Career Companion

Career ComPAnion
An Essential Physician Assistant Resource

2011 edition
PREPARE FOR PA LICENSURE AND CERTIFICATION NAVIGATE YOUR PA JOB SEARCH LEARN YOUR PRESCRIBING PRIVILEGES INSURE YOUR PROFESSIONAL FUTURE WITH LIABILITY COVERAGE
Glossary of Web Links
Career ComPAnion
The electronic Career ComPAnion has the ability to quickly navigate to suggested external websites with a click of a button. This glossary of web links allow you to take advantage of the suggested sites by simply typing the web address into your internet browser.
AAPA
www.aapa.org
Page 10 Resume Sample Resume

http://careers.dyc.edu/guide/sec3/resumes/pa_1.pdf
Suggested Resume Headings

http://www.thedoctorjob.com/careercorner/view_article.php?id_article=12&button=true
What to Showcase
http://college.monster.com/benefits-entry-level-resume/articles/210-entry-level-resume-dilemma-recent-college-graduate
Page 19 Finance Moneydance

http://moneydance.com
Quicken
http://quicken.intuit.com
Mint
www.mint.com
Wesabe
www.wesabe.com
Thrive
www.justthrive.com
Page 53 Insurance/Malpractice Medical Malpractice Terms

www.camedicalmalpractice.net/glossary.htm
Insurance Terms
www.medpro.com/web/medpro/glossary
NPI
https://nppes.cms.hhs.gov/
Copyright 2011 by the American Academy of Physician Assistants All rights reserved
Table of Contents
CHAPTER 1: THE PA STUDENTCAREER PREPARATION Introduction.................................................................................................. 3 A. Creating Your Professional File................................................................. 5 Records to Maintain............................................................................... 5 Professional Development Portfolio....................................................... 7 B. Rotations................................................................................................. 8 What to Expect...................................................................................... 8 Rotation Dos and Donts........................................................................ 8 Specialties and Electives....................................................................... 9 C. First PA Job Search................................................................................. 10 Rsums and CVs................................................................................ 10 Cover Letters....................................................................................... 10 Employment Resources........................................................................11 D. Interview Preparation............................................................................ 12 Before the Interview............................................................................ 12 During the Interview............................................................................ 12 After the Interview............................................................................... 13 E. Compensation. ....................................................................................... 14 Before You Make Your Decision Checklist............................................. 16 F. Financial Management........................................................................... 18 Loans and Repayment......................................................................... 18 Creating a Budget................................................................................ 19 Analyzing Your Budget......................................................................... 21 CHAPTER 2: BEGINNING YOUR PA CAREER Introduction................................................................................................ 25 A. New PA Checklist................................................................................... 27 B. Work Settings and Specialties............................................................... 28 Specialty Practice................................................................................ 28 Hospital Practice................................................................................. 29 C. Working with Physicians and Patients.................................................... 30 Ethical Conduct................................................................................... 30 PA-Patient Relationships. ..................................................................... 31
Table of Contents
The Physician-PA Team........................................................................ 32 D. NCCPA Certification................................................................................ 34 How to Get Certified............................................................................ 34 Preparing for the PANCE...................................................................... 34 Maintaining Certification..................................................................... 34 E. State Practice Authorization/Licensure. .................................................. 36 Obtaining Licensure, Registration or State Certification........................ 36 Temporary or Graduate Licensure.................................................. 36 Federally Employed PAs....................................................................... 36 Maintaining Your License, Registration or State Certification................ 36
F. Continuing Medical Education................................................................ 40 CME Opportunities.............................................................................. 40 Logging CME Credits. ........................................................................... 41 G. PA Prescribing and Dispensing............................................................... 42 State Regulation.................................................................................. 42 Types of Drugs..................................................................................... 42 DEA Registration................................................................................. 42 Drug Dispensing.................................................................................. 43 Drug Samples...................................................................................... 43
H. Contracts and Employment.................................................................... 46 Written Contract Components.............................................................. 46 Contract Checklist............................................................................... 49 Other Employment Options. ................................................................. 50 I. Professional Liability Insurance............................................................. 51 Policy Types.........................................................................................51 Sources of Coverage............................................................................ 52 Insurance Carriers............................................................................... 53 Where to Obtain Coverage................................................................... 53 Liability Coverage Checklist................................................................. 54
J. PA Reimbursement................................................................................. 56 Coverage and Claims........................................................................... 56 Claims Denials. .................................................................................... 57 Conclusion.................................................................................................. 58
Chapter 1:
The PA Student Career Preparation
Introduction
The time to begin planning your PA career is while you are still a student. Preparing essential information, exercising professionalism and educating yourself about what practice entails will help you more easily transition into your rst job as a PA. In this section, you will nd details about establishing a professional le, why it is important and what it should include. You will also learn about what to expect on rotations and how to make the most of this important part of your training. This section also includes practical information about searching for your rst PA jobwhat you will need to prepare, information you should have ready and questions you should ask prospective employers. Additionally, there are tips for managing student loan debt and for creating a personal budget.
Career ComPAnion
Creating Your Professional File

You should start gathering information for your professional le as early as possibleat least by the beginning of your second year of PA school. A professional le is a record of your education, career, professional materials and achievements that you maintain throughout your career. This reference is extremely helpful when you apply for employment or licensure, enroll in postgraduate training, log your continuing medical education hours or submit a manuscript for publication. Establishing your professional le while you are still a student ensures that you will have complete records from your education and the beginning of your PA career.
RECORDS TO MAINTAIN Since everyones path after graduation and certification varies, every file is different. However, there are standard records that all students and practicing PAs should collect and maintain: Educational Information Transcripts and diplomas: Keep one copy for each college degree. You can obtain these from your college or universitys registrars office, usually for a small fee. Clinical rotation information: Note locations, dates, names and positions of people with whom you worked. Keep contact information for your preceptors. Include a list of duties/ procedures performed for each of your rotations. Credentialing Rsum and curriculum vitae: Always have these up to date and ready to submit for employment or credentialing. E dit your rsum to ensure that it is relevant to any positions for which you are applying. Y ou can find tips on rsum or CV preparation in the First PA Job Search section. Licensing/registration/ certification materials: K eep a copy of your state license, registration or certification.
Career ComPAnion
Paper Trails Keep a notebook of your professional file, as well as electronic copies. You can take your notebook version with you to interviews.
Becoming a PA-C Begin planning for your NCCPA certification while still a student. See page 34 for details and visit www.nccpa.net.
Rsum Prep You can find tips on rsum or CV preparation in the First PA Job Search section on page 10.
Planning Ahead Download the state license application well before youre scheduled to graduate. That way you have time to complete it and are aware of any unique requirements specific to your state.
Record your NCCPA certificate number and the date of your certification. Retain copies of your credentials from various trainings you may have completed (BLS, ACLS, PALS, ATLS, etc.). Keep printed copies of your states PA laws, rules and regulations. Hospital credentialing forms: K eep copies of the forms you complete for credentialing and privileging in all hospitals where you practice. K eep all correspondence related to credentialing and privileging. Procedure log: B e sure to list the name of the institution, type of procedure, date and name of the physician from your team for each procedure. Professional Education Classes/Education: U se a calendar to document periodic grand rounds, trainings you attended, preceptorships, classes, etc. D ocument your education in pharmacology or other clinical topics that are required by your state for licensure. CME records: K eep copies of the CME logging forms and certificates
of completion from all CME courses you attend. Supporting Documents References: A nticipate those that will be most helpful and request them before a reference is needed. I f someone volunteers to provide a reference in case you ever need one, accept the reference and keep it on file. Personal correspondence: K eep congratulatory letters and endorsements from patients or agencies you may have assisted. C ollect articles or informational brochures featuring you or your practice. Publications and presentations: K eep copies of any articles that you author or co-author, as well as any reviews or correspondence referencing the article or paper. N ote presentations you have delivered (CME presentations, lectures for PA programs, department in-services, etc.). K eep copies of any patient educational materials you helped develop. Organization records: R ecord your professional organization membership(s) and positions of leadership you held, meetings you attended and activities in
Career ComPAnion
which you were involved with the organization(s). Awards or honors: K eep records of awards or honors that you received in your professional role or in community activities. Volunteer activities: D ocument any medically related volunteer activities in which you participate, including training, mission trips, etc. Sample write-ups: K eep copies of sample writeups that do not include patient information. W rite-ups can encompass Op notes, discharge summaries, history and physical exams, SOAP notes, etc. Financial Records Employment contract: R etain a copy of your contract or employment agreement for every fulland part-time position. K eep copies of your annual evaluation or review. Malpractice (liability) insurance records: R etain copies of all policies you currently hold and any you
held in the past. (If you are on a group policy, ask for a copy of the policy or the certificate of insurance. Either document should include the name of the insurance company, the insured entity, the policy number and the dates of coverage.) E xpense records: S ave records of all professional dues, expenses related to your practice, equipment you bought for your practice, CME expenses, etc. Reimbursement information: K eep copies of reimbursement coverage policies for your state. PROFESSIONAL DEVELOPMENT PORTFOLIO AAPA offers a convenient way for members to manage their professional files. You can access our online tool, the physician assistant Professional Development Portfolio, to record and manage all the details of your professional file. The PDP is free for all members and allows you to efficiently track your education, work history, advanced training and other educational activities. To create your PDP account, please visit our website.
Payment for PA Services AAPA researches private insurance payment policies for PA services. To learn more and to read about state-specific information, visit AAPAs website.
Own Your Career AAPAs Professional Development Portfolio is customizable and portable. At the touch of a button on your smartphone or a few easy clicks on your laptop, you can access and update your personal portfolio.
Career ComPAnion
Rotations
Clinical rotations give you the chance to put your classroom lessons into practice. They also help you to learn more about working with physicians and patients. Although all rotations are different, there are similarities in how you should approach each rotation.
WHAT TO EXPECT Although most programs will provide you with a clinical rotations handbook, be prepared to also learn and follow each hospitals written and unwritten rules. Organizations have different methods that are acceptable for writing chart notes, dictating, writing prescriptions and making referrals. Additionally, you should be sure to clarify your preceptors expectations, including your work and on-call hours, your level of responsibility and how to do rounds. You also need to be aware of your legal limitations and the regulations for PAs in your state. During all clinical rotations, you will be expected to take an interest in your learning. Volunteer to do procedures, ask for help and always speak up if you need clarification. ROTATION DOS AND DONTS Do: A lways come prepared to your rotationbring a pen, notebook, stethoscope, etc. I nvest in professional and comfortable shoes. T urn your cell phone to vibrate or turn it off completely. S pend as much time as you can with your patients and learn their personal histories and interests. A sk you preceptor questions, especially if you are unsure. D isplay your credentials prominently. V olunteer to take extra work or work additional hours, but not at the expense of your studies. H ave a good attitude about being at every rotation; consider it a privilege to be there. C ome to rotations well-groomed and appropriately dressed. S hare your resources with everyone. R emember you are on a perpetual interview while on rotations. You never know who is watching and is interested in hiring you. B e confident and willing to exercise your judgment. F amiliarize yourself with your environment so when emergencies happen, youll know where to find the proper supplies, medicine, equipment, etc.
Dont Forget to update your professional file whenever you begin a new rotation.
Career ComPAnion
S ay yes when your preceptor asks you to do something. B e courteous to your patients families and loved ones. B efriend the nurses and learn nursing skills. Follow HIPAA regulations carefully and uphold patient confidentiality. C arry trauma scissors: When all else fails and you have no idea what is going on, you can always help by cutting off someones clothing. Dont: Forget to study during rotations. Complain. Show up late. Text. W ait for preceptors to ask you to do something; be proactive and motivated every day. T reat the office or nursing staff disrespectfully. A ct uninterested or as if you already know what you are being taught. S ay, I dont like (specialty). Instead say, Im not too familiar with (specialty). Forget to smile. C orrect the preceptor, even when you think he or she is wrong; ask a question instead. C ompare yourself to medical studentsyou are in two different professions.
E ver do something you feel uncomfortable doing. A sk to leave early; your preceptor will let you know when you are finished. T alk on your cell phone in the room with patients, even if the physician does. G et discouraged if you dont understand a discipline everyone has his or her strengths and weaknesses. Thats why medicine is a team profession. T hink it will be easy, but always remember it will be worth it! SPECIALTIES AND ELECTIVES For rotations, the majority of specialties you will study are determined by your PA programs curriculum. However, most clinical portions of study offer one or two elective rotations. For your electives, you can choose to spend more time in a specialty with which you are familiar, or you can try something new or clinically challenging for you. Also, many students are hired by organizations where they spent time during their clinical rotations. So, the contacts you make during rotations can be valuable sources for future employment. Because of this, you should also consider the geographic location or organization type when planning your elective rotations.
Connect with Other Students The Student Academy of the American Academy of Physician Assistants has a Facebook page. There, you can join discussion boards, post to the wall and access information specifically tailored to the lifestyles of busy PA students. Visit and like us at www.facebook. com/AAPAstudents.
Career ComPAnion
First PA Job Search

