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Monday, June 19, 2023

Psychologist

From Wikipedia, the free encyclopedia
Psychologist
EEG early studies edited.jpg
Description
CompetenciesPsychotherapy, psychological assessment and testing, depends on specialty
Education required
Differs by location and specialty, Bachelor's degree with honors in Psychology, Master's degree in Psychology, PsyD or PhD
Fields of
employment
Clinical neuropsychology, clinical, Medical, community, counselling, educational and developmental, forensic, health, organisational or sport and exercise
Related jobs

A psychologist is a professional who practices psychology and studies mental states, perceptual, cognitive, emotional, and social processes and behavior. Their work often involves the experimentation, observation, and interpretation of how individuals relate to each other and to their environments.

Psychologists usually acquire a bachelor's degree in psychology, followed by a master's degree or doctorate in psychology. Unlike psychiatric physicians and psychiatric nurse-practitioners, psychologists usually cannot prescribe medication, but depending on the jurisdiction, some psychologists with additional training can be licensed to prescribe medications; qualification requirements may be different from a bachelor's degree and master's degree.

Psychologists receive extensive training in psychological testing, scoring, interpretation, and reporting, while psychiatrists are not usually trained in psychological testing. Psychologists are also trained in, and often specialize in, one or more psychotherapies to improve symptoms of many mental disorders, including but not limited to treatment for anxiety, depression, post-traumatic stress disorder, schizophrenia, bipolar disorder, personality disorders and eating disorders. Treatment from psychologists can be individual or in groups. Cognitive behavioral therapy is a commonly used, well studied and high efficacy psychotherapy practiced by psychologists. Psychologists can work with a range of institutions and people, such as schools, prisons, in a private clinic, in a workplace, or with a sports team.

Applied psychology applies theory to solve problems in human and animal behavior. Applied fields include clinical psychology, counseling psychology, sport psychology, forensic psychology, industrial and organizational psychology, health psychology and school psychology. Licensing and regulations can vary by state and profession.

Australia

In Australia, the psychology profession, and the use of the title "psychologist", is regulated by an Act of Parliament, the Health Practitioner Regulation (Administrative Arrangements) National Law Act 2008, following an agreement between state and territorial governments. Under this national law, registration of psychologists is administered by the Psychology Board of Australia (PsyBA). Before July 2010, the professional registration of psychologists was governed by various state and territorial Psychology Registration Boards. The Australian Psychology Accreditation Council (APAC) oversees education standards for the profession.

The minimum requirements for general registration in psychology, including the right to use the title "psychologist", are an APAC approved four-year degree in psychology followed by either a two-year master's program or two years of practice supervised by a registered psychologist. However, the Australian Health Practitioner Regulation Agency (AHPRA) is currently in the process of phasing out the 4 + 2 internship pathway. Once the 4 + 2 pathway is phased out, a master's degree or PhD will be required to become a psychologist in Australia. This is because of concerns about public safety, and to reduce the burden of training on employers. There is also a '5 + 1' registration pathway, including a four-year APAC approved degree followed by one year of postgraduate study and one year of supervised practice. Endorsement within a specific area of practice requires additional qualifications. These notations are not "specialist" titles (Western Australian psychologists could use "specialist" in their titles during a three-year transitional period from 17 October 2010 to 17 October 2013).

Membership with Australian Psychological Society (APS) differs from registration as a psychologist. The standard route to full membership (MAPS) of the APS usually requires four years of APAC-accredited undergraduate study, plus a master's or doctorate in psychology from an accredited institution. An alternate route is available for academics and practitioners who have gained appropriate experience and made a substantial contribution to the field of psychology.

Restrictions apply to all individuals using the title "psychologist" in all states and territories of Australia. However, the terms "psychotherapist", "social worker", and "counselor" are currently self-regulated, with several organizations campaigning for government regulation.

Belgium

Since 1933, the title "psychologist" has been protected by law in Belgium. It can only be used by people who are on the National Government Commission list. The minimum requirement is the completion of five years of university training in psychology (master's degree or equivalent). The title of "psychotherapist" is not legally protected. As of 2016, Belgian law recognizes the clinical psychologist as an autonomous health profession. It reserves the practice of psychotherapy to medical doctors, clinical psychologists and clinical orthopedagogists.

