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Physician assistants (PAs) in orthopedics and "orthopedic physician's assistants" (OPAs) are distinctly different professions. PAs have broad medical training at accredited programs and work with physicians in any specialty, including orthopedics. PAs are licensed in all states and are recognized Medicare and Medicaid providers. Most OPAs are trained on the job and work as orthopedic technologists or surgical assistants. They may be certified, but few states regulate their practice. OPA are not recognized as providers under teh Medicare program.
Although the professional titles are similar, PAs and OPAs have significantly different training and responsibilities. Working with physicians in all medical and surgical specialties, PAs diagnose and treat patients, order tests and prescribe medications. OPAs have a limited scope of practice within orthopaedics, working directly with the
surgeon in a supportive role.
PAs are trained in intensive educational programs accredited by the Accreditation Review Commission on Education for the Physician Assistant. The programs are approximately 26 months long and are offered at medical schools, colleges and universities, and teaching hospitals.1
PA education promotes the development of practical skills in clinical problem solving and decision making. The rigorous PA program curriculum consists of classroom and laboratory instruction in basic medical and behavioral sciences, including anatomy, pathophysiology, pharmacology and clinical diagnosis. Classroom work is followed by clinical rotations that include primary care specialties, surgery and surgical subspecialties, psychiatry and emergency medicine. PA students complete, on average, 2,000 hours of supervised clinical practice prior to graduation. PA educational programs, first accredited by the American Medical Association (AMA) in 1972, are now accredited by the Accreditation Review Commission onEducation for the Physician Assistant. There are currently more than 180 accredited programs. More than ninety percent offer master’s degrees.2 Before they can be licensed, PAs take the national PA certifying examination administered by the National Commission on Certification of Physician Assistants (NCCPA).
This certifying exam also functions as a de facto licensing examination; all states require passage of the NCCPA exam as a prerequisite for full licensure as a PA. To maintain national certification, PAs must complete 100 hours of continuing medical education every two years and pass a recertification examination every six years (10 years beginning in 2014).
Each PA's scope of practice is defined at the practice level, consistent with the PA's education, experience and preference, facility policy, and state laws. PAs are free to choose any medical or surgical specialty after graduation. Some PAs work in the specialty of orthopaedics with physicians who are orthopaedic surgeons. These physician assistants are referred to as PAs in orthopaedics.
PAs in orthopaedics perform histories and examinations, order and interpret diagnostic tests and prescribe medications and therapy. In addition to first assisting at surgery, procedures provided by PAs include tendon repairs, wound closures and debridements, injection of joints and fracture management. In the hospital, PAs conduct post-op rounds, write orders, take call and perform admission and discharge work.
Sample questions from the NCCPA examination indicate the breadth and scope of PA training.
1. A 65 year old man with severe osteoarthritis of the knees has exertional angina pectoris. Which of the following is the most appropriate initial diagnostic test?
(a) Adenosine myocardial perfusion scintigraphy
(c) Transesophaegeal echocardiography
(d) Treadmill stress testing
(e) 24 hour ambulatory monitoring
2. Which of the following is the most common adverse effect of alendronate (Fosamax)?
(a) Breast tenderness
(b) Gastrointestinal irritation
(c) Hot flashes
(d) Leg cramps
3. A 4 year old boy who has been developmentally normal now has difficulty rising from the floor. Examination shows hip girdle weakness, enlargement of calf muscles, and wasting of thigh muscles. Serum creatine kinase level is 25,000u/L.
Which of the following is the most likely diagnosis?
(a) Cerebral palsy
(b) Duchenne muscular dystrophy
(c) Infantile spinal muscular atrophy (Wernig-Hoffman disease)
(d) Myasthenia gravis
4. Which of the following medications binds with warfarin on the intestinal tract, resulting in decreased absorption and bioavailability?