You may begin looking for your rst job as a practicing PA during your clinical rotations. At that time, you can begin to get a sense of where you would like to practice and with whom. You should not only prepare your rsum or CV for unexpected job opportunities, but also prepare yourself for the interviews that will follow.
Use Your Resources To see cover letter examples, go online or ask friends who have had successful job searches. Click on the links below for tips on what to include in a rsum: Sample Rsum Suggested Rsum Headings What to Showcase
RSUMS AND CVS The rsum or curriculum vitae is typically the first opportunity PAs have to make an impression on potential employers. Whether you need a resume or CV depends upon the positions for which you apply. It is more likely that as a new PA graduate seeking a clinical position you will use a rsum. CVs are generally used in scientific and academic settings where it is necessary to provide detailed information about teaching, research, publications and presentations. Rsum A rsum is a condensed list, usually one or two pages, highlighting and summarizing previous and current jobs or other relevant experience. Rsums highlight information that specifically relates to the job for which you are applying. Rsums should include: Contact information Your objective Employment history
Education information Additional clinical training License/certification information Curriculum Vitae A CV is a longer, more detailed document designed to demonstrate expertise and authority. This compilation might include information that is not specifically related to the job but is important to your professional career. CVs generally include: Contact information Employment history Education information Professional qualifications Awards Publications Presentations Professional memberships Interests COVER LETTERS A cover letter is a way to introduce yourself and your work to prospective employers. Cover letters should be direct, concise
10
Career ComPAnion
and tailored to each position for which you apply. Although each cover letter will include different specific information, all cover letters follow a general format: E ach letter should be about one page long, consisting of about three paragraphs Y ou should maintain an enthusiastic yet professional tone throughout T he purpose of your letter should be stated in the first paragraph I n the body of the letter, explain how your skills benefit the practice or organization M ention areas of excellence that are listed on your rsum or CV and explain them further C lose with proposed next steps, such as calling to follow up within a week EMPLOYMENT RESOURCES PA Job Link To help connect PAs and employers, AAPA developed the PA Job Linka free, comprehensive employment resource for PA students and
practicing PAs. The Job Link not only includes job postings, but also has professional development tools, salary profiles, interviewing tips and contract templates to assist you in negotiating an employment package. You can search for jobs by geographic location, specialty discipline and keywords. You can access the PA Job Link at www.aapa.org/joblink. Networking Consider visiting state chapter websites or attending state chapter events and conferences. You will have the opportunity to meet with PAs who work in your area and who may be able to connect you to employers who are hiring PAs. You also can become involved with your PA programs alumni group as a networking resource.
Did You Know? Many employers find value in their PA(s) belonging to professional associations and will often reimburse you for your AAPA fellow membership. You can address this issue when discussing your employment contract with a new employer.
Career ComPAnion
11
Interview Preparation
Know Your Worth AAPAs Annual Salary Report is a comprehensive report that includes salary information for all specialties in all states. Salary information is listed by practice setting, organization type and years of experience. It is available on the AAPA website; keyword search: Salary Survey.
The job interview is your chance to market yourself to an employer. It is also your chance to gain a better understanding of the practice or organization. As you interview for positions, be sure to consider the balance of quality of life, quality of practice (autonomy, philosophy of patient care), familiarity with team practice and level of compensation each position offers. Also, before you can begin working you will need a license (or, depending on the state, registration or certication), malpractice coverage and possibly hospital privileges.
BEFORE THE INTERVIEW: P repare a list of references to provide as well as copies of your relevant certificates (PA program, NCCPA). U pdate and organize your professional file (your notebook version) to bring with you to the interview. F amiliarize yourself with the laws and regulations governing PA practice in your state, particularly concerning your physician-PA team. You can find links to all state PA practice acts on the AAPA website. Consider bringing a copy of AAPAs state law summary to first-time PA employers. R eview the licensure application to know whether the physician from your team needs to submit paperwork. G ather information about the practice and the physicians that will be on your team. You can look for news articles, search the Internet, check the state licensing board for any disciplinary actions against individuals and even check the Medicare fraud listings (Exclusions Program) at http://oig.hhs.gov. I f the practice or facility is in your community, talk to friends and neighbors to learn about the organizations reputation. R esearch the health profile and the demographics of the community in which you will work. This will give you a better idea of the types of health problems the area may face. DURING THE INTERVIEW: Questions an interviewer may ask you: W hat are some of your strengths? Weaknesses? Career goals?
12
Career ComPAnion
W hy do you feel you are a good match for this position? How would we benefit from hiring you? Why did you decide to become a PA? What did you do before you became a PA (especially regarding medically related jobs)? What have you been doing during the time that you have not been working as a PA (if there is a gap in your employment history)? How do you envision your role in this position? What type of duties do you enjoy most? What do you hope to gain from this position? How would you describe yourself? What are your professional interests? Where do you see yourself in five years? As the physician on the team, what is my liability? Does the physician-PA team agreement require the presence of a physician at all times? Do I need to add you to my malpractice insurance, or will you have your own policy? Can we bill for your services? Will the income you generate cover your costs to the practice? How soon could you start working? Questions you should ask the employer: H ave you worked with PAs before? What is your vision of what PAs do? What do you know about the PA profession? How will the team be arranged? Will we establish a practice agreement? What hours will I be expected to work?
W hat roles will I be expected to play? What will my primary duties be? In which practice settings will I be working? What is your perspective on precepting students? Will I be allowed to work as a preceptor? How do you envision my role or responsibilities changing over time? Who is in charge of scheduling? How will patients be assigned? Who will decide and how? Will I have my own panel of patients? How does the telephone triage system work? How is the staff structured? Who are the other employees and partners? What are their roles? Who would be available to assist me? Has your staff worked with PAs before? If not, how will they be educated about the role of a PA? Is there anything I can do to help? How many PAs have been in this position in the past few years? Is the practice for sale? Is a sale possible in the next year? Is it merging with a health system? Will you be offering a written contract? AFTER THE INTERVIEW: I f you are interested in the position, send a thank you letter reaffirming your interest and restating the contributions you can make to the organization or practice. I f you are no longer interested, send a letter to thank the interviewer for his or her time and to notify him or her of your intentions.
Employer Education AAPA offers many types of informational documents to help potential employers understand PA practice and the benefits associated with physician-PA practice: Partners in Medicine brochure Physician-PA Team issue brief What is a PA? PowerPoint presentation Guide for New PA Employers booklet To learn more, visit www.aapa.org.
Career ComPAnion
13
Compensation
2009 National Survey The average yearly salary for PAs with less than one year of experience is $78,201.
This compensation information is taken from AAPAs 2009 Salary Report, which includes data compiled from the Bureau of Labor Statistics and the 2009 AAPA Annual Census. The data presented here represent the national sample of PAs working at least 32 hours per week and who are not self-employed. For more detailed information, order a complete 2009 Salary Report on our website. The report is a comprehensive document that presents salary information by region, division and state. Salaries are further broken down by years of experience, practice setting and specialty.
TABLE 1. Salary by primary care specialty for PAs with less than one year of experience
TABLE 2. Salary by specialty for PAs with less than one year of experience
Primary Care Specialty Family Medicine Family Medicine with Urgent Care General Internal Medicine General Pediatrics Obstetrics/Gynecology
(Source: 2009 AAPA Annual Salary Report)
Average Salary $73,188 $76,666 $75,243 $74,821 $72,065
Specialty Dermatology Emergency Medicine Hospital Medicine Occupational Medicine Pain Management Psychiatry Other
Average Salary $75,909 $87,129 $79,318 $74,833 $76,818 $75,441 $82,241
14
Career ComPAnion
TABLE 3. Salary by subspecialty for PAs with less than one year of experience
TABLE 4. Salary by surgical subspecialty for PAs with less than one year of experience
Subspecialty Surgical Pediatric Internal Medicine
Average Salary $79,678 $77,016 $75,707
Surgical Subspecialty General Surgery Surg: Cardiovascular/ Cardiothoracic Surg: Neurology Surg: Orthopedic Surg: Otorhinolaryngology Surg: Plastic Surg: Urology Surg: Spine
Average Salary $75,681 $82,214 $81,861 $79,290 $75,576 $78,750 $81,029 $79,833
TABLE 5. Salary by internal medicine subspecialty for PAs with less than one year of experience
TABLE 6. Fringe benefits for PAs who work at least 32 hours a week for their primary employer and are not self-employed
Internal Medicine Subspecialty IM: Cardiology IM: Gastroenterology IM: Neurology IM: Oncology
Average Salary $75,694 $74,615 $76,500 $76,730
Fringe Benefits Vacation (1 year in current position) Paid Sick Leave Paid CME Leave
Average Days per Year 15 8 6
Career ComPAnion
15
Before You Make Your Decision Checklist

