorate, board exam required in FL, most specialize. |
| Therapy/rehab providers | PT = doctoral degree, licensed, rehab/modalities. OT = master's, licensed, ADLs & independence. Speech-Language Pathologist = master's, licensed. Audiologist = doctorate, licensed, hearing & balance. |
| Pharmacy team | Pharmacist = PharmD, regulated by State Board of Pharmacy, growing trend toward prescribing (varies by state). Pharmacy Technician = OJT/certificate, national certification exam. |
| Social work credentials | Social Worker = bachelor's (direct practice) or master's (clinical); LCSW specifically denotes training in psychotherapy. |
| Topic | One-glance facts |
|---|---|
| Where PAs practice | "Anywhere there are physicians": primary care · hospital inpatient & Emergency Departments · surgical specialties · medical specialty care · federal government · uniformed services. |
| 5 C's of primary care | Comprehensive (full range of services) · Continuous (care throughout the years) · Coordinated (with specialists) · Accessible (first point of contact, timely) · Patient-centered (attentive to satisfaction). |
| Primary-care fields | Family medicine, internal medicine, and pediatrics; lecture also asks students to distinguish primary vs. secondary vs. tertiary care. |
| Specialization | PAs specialize across both surgical and medical fields; hospitalist practice is cited as a growing role. |
| Alternative career roles | Beyond direct clinical care: administration, education, research, industry, and leadership. |
| Credentialing | Detailed credentialing/privileging/scope breakdown is covered in Lecture 3 (Professional Practice) — primary-source verification, institution-granted privileges. |
| Topic | One-glance facts |
|---|---|
| What is professionalism? | Not one quality but a combination that takes time to perfect; per PAEA, a top-10 noncognitive attribute. Qualities: responsible, ethical, accountable, integrity, honesty, excellence, lifelong learning, self-regulating, service, communication, team-oriented, time management, critical thinking. |
| Dress standards | PA school: no artificial nails, hair out of patient space, badge above the waist, closed-toe shoes. Professional clinical dress: collared shirt tucked in + belt (men); no cleavage, hems below fingertips, heels ≤2" (women); closed-toe/back shoes only. |
| Communication norms | Casual/informal with students; formal with faculty/staff (address as "Dr."/"Professor," arrive ≥15 min early — "early is on time, on time is late, late is unacceptable"). Never share patient info on social media (HIPAA violation). |
| 4 competency domains of professionalism | Toward the Patient (respect, compassion, integrity, HIPAA) · Toward Other Professionals (teamwork) · Toward the Public (accountability, ethics) · Toward Oneself (self-regulation = the hallmark, lifelong learning, self-assessment). |
| Intellectual honesty | Being honest when acquiring, analyzing, and transmitting information/ideas — stating the truth whether easy or hard, regardless of personal belief; decisions based on facts. |
| Academic integrity (ICAI) | Commitment, even in adversity, to six values: honesty, trust, fairness, respect, responsibility, courage. NSU violations: cheating, plagiarism (including AI), fabrication, multiple submissions, misrepresentation, bribery, forgery, falsification. |
| Collaboration rules | Allowed for simulations and small groups. Not allowed for written/computerized exams, OSCEs, or written assignments. |
| Topic | One-glance facts |
|---|---|
| NURSE | For strong emotion in the moment: Name · Understand (legitimize) · Respect · Support · Explore. |
| SPIKES | For delivering unexpected/serious/complex news: Setting · Perception · Invitation · Knowledge · Emotions · Strategy/Summary. Use a warning statement before delivering news, pause/allow silence after, then respond to emotion with NURSE before continuing. |
| CUS | For an immediate patient-safety concern, in the moment: Concerned · Uncomfortable · Safety issue (escalating). If not acknowledged, escalate immediately via chain of command. |
| DESC | For recurring interpersonal conflict, addressed privately after the moment: Describe · Express · Suggest · Consequences. |
| SHARE | For preference-sensitive shared decision-making (AHRQ 5-step). Clinician brings medical expertise, patient brings expertise on goals/values/circumstances — neither alone is sufficient; document the SDM process. |
| 3 communication channels | Verbal content (the words) · paralanguage (tone/pace/volume) · nonverbal behavior (expression/posture/silence). Incongruence (words ≠ behavior) should be approached with curiosity, not assumption. |
| Setting the tone | With patients: confirm preferred name, ensure privacy, ask what they already understand, avoid premature reassurance. With support systems: get explicit permission before including others, use a professional interpreter (never family for medical interpretation). |