Canada

A professional in the U.S. or Canada must hold a graduate degree in psychology (MA, Psy.D., Ed.D., or Ph.D.), or have a provincial license to use the title "psychologist". Provincial regulators include:

Dominican Republic

A professional psychologist in the Dominican Republic must have a suitable qualification and be a member of the Dominican College of Psychologists.

Finland

In Finland, the title "psychologist" is protected by law. The restriction for psychologists (licensed professionals) is governed by National Supervisory Authority for Welfare and Health (Finland) (Valvira). It takes 330 ECTS-credits (about six years) to complete the university studies (master's degree). There are about 6,200 licensed psychologists in Finland.

Germany

In Germany, the use of the title Diplom-Psychologe (Dipl.-Psych.) is restricted by law, and a practitioner is legally required to hold the corresponding academic title, which is comparable to a M.Sc. degree and requires at least five years of training at a university. Originally, a diploma degree in psychology awarded in Germany included the subject of clinical psychology. With the Bologna-reform, this degree was replaced by a master's degree. The academic degree of Diplom-Psychologe or M.Sc. (Psychologie) does not include a psychotherapeutic qualification, which requires three to five years of additional training. The psychotherapeutic training combines in-depth theoretical knowledge with supervised patient care and self-reflection units. After having completed the training requirements, psychologists take a state-run exam, which, upon successful completion (Approbation), confers the official title of "psychological psychotherapist" (Psychologischer Psychotherapeut). After many years of inter-professional political controversy, non-physician psychotherapy was given an adequate legal foundation through the creation of two new academic healthcare professions.

Greece

Since 1979, the title "psychologist" has been protected by law in Greece. It can only be used by people who hold a relevant license or certificate, which is issued by the Greek authorities, to practice as a psychologist. The minimum requirement is the completion of university training in psychology at a Greek university, or at a university recognized by the Greek authorities. Psychologists in Greece are legally required to abide by the Code of Conduct of Psychologists (2019). Psychologists in Greece are not required to register with any psychology body in the country in order to legally practice the profession.  Titles such as "psychotherapist" or "counselor" are not protected by law in Greece and anyone may call themselves a "psychotherapist" or "counselor" without having earned a graduate degree in psychology.

India

In India, "clinical psychologist" is specifically defined in the Mental Health Act, 2017. An MPhil in Clinical Psychology degree of two years duration recognized by the Rehabilitation Council of India is required to apply for registration as a clinical psychologist. This procedure has been criticized by some stakeholders since clinical psychology is not limited to the area of rehabilitation. Titles such as "counselor" or "psychotherapist" are not protected at present. In other words, an individual may call themselves a "psychotherapist" or "counselor" without having earned a graduate degree in clinical psychology or another mental health field, and without having to register with the Rehabilitation Council of India.

New Zealand

In New Zealand, the use of the title "psychologist" is restricted by law. Prior to 2004, only the title "registered psychologist" was restricted to people qualified and registered as such. However, with the proclamation of the Health Practitioners Competence Assurance Act, in 2003, the use of the title "psychologist" was limited to practitioners registered with the New Zealand Psychologists Board. The titles "clinical psychologist", "counseling psychologist", "educational psychologist", "intern psychologist", and "trainee psychologist" are similarly protected. This is to protect the public by providing assurance that the title-holder is registered and therefore qualified and competent to practice, and can be held accountable. The legislation does not include an exemption clause for any class of practitioner (e.g., academics, or government employees).

Norway

In Norway, the title "psychologist" is restricted by law and can only be obtained by completing a 6-year integrated program, leading to the Candidate of Psychology degree. Psychologists are considered health personnel, and their work is regulated through the "health personnel act".

South Africa

South African psychologist Pumla Gobodo-Madikizela

In South Africa, psychologists are qualified in either clinical, counseling, educational, organizational, or research psychology. As below, qualification requires at least five years of study, and at least one of internship.