notes Use this checklist to help you consider your employment options: Practice Hours and Location
How many office locations are there? In how many of these will you be expected to work? What are the hours of operation for each location? How many hours are you expected to work per week? Is there an on-call schedule? Is it flexible? How will holidays be covered? What time do weekends begin and end?
Responsibilities
Is this the type of work you want to do? What are the physicians expectations of what you will do? How will you interact as part of the physician-PA team? What level of autonomy will you have? What is the availability of the physician on your team? What is your relationship to your co-workers? Will you have supervisory responsibilities? In how many hospitals is the physician privileged? Will you be privileged, too? What are your hospital responsibilities (rounds, ER, evaluations, deliveries, surgical assisting)? Will you have hospital committee work? In how many nursing homes does the physician follow patients? What will be your responsibilities in the nursing home(s)? Will you be allowed to precept students?
Legal Issues
Is the necessary paperwork filed with the state licensing board or department? Did you review state statutes and regulations with the physician? Have you discussed rules/regulations and gray areas with your employer? Did you review the nursing home regulations? Is there a probationary period with the employer? Does the employer provide a written contract? Did you review and discuss the physicians malpractice policy type and coverage?
16
Career ComPAnion
Did you discuss the malpractice policy type and coverage you will need? Does the employer provide tail coverage (if needed)? Is there a non-compete clause? Is it enforced if you are terminated without cause?
Insurance
What malpractice coverage does the employer have (personal occurrence policy, personal claims-made policy with paid tail coverage or rider on physicians policy)? Is health and dental insurance provided? For dependents? Is life and disability insurance provided?
Leave
What is the annual leave policy? What are the paid holidays? What is the sick leave policy? What is the family/maternity leave policy? What is the unpaid leave policy? How many days are given for paid jury duty? How many days are given for CME?
PANCE stands for Physician Assistant National Certifying Exam and is the initial certifying examination for practicing PAs. Once you pass the exam, you can then use the credentials PA-C for physician assistant-certified.
Professional Expenses
Is the PANCE expense covered? Is the PANRE expense covered? Are AAPAs Annual Conference expenses covered? Are state chapter CME conference expenses covered? What amount is available for CME? Are AAPA annual membership dues covered? Are the state chapter annual membership dues covered? Is professional activity in local, state and national PA organizations permitted? Is malpractice insurance paid/provided?
PANRE stands for Physician Assistant National Recertifying Exam and is the exam that PAs take every six years to maintain their national certification.
Income
What is the base salary? Does this match your research? Is a partnership available? How often will you be paid? How often will you receive a performance review? Is there a bonus plan available? Is there a profit-sharing plan available? Is a pension/retirement plan provided?
Career ComPAnion
17
Financial Management
Once you land your dream job and prepare for work, you will need to reassess your personal budget. Your nancial prole will change somewhat; you will have a new monthly income and will likely also begin repaying student loans. Money from loans generally form the foundation of student nancial aid. Some nancial aid packages also include scholarships and grants that you do not need to repay. For more information on funding your education or details about your specic nancial aid package, contact your nancial aid department. Also, visit AAPAs Student Academy resource page to review available scholarships and traineeships.
Borrowed Time A grace period is an amount of time usually six months when no loan payment is due to the lender and the loan is considered deferred.
LOANS AND REPAYMENT Most student loans are reported on all three credit bureaus: Equifax, Experian and TransUnion. Therefore, it is important that you manage your loans and take steps to ensure you follow you lenders repayment processes. As you get closer to graduation, you should collect and review all financial aid information for your PA education. It is best to review the guidelines for loan repayment well before you graduate. Usually, most student loan providers allow a grace period before you need to begin repayment. Nonpayment during this time will not adversely affect your credit. You may have subsidized loans, unsubsidized loans or both. If you have a subsidized loan, then the
government will pay the interest on the loan during the grace period. If you have an unsubsidized loan, however, the interest will continue to accrue on the loaneven in deferment. Therefore, depending on your employment status, you may choose to make interest payments on unsubsidized loans while they are still in deferment. Many student loan companies offer various repayment options to meet borrowers needs. You should check with your financial aid company for a list of their repayment options and the qualifications necessary for each option. Student loan companies also often provide deferment options based on certain borrower qualifications. There are many reasons to qualify for a deferment, including being unemployed, being a full-time student or experiencing a financial hardship.
18
Career ComPAnion
CREATING A BUDGET After your grace period has expired, you will need tools to manage repaying your loans. A fundamental tool is a budget that thoroughly accounts for all income and expenses. It is best to prepare your budget during your grace period so you have time to secure a loan repayment plan that will fit your financial needs. 1. Income: For employment, use net incomewhat you are paid after paying federal and state taxes, social security, any deductions for 401K or health insurance, etc. Employment income
T OTA L N E T I N COM E
Financial Management Tools ________ ________ ________ There are many software packages and online resources available for personal financial management: Moneydance Quicken Mint Wesabe Thrive
Income from trusts/investments
2. Fixed expenses: Rent or mortgage payment Association dues Car payment(s) Car insurance Telephone/cell phone Cable TV/satellite TV Internet service Water, sewage and garbage Gas and electric Health insurance (if you pay your own) Life insurance Child care Student loan payment(s)
T OTA L F I X E D E X P E N S E S
________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________
Career ComPAnion
19
Career Costs Be sure to budget for: NCCPA Certification (approximately $500 to take the PANCE) State Licensing (rangescan cost up to $300)
3. Fluctuating expenses: Best estimates of monthly costs Groceries Meals out Clothing Laundry/dry cleaning Gas/parking Public transit Home repairs Prescriptions/glasses Credit card payment(s) Beauty care Entertainment Pets Gifts/charity Newspapers/magazines CME expenses Membership dues Vacation
T OTA L F L U C T U AT I N G E X P E NS E S
________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________
4. Savings expenses: Determine how much you pay monthly for investments and retirement. For your emergency fund, you should ideally have three months of your total expenses in a savings account. Investments Retirement Emergency fund
T OTA L S AV I N G S E X P E NS E S
________ ________ ________ ________ ________
TOTAL EXPENSES (FROM 2, 3 AND 4)
20
Career ComPAnion
ANALYZING YOUR BUDGET After you have filled in all applicable information, compare your total expenses to your total income. If they are fairly close, then you have developed a good working budget. If you have substantially more income left over every month, then you can opt to pay more toward savings, student loans or credit card debt. If your expenses
are greater than your income, you will need to determine where you can cut back on expensesfor example, not having cable TV or where you can realistically obtain more monthly income. Remember, many student loan companies offer flexible repayment methods. Be sure to research all available payment options.
Did You Know? The U.S. Department of Education has tools to help you manage your student loans and calculate payments based on different repayment plans. To access these tools, visit the federal student aid website.
Career ComPAnion
21
Chapter 2:
Beginning Your PA Career
Introduction
When you nd the perfect job you will want to jump right in. But there are a number of things you will need to address before you don your white coat and see your rst patients. This section covers all the essential steps you must take to begin practicing as a new PA. You will need to become nationally certied, obtain state authorization to practice (via state license, registration or certication) and begin logging continuing medical education hours. You will need to understand how to navigate new relationships with both your physician-PA team and your patients. This section also covers what you should know about prescribing and how to negotiate an employment contract. There are details about professional liability insurance and how to obtain it before you begin practicing. In addition, the last section provides an overview of PA reimbursement and what you will need to know about claims processing.
Career ComPAnion
25
New PA Checklist
Before you treat any patients as a PA you will need to make sure you: Take and pass the PANCE (to become NCCPA-certified) Have state authorization to practice (license, registration or state certification) Have a National Provider Identifier number Have a Drug Enforcement Administration registration number (to prescribe controlled medications) Obtain hospital privileges and a credential number (if you will be working in a hospital setting) Have liability (malpractice) insurance coverage notes
Career ComPAnion
27
Work Settings and Specialties