Orthopedic Physician Assistants
In 1973, eight OPA educational programs were accredited by the American Medical Association (AMA). However, in 1974, the American Academy of Orthopaedic Surgeons (AAOS) announced its intent to withdraw sponsorship from the accreditation process. Allied health accreditation was not sponsored by the AMA unless there was involvement by the medical society or societies most closely associated with the occupation. Without AAOS, therefore, there could be no further accreditation of OPA programs. AMA announced a moratorium on the accreditation of any additional OPA programs and, in the fall of 1974, accreditation was discontinued.
OPA programs were never accredited as PA programs. OPAs were trained as assistants to orthopaedic surgeons, with an emphasis on orthopaedic disease and injury, management of equipment and supplies, operating room techniques, cast application and removal, office procedures, and an orientation to prosthetics and orthotics. Graduates of OPA programs were never eligible to take the exam given by NCCPA. OPAs established a National Board for Certification of Orthopaedic Physician Assistants (NBCOPA) and developed an exam that is administered by the Professional Testing Corporation. According to the American Society of Orthopaedic Physician’s Assistants, to be eligible to take the exam, candidates must "have a solid background with a minimum of five years [on-the-job training] in orthopaedic medicine…."3 Passage of the exam allows an OPA to use the initials "OPA-C" after his or her name.
In 2011, an OPA educational program became available at the University of St. Augustine. The only OPA program in the United States, it is accredited by the Distance Education and Training Council.
Following are sample questions from the NBCOPA examination:
The skeleton of the adult hand consists of how many bones?
What is the best method of treatment for a 13-year-old who presents with a slipped capital epiphysis?
(d) Crutches with partial weight bearing
A deficiency of Vitamin D may cause which of the following bone problems?
OPAs are not PAs. OPAs were trained at separate programs with a different curriculum, are accredited by different standards and take a separate certification examination. The only similarity is that both OPAs and PAs work in teams with physicians and have similar titles. Such similarities do not make an OPA a PA. Unfortunately, AAPA and NCCPA cannot prohibit the use of "OPA-C" by OPAs, even though the similarity to PA credentials is confusing to patients. NCCPA only controls the use of the letters "PA-C."
With very few exceptions, OPA practice is unregulated. Only Tennessee has an OPA practice act. New York allows OPAs to register as specialist assistants. California allows a limited number of OPAs (those who completed their education between 1971 and 1974 and who do not meet the requirements for licensure as PAs) to provide services to orthopaedic physicians.4 From 1983 to 1985, a handful of OPAs were permitted to register as PAs under Minnesota’s first set of PA regulations, administered by the Department of Health. In subsequent actions by the Minnesota Legislature and medical licensing board, PAs have been granted a broader scope of practice, including prescriptive privileges. No new OPA applications have been accepted. No state allows OPAs to prescribe. The differences between PAs and OPAs have long been recognized by the federal government. Medicare recognizes PAs as enrolled providers and covers services provided by PAs who are state-licensed and have passed the NCCPA certification examination. OPAs are not enrolled nor recognized as providers in the Medicare program.
For a side by side comparison refer to the chart on the following pages. For additional information about PA education, PA scope of practice and PA practice areas, visit AAPA’s Resources page at www.aapa.org/issue-briefs.
- Physician Assistant Education Association. (2010–2011). Twenty-seventh annual report on physician assistant educational programs in the United States. Alexandria,VA.
- Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). (2013). Accredited Programs. Retrieved December 12, 2013, from
- American Society of Orthopaedic Physician’s Assistants. What is an orthopaedic physician’s assistant? Retrieved February 3, 2009, from www. asopa.org/pdfs/opawhitepaper.pdf.
- American Society of Orthopaedic Physician’s Assistants. (2009). Recognition. Retrieved February 5, 2013, from www.asopa.org/sections/licensure.php.
American Academy of Physician Assistants
Department of Government & Professional Affairs
950 North Washington Street
Alexandria, VA 22314-1552
*Reprinted from the American Academy of Physician Assistants - http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_State_Affairs/Resource_Items/PAs_and_OPAs_The_Distinctions_12-13.pdf