To become qualified, one must complete a recognized master's degree in Psychology, an appropriate practicum at a recognized training institution, and take an examination set by the Professional Board for Psychology. Registration with the Health Professions Council of South Africa (HPCSA) is required and includes a Continuing Professional Development component.

The practicum usually involves a full year internship, and in some specializations, the HPCSA requires completion of an additional year of community service. The master's program consists of seminars, coursework-based theoretical and practical training, and a dissertation of limited scope, and is (in most cases) two years in duration. Prior to enrolling in the master's program, the student studies psychology for three years as an undergraduate (B.A. or B.Sc., and, for organizational psychology, also B.Com.), followed by an additional postgraduate honours degree in psychology; see List of universities in South Africa.

The undergraduate B.Psyc. is a four-year program integrating theory and practical training, and—with the required examination set by the Professional Board for Psychology—is sufficient for practice as a psychometrist or counselor.

United Kingdom

In the UK, "registered psychologist" and "practitioner psychologist" are protected titles. The title of "neuropsychologist" is not protected. In addition, the following specialist titles are also protected by law: "clinical psychologist", "counselling psychologist", "educational psychologist", "forensic psychologist", "health psychologist", "occupational psychologist" and "sport and exercise psychologist". The Health and Care Professions Council (HCPC) is the statutory regulator for practitioner psychologists in the UK. In the UK, the use of the title "chartered psychologist" is also protected by statutory regulation, but that title simply means that the psychologist is a chartered member of the British Psychological Society, but is not necessarily registered with the HCPC. However, it is illegal for someone who is not in the appropriate section of the HCPC register to provide psychological services. The requirement to register as a clinical, counselling, or educational psychologist is a professional doctorate (and in the case of the latter two the British Psychological Society's Professional Qualification, which meets the standards of a professional doctorate). The title of "psychologist", by itself, is not protected. The British Psychological Society is working with the HCPC to ensure that the title of "neuropsychologist" is regulated as a specialist title for practitioner psychologists.

Employment

As of December 2012, in the United Kingdom, there are 19,000 practitioner psychologists registered across seven categories: clinical psychologist, counselling psychologist, educational psychologist, forensic psychologist, health psychologist, occupational psychologist, sport and exercise psychologist. At least 9,500 of these are clinical psychologists, which is the largest group of psychologists in clinical settings such as the NHS. Around 2,000 are educational psychologists.

United States

Education and training

In the United States and Canada, full membership in each country's professional association—American Psychological Association (APA) and Canadian Psychological Association (CPA), respectively—requires doctoral training (except in some Canadian provinces, such as Alberta, where a master's degree is sufficient). The minimal requirement for full membership can be waived in circumstances where there is evidence that significant contribution or performance in the field of psychology has been made. Associate membership requires at least two years of postgraduate studies in psychology or an approved related discipline.

The University of Pennsylvania was the first institution to offer formal education in clinical psychology in the U.S.

Some U.S. schools offer accredited programs in clinical psychology resulting in a master's degree. Such programs can range from forty-eight to eighty-four units, most often taking two to three years to complete after the undergraduate degree. Training usually emphasizes theory and treatment over research, quite often with a focus on school or couples and family counseling. Similar to doctoral programs, master's level students usually must complete a clinical practicum under supervision; some programs also require a minimum amount of personal psychotherapy. While many graduates from master's level training go on to doctoral psychology programs, a large number also go directly into practice—often as a licensed professional counselor (LPC), marriage and family therapist (MFT), or other similar licensed practice, which varies by state.