PAs practice in a range of settings in almost all medical and surgical specialties and subspecialties. As of 2009, nearly half of PAs (44 percent) worked in group practices or solo physician ofces; 38 percent worked in hospitals. Yet, the work spectrum is broad and also includes rural clinics, community health centers, freestanding surgical facilities, nursing homes, school- or college-based facilities, industrial settings and correctional systems.
SPECIALTY PRACTICE AAPAs Specialty Practice Issue Briefs illuminate PA practice in many specialties and are useful resources for new PAs considering specialty practice career paths. The collection is available on AAPAs website. PAs practice in six general specialty practice areas: Primary care Family medicine General internal medicine General pediatrics Geriatrics Obstetrics/gynecology Surgical practice General surgery Cardiovascular surgery Neurosurgery Orthopedic surgery Otolaryngology Plastic surgery Emergency medicine Pediatric subspecialties Neonatal intensive care Pediatric intensive care Pediatric orthopedics Internal medicine subspecialties Allergy and immunology Cardiology Endocrinology Gastroenterology and hepatology Nephrology Rheumatology Urology Others Addiction medicine Anesthesiology Dermatology Hospital medicine Occupational medicine Oncology Psychiatry Radiology
28
Career ComPAnion
HOSPITAL PRACTICE PAs who practice in hospitals work in virtually every department and practice with physicians of every medical and surgical specialty. These PAs may be employed by the hospital, a medical practice or hospital medicine group. If you are going to work in a hospital, you must obtain hospital privileges first. Also, the physician on your physician-PA team must be a member of the medical staff before you can apply for privileges. Hospitals have some options about the process for privileging PAs, but most likely, you will apply through the medical staff office (within the human resources department or other staffing office). Credentialing is the first step in obtaining privileges. The credentialing staff at the hospital will check your basic professional credentials: PA program graduation, state license/registration/ certification (federal employees may have different requirements) and NCCPA certification. They will also require proof of medical liability insurance coverage, either your own policy or through your employer. If your state licensing board requires other documents for example, DEA registration, narcotics registration or a practice agreementthe credentialing staff will need copies. Once the credentialing process is complete, the medical staff will
consider the specific privileges you have requested. They will want assurance from the physician on your physician-PA team through recommendations and supporting documentation that you are qualified to perform the privileges requested. They will ask for proof of your relevant training or experience and proof of your ability to perform the privileges requested. In the case of a new graduate PA, they may accept procedure logs from PA student rotations, letters from the physician-PA team you worked with during rotations or letters from your PA program faculty. Like physicians, the credentialing and privileging standards for PAs are guided by the same six general competencies identified for physicians by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties. These competencies are: patient care medical/clinical knowledge p ractice-based learning and improvement i nterpersonal and communication skills professionalism systems-based practice For more information about credentialing, privileging and medical staff membership, visit www.aapa.org and keyword search hospital practice.
The Credentialing and Privileging Process The process for obtaining hospital privileges can be lengthy. To see a list of all the information you may need to provide, visit www.aapa.org and keyword search hospital practice.
Career ComPAnion
29
Working with Physicians and Patients

When you rst begin working with physicians and patients, you may be unsure how to navigate these new relationships. To help guide you, AAPA has developed ethical guidelines for the PA profession that offer a framework for your decision-making. We also have tools available to help PAs work efciently and effectively with their physician-PA team.
Core Competencies You should also review the Competencies for the PA Profession before you begin practicing. Developed by the National Commission on Certification of Physician Assistants, the Certification Review Commission on Education for the Physician Assistant, the Physician Assistant Education Association and the American Academy of Physician Assistants, the competencies help guide you through your career as a PA.
ETHICAL CONDUCT (Excerpt from AAPAs Guidelines for Ethical Conduct for the Physician Assistant Profession) The PA profession has revised its code of ethics several times since the profession began. Although the fundamental principles underlying the ethical care of patients have not changed, the societal framework in which those principles are applied has. Economic pressures of the health care system, social pressures of church and state, technological advances and changing patient demographics continually transform the landscape in which PAs practice. Individual PAs must use their best judgment in a given situation while considering the preferences of the patient and your physician-PA team, clinical information, ethical concepts and legal obligations. Four main bioethical principles broadly guided the development of these guidelines: 1) autonomy,
2) beneficence, 3) nonmaleficence and 4) justice. Autonomy Strictly speaking, autonomy means self-rule. Patients have the right to make autonomous decisions and choices, and PAs should respect these decisions and choices. Beneficence PAs should act in the patients best interest. In certain cases, respecting the patients autonomy and acting in their best interests may be difficult to balance. Nonmaleficence Do no harm and do not impose unnecessary or unacceptable burden upon the patient. Justice Patients in similar circumstances should receive similar care. Justice also applies to norms for the fair distribution of resources, risks and costs.
30
Career ComPAnion
PA-PATIENT RELATIONSHIPS The principle value of the PA profession is to respect the health, safety, welfare and dignity of all people. This concept is the foundation of the patient-PA relationship. You have an ethical obligation to see that each patient receives appropriate care. You should also be sensitive to patient beliefs and expectations and should recognize that each patient has an ethical right to self-determination. While PAs are not expected to ignore their own values, scientific principles, ethical standards or the law, they should not allow their personal beliefs to restrict patient access to care. You have an ethical duty to offer each patient the full range of information on relevant options for his or her health care. If personal moral, religious or ethical beliefs prevent you from offering the full range of treatments available or care the patient desires, you have an ethical duty to refer the patient to another qualified provider. Points from AAPAs Guidelines for Ethical Conduct for the Physician Assistant Profession: C ost Containment You should inform patients of financial incentives to limit care, use resources in a fair and efficient way and avoid arrangements or financial incentives that conflict with the patients best interests. D iversity You should respect the culture, values, beliefs and expectations of the patient.
N on-discrimination You should not discriminate against patients based on gender, color, creed, race, religion, age, ethnic or national origin, political beliefs, nature of illness, disability, socioeconomic status, physical stature, body size, gender identity, marital status or sexual orientation. I nitiation and Discontinuation of Care In the absence of a pre-existing patient-PA relationship, you are under no ethical obligation to care for a person unless no other provider is available. However, you are morally bound to provide care in emergency situations. You and your physician-PA team may discontinue the relationship with an established patient as long as proper procedures are followed. I nformed Consent The doctrine of informed consent means that you will provide adequate information that is comprehensible to a competent patient or patient surrogate. C onfidentiality You should maintain confidentiality. You should also choose methods of information storage and transmission that minimize the likelihood that patient data can become available to unauthorized persons or organizations. P atient Medical Records You must keep information in the patients medical record confidential. This information is the property of the patient,
Career ComPAnion
31
and both ethically and legally, a patient has rights to know the information contained in his or her medical chart. C are of Family Members or Co-Workers Treating oneself, co-workers, close friends, family members or students whom you supervise or teach may be unethical or create conflicts of interest. G enetic Testing You should be sure that patients understand the potential consequences of undergoing genetic testsfrom impact on patients themselves, possible implications for other family members, and potential use of the information by insurance companies or others who might have access to the information. R eproductive Decision-Making Patients have a right to access the full range of reproductive health care services, including fertility treatments, contraception, sterilization and abortion. E nd of Life Dying is a personal experience and part of the life cycle. You should provide patients with the opportunity to plan for end-of-life care and should involve the physician in all near-death planning. CONFIDENTIALITY IN THE INTERNET AGE The ubiquity of online social networking makes upholding
patient confidentiality even more important. Once information is posted online, you are no longer able to control who sees it and for how long. You should not discuss your patients online and you should never post pictures of patients (even if they are inadvertently included in a picture with you). Ensuring that your patients privacy is protected is a guiding principle of the PA profession, and patient confidentiality is mandated under federal law. THE PHYSICIAN-PA TEAM Team practice is fundamental to the PA profession. This concept however, does not mean that the physician must always be present with you or direct every aspect of care you provide. You and the physician should define your roles in the practice. You should seek input from the physician when you have questions that exceed your clinical expertise or when physician involvement is necessary for care. The most effective physician-PA teams provide optimum patient care by designing a practice model where the skills and abilities of each team member are used most efficiently. Successful team practice depends on all parties having a clear understanding of individual roles and responsibilities. Here are some things to consider when beginning practice with your physician-PA team:
32
Career ComPAnion
P ractice agreement A practice agreement, sometimes called a delegation agreement, outlines in a general way the patient problems and procedures that the physician authorizes the PA to address or perform. The agreement should be reviewed and updated periodically as the physician-PA team evolves in the way it delivers care. Like any partnership, the physician-PA team requires open communication and ongoing evaluation between you and the physician on your team to remain effective. For more guidance on practice agreements, please visit AAPAs website. S tate law supervision requirements All PAs practice medicine with physician supervision. However, not all states define supervision the same way. All states have
different requirements regarding physician co-signatures, physicians supervising multiple PAs and appropriate methods of supervision. Go to AAPAs website to access a summary of your states laws and regulations. P A scope of practice defined in state law To a large extent, PA scope of practice is determined by the delegatory decisions made by the supervising physician, but state laws and regulations play a significant role as well. For more information about your states PA practice act, visit the AAPA website or contact your states PA regulatory authority.
Physician Supervision does not mean that your supervising physician must be with you at all times. Depending on your state laws and practice policies, you and your supervising physician may not even need to be at the same location at the same time. See AAPAs website for more information about supervision.
Sample Practice Agreement Visit the AAPA website to view a sample practice agreement. You can tailor it to your needs or you can simply use it as a reference when defining your duties with your physician-PA team.
Career ComPAnion
33
NCCPA Certification
Before you can obtain state authorization to practice, you must rst pass the Physician Assistant National Certifying Examination administered by the National Commission on Certication of Physician Assistants.
HOW TO GET CERTIFIED You must pass PANCE, a multiple-choice test that assesses entry-level medical and surgical knowledge. Only graduates of accredited PA programs may take the exam, which is available at Pearson VUE testing centers throughout the country. Test dates are available continually during the year. Contact NCCPA for details on when and how to register for the exam at www.nccpa.net or at 678-417-8100. V isit www.pearsonvue.com/ nccpa to find testing locations in your area. PREPARING FOR THE PANCE AAPA has collected information about many different preparation resources: C ourses There are a number of examination review courses available throughout the U.S. Please visit the AAPA website for an updated list with dates and locations. M aterials There are also a number of print resources available for examination preparation. Please see the most updated list on AAPAs website. MAINTAINING CERTIFICATION National recertification for PAs is voluntary, except as required by certain states for licensure or by your employer. To maintain your NCCPA certification, you must complete an ongoing 6-year process that involves: 1) completing continuing medical education and 2) passing a recertification examination. R ecertification Examination For recertification you must pass the Physician Assistant National Recertifying Examination, a computer-based exam administered by Pearson VUE throughout the U.S. and internationally. You can take the PANRE as early as year five, and can have as many as four opportunities (two per year) to take and pass the exam.
Did You Know? You must log 100 hours of continuing medical education every two years to maintain a valid NCCPA certification. PAs may earn CME credit as soon as their NCCPA certificate is issued.
34
Career ComPAnion
C ontinuing Medical Education Every two years, PAs must earn at least 100 hours of CME credit, including at least 50 hours of Category I CME credit. Category I activities are reviewed and preapproved by one of the following organizations: AAPA, American Academy of Family Physicians, American Osteopathic Association and organizations accredited by the Accreditation
Council on Continuing Medical Education (which includes the American Medical Association). For more information about CME, please see the Continuing Medical Education section on page 40 or visit AAPAs website.
If you are submitting CME hours for the first time, contact the NCCPA for deadlines, which may vary depending on when your certificate was issued.
Career ComPAnion
35
State Practice Authorization/Licensure

Before you can begin practicing, you must be authorized to practice by the state in which you plan to work. State laws and regulations dictate who may practice as a PA, the medical services a PA may perform and the requirements for the physician-PA team. Most states grant licenses to PAs; however, a few states use the terms registration or certication for PAs who are authorized to practice in those states.
Keep in Mind All states have different PA practice acts and different licensing boards. It is important that you check your states specific requirements for PA licensing.
OBTAINING LICENSURE, REGISTRATION OR STATE CERTIFICATION To obtain an application for state authorization to practice, or for more specific information, contact the PA licensing agency in the state where you are planning to practice. A list of state and territorial regulatory authorities is available on AAPAs website. TEMPORARY OR GRADUATE LICENSURE The majority of states allow new graduates to practice with temporary or graduate licenses so new PA graduates can practice between graduation and NCCPA certification. You must apply for a temporary or graduate license just as you do for full licensure, and you may not work as a PA until it is issued. For more information, visit the AAPA website. FEDERALLY EMPLOYED PAS Each federal employer of PAs
such as the Department of Veterans Affairs, Indian Health Service, Federal Bureau of Prisons and the Armed Serviceshas its own requirements for PA practice. If you plan to work for the federal government, you must ensure you are appropriately credentialed by your federal employer before you begin work. MAINTAINING YOUR LICENSE, REGISTRATION OR STATE CERTIFICATION Although all 50 states require PAs to pass the PANCE to obtain initial state authorization to practice, renewal requirements vary by state. Some states require that you maintain NCCPA certification for renewal while others require that you earn CME only. All PAs should obtain a copy of the statute and administrative rules that govern their state authorization to practice. Contact the PA licensing agency in your state.
36
Career ComPAnion
Table 7 lists state licensure and renewal requirements. You can also view an updated chart on AAPAs website.
TABLE 7. State statutory and regulatory requirements for licensure
State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia
Graduation from PA Program

and baccalaureate degree
Passage of NCCPA Exam (PANCE)

Current NCCPA Certification

Renewal Requirements
CME NCCPA CME CME

NCCPA CME CME CME CME CME

and baccalaureate degree and/or NCCPA certification
Florida Osteopathic
Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana
NCCPA NCCPA
NCCPA NCCPA CME CME

NCCPA NCCPA CME CME CME
Maine Osteopathic
Maryland
Career ComPAnion
37
State
Massachusetts

CME
Michigan Osteopathic
Minnesota Mississippi Missouri
CME (NCCPA for Rx) CME NCCPA
and masters degree
**
and masters degree for those graduating after 1/1/08
Montana Nebraska

masters degree
NCCPA CME CME CME NCCPA CME NCCPA NCCPA CME
Nevada Osteopathic
New Hampshire New Jersey New Mexico Osteopathic New York North Carolina North Dakota Ohio**** Oklahoma
NCCPA NCCPA CME
For graduates after 7/07 program must meet specific requirements
Oregon Pennsylvania Osteopathic Rhode Island South Carolina South Dakota Tennessee Texas

NCCPA for Sch. II prescribing NCCPA NCCPA CME NCCPA CME CME CME
38
Career ComPAnion
State
Utah Vermont Virginia Washington Osteopathic West Virginia Osteopathic Wisconsin Wyoming


CME CME
NCCPA CME CME (NCCPA Sch. II for Rx)
CME (NCCPA for Rx) CME (NCCPA for Rx) NCCPA
** Program requirement waived for those employed as PAs prior to 1986. Board may issue temporary license to PAs enrolled in a masters program. **** The masters degree requirement is waived for PAs licensed by any state prior to 01/01/2008.
Career ComPAnion
39
Continuing Medical Education

CME plays an important role in every medical professionals life. It not only fullls the essential requirement of retaining licensure, but also encourages lifelong learning.
For NCCPA recertification, you will need to complete 100 hours of CME credit every two years; at least 50 hours of CME must include Category I CME. C ategory I Activities that are preapproved. All Category I activities must be documented by certificates of completion, attendance or official verification from the programs provider. C ategory II Activities that are elective; they have not been reviewed for educational content. Category II activities should be chosen according to the following guidelines and submitted on an hour-per-hour basis: A ny practice-related program that is not eligible for Category I CME credit. This includes many educational programs provided by pharmaceutical companies and medical device manufacturers. A ny practice-related, voluntary, self-learning activity (journal reading, medical text reading, precepting, etc.).
A ny practice-related postgraduate course, excluding courses taken in actual PA programs. CME OPPORTUNITIES For information on the wide variety of CME opportunities available, please visit AAPAs website. A few are listed below: A APAs Annual Conference On site There is a comprehensive schedule of CMEs offered at each years conference. The offerings consist of a range of topics, often with more than 300 sessions available. Off site Select presentations from the most recent conference are available for purchase. For more information and to access these sessions, see IMPACT On-Demand on the AAPA website. IMPACT On-Demand has been approved for AAPA Category I CME credit, and a certificate of completion will be accessible after viewing a presentation and completing the corresponding evaluation.
40
Career ComPAnion
H ome Study Programs (Enduring Materials) More than 50 hours of Category I CME credit can be earned through home study programs listed on AAPAs website. Some programs use only online tools, while others require purchasing materials before completing a post-test. Additional CME services AAPA provides: O nline Post-Test To verify completion of a home study program, AAPA gives fellow members the option of submitting post-tests online and obtaining the certificate of completion immediately. C onference Certificate Electronic certificates documenting participation in AAPAs Annual Conferences are available online for two years after the conference closes. If you need a certificate for a workshop you attended, please email CME@aapa.org and indicate which conference you attended and the title of the workshop. A APAs CME Calendar A calendar of CME programs offered by constituent organizations can be found on our website. The calendar includes dates, provider, location, contact name and CME credit information for each program.
C ME Approval Category I CME approval is available for programs presented in a variety of formats: live programs; postgraduate programs; journal articles; and enduring material programs (including online activities, CD-ROMs and DVDs). Approval fees vary according to the provider type and number of CME hours requested. For more information, email CME Services at CME@aapa.org. LOGGING CME CREDITS For national certification maintenance, you must log your CME credit hours with NCCPA at www.nccpa.net. Before contacting the NCCPA, be sure to have the following information available: Title of the program P rovider (the organization administering the program) Number of credits S ponsor (the organization that designates the program for CME credit) If you are logging CME credit for your state license only, please contact your state licensing board for instructions. For a list of licensing boards and their contact information, visit the AAPA website.
Career ComPAnion
41
PA Prescribing and Dispensing

Legend Drug Any medication that requires a prescription.
All states, the District of Columbia, the Commonwealth of the Northern Mariana Islands and Guam permit delegated prescribing by PAs, and nearly all states include controlled substances in that authority.
Controlled Medications Controlled medications have a high potential for abuse, and are therefore regulated by the DEA. These medications are categorized by SchedulesI through V. The schedules rank medications by the possible level of physical or emotional dependency. Schedule I drugs, which include heroin and LSD, have no accepted medical use in the U.S.
STATE REGULATION The laws and regulations for PA prescribing vary by state. The regulations are administered by medical or PA licensing boards and rarelyby pharmacy boards. In general, PAs are authorized to sign prescriptions with their names; prescription blanks are required to bear the PAs name and, in some states, the name of the physician from your team. For state summaries of the information that must be included on PA-written prescriptions, please see AAPAs website. TYPES OF DRUGS When PAs have prescriptive privileges, it means that, at minimum, they can sign for legend drugs without obtaining a physicians signature. Forty-eight states, the District of Columbia and Guam permit PAs to prescribe controlled medications. The list of controlled medications PAs may prescribe and the conditions under which PAs may prescribe them vary with state law (see Table 8).
To review summaries of state laws regarding controlled medication prescribing, visit the AAPA website. A few states have also developed formularies (lists of drug categories) to guide prescribing. For information on which states require formularies, see the restrictions category in Table 8. DEA REGISTRATION The federal governments Drug Enforcement Administration enforces the controlled medications laws of the United States. As part of its effort to limit illegal diversion of controlled drugs, the DEA keeps detailed records of these prescriptions. Therefore, you must register with the DEA in order to prescribe controlled medications (provided that state law authorizes PAs this prescriptive authority). You may use the same DEA registration number when practicing in different locations within the same state. However, you will need a separate DEA registration for each state in which you practice.
42
Career ComPAnion
You can apply for DEA registration through the Office of Diversion Controls website or by calling 800-882-9539. For more detailed information on DEA registration for PAs, please see AAPAs website. DRUG DISPENSING Approximately 28 jurisdictions allow physicians to delegate dispensing privileges to PAs. Depending on the state, dispensing may be restricted to certain kinds of health care facilities or geographic locations; the quantity of drugs dispensed may also be limited. You can check your states dispensing
privileges by reviewing its PA practice act or by referencing AAPAs summaries of PA practice acts. DRUG SAMPLES In 1987, Congress enacted the Prescription Drug Marketing Act, which sets storage, handling and accounting requirements for drug samples; bans the re-importation of prescription drugs; and prohibits certain wholesale drug distribution practices. The law contains language allowing individuals licensed or otherwise authorized by the state to prescribe to request and sign for drug samples. Only PAs with prescriptive privileges may request and sign for samples.
TABLE 8. Where PAs are authorized to prescribe

Jurisdiction Alabama Alaska Arizona Restrictions Controlled Substances Sch. III-V Sch. II-V Sch. II-III limited to 14-day supply with board prescribing certification (72-hours without); Sch. IV-V not more than 5 times in 6-month period per patient Sch. III-V Sch. II-V1 Sch. II-V Sch. II-V Sch. II-V Sch. II-V
Arkansas California Colorado Connecticut Delaware District of Columbia
Career ComPAnion
43
Jurisdiction Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine
Restrictions Formulary of prohibited drugs Formulary
Controlled Substances
Sch. III-V Sch. III-V Sch. III-V Sch. II-V Sch. II-V2 Sch. III-V Sch. II-V; Sch. II (except depressants) Sch. II-V Sch. III-V Sch. III-V (Medical board may approve Sch. II for individual PAs practicing within a physician-PA team. No such provision for osteopathic board.) Sch. II-V Sch. II-V Sch. III-V; Sch. II (7-day supply) as discharge meds
Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Formulary Formulary Formulary Formulary
Sch. II-V Sch. II-V Sch. III-V3 Sch. II-V (Sch. II limited to 34-day supply) Sch. II-V Sch. II-V Sch. II-V Sch. II-V (certain conditions apply) Sch. II-V Sch. II-V Sch. II-V (Sch. II-III limited to 30-day supply) Sch. II-V Sch. III-V Sch. III-V (limited to 30-day supply) Sch. II-V
44
Career ComPAnion
Jurisdiction Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
1
Restrictions
Controlled Substances Sch. II-V. (Sch. II limited to 72-hours for initial therapy; 30 days for ongoing therapy) Sch. II-V Sch. III-V Sch. II-V (Sch. II limited to 30-day supply) Sch. II-V Sch. III-V (limited to 30-day supply) Sch. II-V Sch. II-V Sch. II-V Sch. II-V
Formulary
Sch. III-V (Sch. III limited to 72-hour supply) Sch. II-V Sch. II-V
In California, PAs may write drug orders, which, for the purposes of the DEA registration, meet the federal definition of a prescription. Controlled medications require a patient-specific order from the physician-PA team unless the PA has completed a board-approved course on controlled substances. Illinois law to authorize physicians to delegate prescriptive authority for Sch. II controlled substances to PAs was passed in May 2009. Regulations necessary to implement the law have not yet been adopted. Missouri law to authorize physicians to delegate prescriptive authority for Sch. III-V controlled substances to PAs was passed in July 2009. Regulations necessary to implement the law have not yet been adopted.
Career ComPAnion
45
Contracts and Employment

Your rst contract lays a critical foundation for your career. Temper your enthusiasm to accept the rst position you are offered and protect yourself with well-researched contract negotiation points. Before you commit to taking a position, it is important to review all the essential components of your employment with your potential employer. Delineating all these components in a contract helps to ensure mutual understanding of what each partys responsibilities and expectations are.
PA compensation plans vary as widely as the multitude of specialties and settings in which PAs practice. Putting all agreements into a written contract protects you if disagreements arise later. The contract should not be written until you and your employer have agreed on the essential components. It is advisable to hire an attorney to review any contract you intend to sign. Retain an attorney who has knowledge of contracts, particularly health care contracts, and who can help you understand the responsibilities and expectations outlined in the contract. A local attorney is best; he or she is more likely to be familiar with your state laws. It is also important to know if the attorney has experience with PA contracts and how many years of experience he or she has had in contract law.
Dont Sign Yet Remembera written contract is a legally binding agreement. Do not sign it until you are absolutely sure of your decision. If you back out after signing a contract, legal action may be taken against you.
WRITTEN CONTRACT COMPONENTS

Terms and Termination The term, or length, of the contract must be stated, including your starting date and the duration of the initial contract. The contract should also state whether it can be terminated early if notice is given. If so, the amount of notice and reasons for justifying early termination should be carefully described. Termination provisions are either with causewhere legitimate causes for dismissal should be clearly definedor without causemeaning the contract can be ended by either party at any time without reason. Your contract should address bonuses, severance pay and vacation or sick time reimbursement. The contract should also clarify who pays malpractice insurance premiums.
46
Career ComPAnion
Performance Reviews The contract should state how often a formal job performance review will be conducted. For a new position, this is typically at one-month, three-month and six-month intervals. Contract Renewal Every contract should include an option to renew or a provision to renegotiate based on a performance evaluation. Performance criteria should be included in the contract. Employee vs. Independent Contractor It is important to specify whether you are an employee or independent contractor because your employers liability regarding employment taxes and pension benefits will be affected. The IRS has guidelines that you and your tax advisor should examine. Services to be Provided The contract should clearly define the area of medicine in which you practice and your duties and obligations, including work days and hours, sites, practice duties, requirements for rounds and on-call duties. If the contract includes clauses that prohibit you from holding a second job (moonlighting), verify whether these restrictions apply to volunteer health care or non-medical employment. Credentials and Privileges The contract should specify the professional credentials (e.g., NCCPA certification) that you must possess or obtain within a specified time. It also should specify whether
you must apply for or obtain privileges at certain hospitals. Compensation Your contract must include whether you will be paid a salary, an hourly rate, a percentage of fees billed or collected, or salary plus bonus based on productivity. If your compensation will be based on a percentage of fees billed, specify which fees will be included in the calculation. If you will be paid an hourly rate, include a minimum number of hours per week or per month you must work. Your contract should also specify the frequency of calculation or payment. Liability (Malpractice) Insurance The contract should list who will pay for liability coverage. If you are paying for it, then your contract should state how much it will cost. The contract should also indicate whether you will be listed on the policy of the physician from your team or have your own policy. You should also understand the different between occurrence and claims-made policies. Occurrence policy covers alleged negligence that occurs during the policy period, regardless of when claims are reported Claims-made policy covers incidents that happen and are reported while the policy is in force; for an extra premium, tail coverage will protect you against claims filed after the policy ends Your malpractice policy should cover liability for services rendered (or
Career ComPAnion
47
Did You Know? AAPA sponsors a professional liability insurance program for its members. For more information and an application form, call 877-356-2272.
not rendered) and all legal costs, regardless of the suits outcome or whether the suit was fraudulent. Try to obtain an ultimate net-loss policy, which will cover all legal fees. See page 51, Professional Liability Insurance, for more information about malpractice coverage. Fringe Benefits The contract should describe both included and excluded fringe benefits. Typical benefits include vacation and education leave, travel expenses related to education leave, professional dues, CME expenses, conference fees, licensure fees, hospital medical staff fees, books and professional journals, NCCPA fees, Drug Enforcement Administration registration fees, health insurance, disability, life insurance and retirement plans. Sick Leave and Disability The contract should specify if you will continue to be paid if you become sick or disabled, and, if so, for how long. Often practices have different disability policies for physicians and other employees; it is important to understand which one will cover you. If you purchase the policy yourself, the federal government does not tax it. Purchasing Into the Practice If you plan to buy into the practice eventually, the conditions of the buy-in and basic terms of purchase should be listed, usually in a separate letter of intent. This letter should include methods for valuing the practice assets and the physical site, and it should outline your participation in
business decisions, the length of time it will take before you become a full partner, and the amount and terms of the purchase. Restrictive Covenants A restrictive covenant, sometimes called a non-compete clause, is a provision in the contract that prohibits you from practicing in a given geographic area or given medical specialty after you leave a practice. This is usually for a defined period of time, often a few years after leaving the practice. These clauses are enforceable in most states if the terms are considered reasonable. Some red flags regarding restrictive covenants: Exclusions from practicing in entire counties or states A prohibition from practicing at a particular hospital An employer that wants you to sign against your better judgment and claims that he or she would never enforce the clause(s) Disputes Be sure that the contract specifies whether disputes between you and your employer will be settled by mandatory arbitration or in court and whether the prevailing party will receive lawyers fees and costs. The contract also should include a clause that allows you and your lawyer access to patient medical records if a lawsuit is brought against you after you leave the practice. (Otherwise, your attorney may have to subpoena the records, which is a costly, protracted process.)
A Word on Moonlighting Some PAs wish to hold a second job (moonlighting) while working for their primary employer. If you want to hold a moonlighting position, verify that your contract allows that kind of employment. Also, you will need to be sure you have your own malpractice insurance to cover your work while moonlighting.
48
Career ComPAnion
Contract Checklist
Defining Your DutiesHave you:
Received a copy of the employee handbook? Defined the term of the contract? Defined the number of days of notice that must be given prior to termination? Defined whether you will be an employee or an independent contractor? If independent contractor, met with your tax advisor to review tax implications? Clearly defined duties and work hours? Discussed with the employer whether various third-party payer contracts include compensation for services provided by a PA?
notes
Benefits
Have you determined the amount of compensation? If paid a percentage of revenue, have you agreed on how it will be calculated? Have you defined whether the employer will pay for NCCPA certification/ recertification, licensing fees, hospital medical staff fees and DEA registration fees, if applicable? Are health and dental insurance provided? Does the employer pay the full premium(s)? Is it single or family coverage? Is life insurance provided? How much coverage? Does the employer pay the full premium? Is disability provided? What is the elimination period, length of time you may be disabled and amount of disability income you will receive? Do you have the option of paying the premium to avoid taxes on the benefit? Is malpractice insurance provided? Are there limits on coverage? Is tail or nose coverage paid for by the employer? Is it your own policy or are you covered under the employers policy through an umbrella or rider? Do you have a copy? How much paid time off is provided for CME, vacation, holidays and sick leave? Is maternity/paternity leave provided? Can you participate in pension and profit-sharing plans? Are funds available for CME fees and travel? Are AAPA and state chapter dues paid by the employer? Are relocation and interview expenses reimbursed? Do you agree on the timing of performance reviews?
Legal Issues
Is a restrictive covenant included in the contract? If so, do you understand its legal ramifications? Has your lawyer reviewed the contract?
Career ComPAnion
49
OTHER EMPLOYMENT OPTIONS Independent Contracting Some PAs wish to practice outside of a traditional employment model and opt to become independent contractors. However, you should consider all the factors that make up independent contracting. Being a self-employed practitioner depends on meeting the IRS guidelines, state regulations, physician availability and third-party payment policies. You also need to consider your ability to pay self-employment taxes, malpractice and health insurance premiums, and the cost of owning or leasing equipment. Although being an independent contractor can increase your freedom of choice and income, it can also adversely affect your work hours and decrease benefits and vacation time. You will also need to manage billing and reimbursement collection, administrative tasks, and negotiations with regulatory agencies, insurance carriers and physicians. It is important to contact a tax attorney or accountant before choosing to work as an independent contractor. You can also review the guidelines the IRS uses to determine whether someone is an employee or independent contractor.
Practice Ownership There are many factors that affect PA practice ownership, including states medical practice acts, the PA practice acts and corporate law. Regardless of the extent to which a practice vests administrative and financial responsibility in a PA, the supervising physician retains professional authority over medical decisions. PAs who are shareholders or owners of professional corporations must maintain adequate malpractice insurance. PAs must also understand how to bill for medical and surgical services provided through a professional corporation. Private payers and Medicare may have differing rules on whether payment to a PAowned corporation is allowed. Because of the complexity of issues involved and the variety of state laws, any PA, physician or administrator who wishes to pursue the issue of PAs as shareholders of professional corporations should consult an attorney who is familiar with the states corporate law and who is knowledgeable about PA practice.
50
Career ComPAnion
Professional Liability Insurance

All practicing PAs should carry professional liability coverage, often called malpractice insurance. This insurance covers your exposure to liability arising from your profession, including allegations of malpractice.
If you are a practicing PA, it is important to always maintain coverage to protect yourself against financial loss and to protect your ability to continue to practice. F inancial Protection A malpractice suit can be brought against you any time after you have seen a patient. You should have active coverage during all time periods in which you practice. P rofessional Protection A malpractice suit can also jeopardize your professional reputation and credentials. You could possibly have your license revoked or suspended. Even if this does not happen, your malpractice history is public record that employers can use to disqualify you from future job opportunities. It is therefore vital that malpractice suits are vigorously defended. Insurers will provide legal representation for you to ensure your best interests. POLICY TYPES There are two types of professional liability coverage available to PAs: occurrence and claims-made. Occurrence Policies Occurrence policies cover incidents that happen during the policy period without regard to when the claims are reported. Occurrence coverage provides protection for each policy period indefinitely. For example, if you had an occurrence policy in 2003 (which you terminated in 2005), and then are sued in 2013 for an incident in 2003, you will be protected. Occurrence Policy Basics: C overage for incidents that happened during the policy periodno matter when the claim is filed W ill not need tail coverage if you take an extended leave from your career P remiums in the first few years are more expensive than claims-made policy premiums (until the claims-made policy reaches maturity); over time, the total costs should even out if you consistently maintain your own policy R elatively rare since insurers have difficulty estimating the cost of claims long after a policy expires
Career ComPAnion
51
Claims-Made Policies Claims-made insurance covers incidents that happen only while the policy is in force; once the policy has been terminated, coverage no longer exists. If you want coverage after the policy has been terminated, then an Extended Reporting Endorsement (tail coverage) must be purchased. For example, if you had a claimsmade policy in 2003 (which you terminated in 2005), and then are sued in 2013 for an incident in 2003, you would not be protected. Claims-Made Policy Basics: C overage for incidents and claims that are filed during the policy period only M ust keep up with your policy/ policies to ensure that you do not have gaps in coverage G enerally inexpensive at first, then gradually increases (steps up) over timeabout 5 years to a mature premium I f an incident happened during the policy period, but the claim was filed after the policy expired, then the insurance will not cover that claim Tail Coverage for a Claims-Made Policy You may need tail coverage if: 1. You take a leave of absence, retire or switch employers 2. You terminated your liability insurance without purchasing a new claims-made policy The tail coverage needed to supplement a claims-made policy
is very expensive because it is covering many potential suits for a lengthy period. Nose Coverage for a Claims-Made Policy If you are purchasing a policy with a new carrier, an alternative to tail coverage is prior acts (nose) coverage. You can purchase nose coverage from your new carrier to ensure that claims that happen prior to the new policy do not go uncovered. Nose coverage is less expensive than using tail coverage from your prior policy. SOURCES OF COVERAGE There are two ways to acquire a professional liability insurance policy: through an individual policy or a group policy. I ndividual Policy An individual policy is one that you purchase for yourself. For your needs, an individual policy is preferred for several reasons: Y ou control the proof of insurance. Therefore, you will not need to rely on an employer to verify coverage when you need to, possibly many years after you have moved on to other employment. Because you own the policy, you are the only named insured. This prevents the possible conflicts of interest that can happen when you are on a group policy. A policy of your own provides you with separate limits of liability; your limits will not be reduced because you share coverage with other employees.
52
Career ComPAnion
A n individual policy should cover you for any additional job, whether working part-time (moonlighting) or volunteering. G roup Policy Some employers may refuse to reimburse you for an individual policy and insist that you be covered under a group policy. This is because some advantages for individuals become disadvantages for employers. For example, if there is a lawsuit, you would have your own attorney representing your interests. However, employers would prefer a single attorney managing a global settlement of any claim, regardless of your personal interest. Additionally, employers may refuse individual coverage because their insurers will not permit employees to have individual policies. Insurers also want settlement processes as streamlined as possible and do not want to negotiate with your own attorney. If you must be covered under a group policy, be sure to: O btain a copy of the entire policy. If that is not possible, obtain a copy of the certificate of insurance, which summarizes the terms of coverage. V erify that you are listed by name on the policy. V erify whether you have occurrence or claimsmade coverage.
O btain copies of the policy or the certificate of insurance every year. If it is a claims-made policy, you should continue to get copies even after you have left the employer. INSURANCE CARRIERS There are many types of insurance carriers, and they have varying forms of regulation. The most important factor is evaluating the carrier for its financial strength. An independent rater of financial strength is A.M. Best & Company, which assigns Excellent, Good and other designations. Avoid any company with less than an Excellent rating, denoted by Best ratings A++ (the highest), A+, A or A-. If a company does not carry any Best rating, this means it does not cooperate with the ratings process and should be avoided. WHERE TO OBTAIN COVERAGE AAPA provides many types of malpractice insurance for its fellow and student members. AAPA Insurance Services offers policies by an A++ rated insurance carrier/ underwriter. Our staff and PA volunteers continually review the policy terms and monitor annual premiums. This service is the best we have identified for our members. For information, rates and to obtain an application, call AAPA Insurance Services at 877-356-2272.
Malpractice Insurance Lexicon Be sure you understand the terms used in your insurance policy. Visit the following links for glossaries on common words and phrases used in liability insurance policies: Medical Malpractice Terms Insurance Terms
Career ComPAnion
53
Liability Coverage Checklist

notes About the Policy
Does the insurance provider offer both claims-made and occurrence policies? Does the provider offer prior acts (nose) coverage and extended reporting endorsement (tail coverage)? What are the immediate and long-term price differences between the claimsmade and occurrence policies? Does the carrier offer a product that can convert a claims-made policy to an occurrence? Is the policy easily transferable if you move out of state or switch employers?
About the Policy Provisions

Is coverage provided when you travel out of state or abroad? What are the exclusions in the policy (volunteer work, criminal acts, etc.)? Is there a requirement for arbitration? Are defense costs included in the limits of liability? After how many years of coverage (or at what age) can you retire and earn free tail coverage? In what circumstances can the policy be modified? For what reasons can a policy be cancelled mid-term by you or the insurance carrier?
About the Insurance Carrier

Does it have a track record of insuring and defending health care professionals? Does it have strong financial backing, with a Best rating of A- or better? Is it recognized by your employer and the hospitals where you may practice?
54
Career ComPAnion
How do other insurance carriers measure up to Medical Protective?

Clear
Cree
k T ra
il
Strength A++ (Superior) A.M. Best rating? AA+ (Extremely strong) S&P rating Defense Dedicated claims professionals, averaging 20 years of experience? Winning: 90% of cases that go to trial? Your consent before any settlement?
5002 Specialized local defense counsel who are experts in your jurisdiction?
Medical Protective
Insurance Carrier B
Yes Yes
________ ________
3209
Yes * Yes * Yes Yes

78 43Yes
________ ________ ________ ________ ________ 3945 ________
Nationwide network of the best expert witnesses? Litigation support services preparing you for testimony or the courtroom? Solutions Dedicated risk management professionals averaging 20 years of experience? Home study, internet and seminar programs for healthcare providers and staff? Continuing medical education credit available?
Yes
Yes * Yes Yes
1003 ________
________ ________
503
Over a century of proven results for healthcare providers?
* Medical Protective Data 2005-2009 Product availability varies based upon business and regulatory approval and may be offered on an admitted or non-admitted basis.
After reading through the Professional Liability Insurance Section and carefully analyzing the topics discussed therein, we invite you to contact a Medical Protective representative, CM&F Group, the Endorsed Agent for the AAPA and see how we stack up to the competition. We are confident you will see why more than 70,000 providers trust us to protect their professional reputations. Consider the following:
n n n n n
Medical Protective was the first exclusive medical liability insurance company in the United States Medical Protective has been in business since 1899 triple the time of the nearest competitor Medical Protective is the only primary MedMal company with A.M. Bests highest rating of A++ Medical Protective is the only primary MedMal company with S&Ps AA+ financial strength rating The 110+ year-old Medical Protective and 90 year-old CM&F together bring over 200 years of insurance experience.
For more information please call our servicing agent, CM&F Group at 800-221-4904. They can also be found at www.cmfgroup.com.
www.professionalriskadvisor.com
Willow Creek
Since 1899 Yes

________
2011 The Medical Protective Company. All Rights Reserved.
PA Reimbursement
Although you do not need to be an expert in PA coverage policies, you should have a general understanding of reimbursement issues. PAs can be reimbursed for their services by the patient directly or by their employer through third-party payers (including private payers and government-funded public payersMedicare, Medicaid and TRICARE).
Each third-party payer has its own guidelines regarding service coverage and payment. Payer Types: M edicare A federal government-administered program designed to provide hospital and medical insurance for the elderly. M edicaid A jointly funded federal/state program that provides medical insurance for certain lowincome individuals, families with dependent children, the aged and the disabled. T RICARE A government-funded insurance program that covers medical care for active duty and retired military personnel, their dependents and survivors of deceased military personnel. P rivate Payers Includes all private industry and nonprofit insurers, such as Blue Cross/Blue Shield, Aetna, Kaiser Permanente, United Healthcare, etc. COVERAGE AND CLAIMS In general, your practices billing personnel will be responsible for submitting claims to insurance carriers for reimbursement. However, it is not uncommon for practices, billing personnel, insurance companies and government agencies to misunderstand or misinterpret PA coverage policies. Therefore, you should have an understanding of the following coverage guidelines: M edicare Coverage Does not pay the PA directly. Pays the PAs employer for medical and surgical services provided by PAs in all settings at 85 percent of the physicians fee schedule. These settings include hospitals (inpatient, outpatient, operating room and emergency departments), nursing facilities, offices, clinics, the patients home and first assisting at surgery. In certain settings, services that PAs provide may be billed at 100 percent under the supervising physicians provider number by meeting the incident to or shared visit billing requirements. M edicaid Coverage Currently, all 50 states and the
NPI Number for Billing The National Provider Identifier is a unique 10-digit identification number for covered health care providers. The NPI number is required for billing Medicare, and many private payers require its usage too. Apply for an NPI online here.
56
Career ComPAnion
District of Columbia cover medical services provided by PAs under their Medicaid fee-for-service or Medicaid managed care programs. The rate of reimbursement is either the same as or slightly less than that paid to physicians.
steps you should take to understand why a claim was denied and how to obtain payment for your services: F irst, check the Explanation of Benefits to verify whether the denial is because a PA provided the services (often stated as service only covered when provided by an MD/DO). I f that is not the denial reason, check the EOB to eliminate the possibility of a simple error, such as a missing signature, incorrect CPT code, etc. I f the denial is not a clerical error, then you should contact the insurance company. Occasionally, insurance carriers use different modifiers for different procedures. It is best to verify with the insurance company whether the claim has the correct CPT code and modifier. To consider about denials: W hen a patient has group health insurance through an employer, the insurance company does not make the final decision about covered services. Therefore, if PA services are not covered and you wish to make an appeal for coverage, you should be sure to direct your message to the appropriate decision maker. If you do get a denial based on the fact that the services were provided by a PA, contact AAPAs Third-Party Reimbursement staff at 703-836-2272. AAPA attempts to keep a record of all insurance companies that do not cover PAprovided care. Reimbursement staff can also help you appeal the insurance companys or employers denial decision.
Career ComPAnion
T RICARE Covers all medically necessary services provided by a PA (excluding psychiatry). The PA must be supervised in accordance with state law, and the supervising physician must be an authorized TRICARE provider. TRICARE reimburses the PAs employer at 85 percent of the physician fee schedule for PA-provided services. P rivate Payers Most cover medical and surgical services provided by PAs. However, private health insurance companies do not necessarily follow Medicares coverage policies. Practices should verify each companys specific policies for PAs. For your assistance, AAPA has extensive information about private payer policies available online. For the most up-to-date and comprehensive information about reimbursement, please visit our website, or contact AAPAs reimbursement staff at 703-836-2272. CLAIMS DENIALS Usually, your practices billing office will work with insurance companies regarding denied claims. However, you may have to help your billing staff untangle possible misunderstandings about PAprovided services. There are certain
57
Conclusion
Being part of the PA profession give you the opportunity to affect the health and wellness of numerous patients for years to come. Your career is a journey, and will take different paths and twists and turns. To keep you sure-footed as you make your way, consider joining state and/or specialty organizations, volunteering, being a preceptor and taking part in advocating for the PA profession. And do not forget to renew your membership with AAPA, the national organization that has represented PAs and the PA profession for more than 40 years. To renew, visit www.aapa.org/renew or call 703-836-2272.
58
Career ComPAnion
2318 Mill Road, Suite 1300 Alexandria, VA 22314 P 703 836 2272 F 703 684 1924 aapa@aapa.org www.aapa.org

Career Companion

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Career Companion

Uploaded by

Copyright:

Available Formats

Career ComPAnion

An Essential Physician Assistant Resource

Glossary of Web Links

Page 10 Resume Sample Resume

Suggested Resume Headings

Page 19 Finance Moneydance

Page 53 Insurance/Malpractice Medical Malpractice Terms

The PA Student Career Preparation

The PA Student Career Preparation

The PA Student Career Preparation

Creating Your Professional File

The PA Student Career Preparation

The PA Student Career Preparation

The PA Student Career Preparation

The PA Student Career Preparation

The PA Student Career Preparation

First PA Job Search

The PA Student Career Preparation

The PA Student Career Preparation

The PA Student Career Preparation

The PA Student Career Preparation

Average Salary $73,188 $76,666 $75,243 $74,821 $72,065

Average Salary $75,909 $87,129 $79,318 $74,833 $76,818 $75,441 $82,241

The PA Student Career Preparation

Subspecialty Surgical Pediatric Internal Medicine

Average Salary $79,678 $77,016 $75,707

(Source: 2009 AAPA Annual Salary Report)

Average Salary $75,694 $74,615 $76,500 $76,730

Average Days per Year 15 8 6

The PA Student Career Preparation

Before You Make Your Decision Checklist

The PA Student Career Preparation

The PA Student Career Preparation

The PA Student Career Preparation

Income from trusts/investments

The PA Student Career Preparation

________ ________ ________ ________ ________

TOTAL EXPENSES (FROM 2, 3 AND 4)

The PA Student Career Preparation

Beginning Your PA Career

Beginning Your PA Career

Beginning Your PA Career

Beginning Your PA Career

Work Settings and Specialties

Beginning Your PA Career

Beginning Your PA Career

Working with Physicians and Patients

Beginning Your PA Career

Beginning Your PA Career

Beginning Your PA Career

Beginning Your PA Career

Beginning Your PA Career

Beginning Your PA Career

State Practice Authorization/Licensure

Beginning Your PA Career

TABLE 7. State statutory and regulatory requirements for licensure

Graduation from PA Program

Passage of NCCPA Exam (PANCE)

Current NCCPA Certification

NCCPA CME CME CME CME CME

NCCPA NCCPA CME CME

NCCPA NCCPA CME CME CME

Beginning Your PA Career

Graduation from PA Program

3945