There is stiff competition to gain acceptance into clinical psychology doctoral programs (acceptance rates of 2–5% are not uncommon). Clinical psychologists in the U.S. undergo many years of graduate training—usually five to seven years after the bachelor's degree—to gain demonstrable competence and experience. Licensure as a psychologist may take an additional one to two years post-PhD/PsyD. Some states require a 1-year postdoctoral residency, while others do not require postdoctoral supervised experience and allow psychology graduates to sit for the licensure exam immediately. Some psychology specialties, such as clinical neuropsychology, require a 2-year postdoctoral experience regardless of the state, as set forth in the Houston Conference Guidelines. Today in America, about half of all clinical psychology graduate students are being trained in PhD programs that emphasize research and are conducted by universities—with the other half in PsyD programs, which have more focus on practice (similar to professional degrees for medicine and law). Both types of doctoral programs (PhD and PsyD) envision practicing clinical psychology in a research-based, scientifically valid manner, and most are accredited by the APA.

APA accreditation is very important for U.S. clinical, counseling, and school psychology programs because graduating from a non-accredited doctoral program may adversely affect employment prospects and present a hurdle for becoming licensed in some jurisdictions.

Doctorate (PhD and PsyD) programs usually involve some variation on the following 5 to 7 year, 90–120 unit curriculum:

  • Bases of behavior—biological, cognitive-affective, and cultural-social
  • Individual differences—personality, lifespan development, psychopathology
  • History and systems—development of psychological theories, practices and scientific knowledge
  • Clinical practice—diagnostics, psychological assessment, psychotherapeutic interventions, psychopharmacology, ethical and legal issues
  • Coursework in statistics and research design
  • Clinical experience
    • Practicum—usually three or four years of working with clients under supervision in a clinical setting. Most practicum placements begin in either the first or second year of doctoral training.
    • Doctoral internship—usually an intensive one or two-year placement in a clinical setting
  • Dissertation—PhD programs usually require original quantitative empirical research, while PsyD dissertations involve original quantitative or qualitative research, theoretical scholarship, program evaluation or development, critical literature analysis or clinical application and analysis. The dissertation typically takes 2–3 years to complete.
  • Specialized electives—many programs offer sets of elective courses for specializations, such as health, child/adolescent, family, community, or neuropsychology.
  • Personal psychotherapy—many programs require students to undertake a certain number of hours of personal psychotherapy (with a non-faculty therapist) although in recent years this requirement has become less frequent.
  • Comprehensive exams or master's thesis: a thesis can involve original data collection and is distinct from a dissertation.

Psychologists can be seen as practicing within two general categories of psychology: health service psychology, which includes "practitioners" or "professionals" and research-oriented psychology which includes "scientists" or "scholars". The training models (Boulder and Vail models) endorsed by the APA require that health service psychologists be trained as both researchers and practitioners, and that they possess advanced degrees.

Psychologists typically have one of two degrees: PsyD or PhD. The PsyD program prepares the student primarily as a practitioner for clinical practice (e.g., testing, psychotherapy), but also as a scholar that consumes research. Depending on the specialty (industrial/organizational, social, clinical, school, etc.), a PhD may be trained in clinical practice as well as in scientific methodology, to prepare for a career in academia or research. Both the PsyD and PhD programs prepare students to take the national psychology licensing exam, the Examination for Professional Practice in Psychology (EPPP).

Within the two main categories are many further types of psychologists as reflected by APA's 54 Divisions, which are specialty or subspecialty or topical areas, including clinical, counseling, and school psychologists. Such professionals work with persons in a variety of therapeutic contexts. People often think of the discipline as involving only such clinical or counseling psychologists. While counseling and psychotherapy are common activities for psychologists, these health service psychology fields are just two branches in the larger domain of psychology. There are other classifications such as industrial and organizational and community psychologists, whose professionals mainly apply psychological research, theories, and techniques to "real-world" problems of business, industry, social benefit organizations, government, and academia.

APA-recognized specialties

Clinical psychologists receive training in a number of psychological therapies, including behavioral, cognitive, humanistic, existential, psychodynamic, and systemic approaches, as well as in-depth training in psychological testing, and to some extent, neuropsychological testing.

Services

Clinical psychologists can offer a range of professional services, including:

  • Psychological treatment (psychotherapy)
  • Administering, scoring, and interpreting psychological tests
  • Prescribing medications (in some States)
  • Conducting psychological research
  • Teaching
  • Developing prevention programs
  • Consulting
  • Program administration
  • Expert testimony
  • Supervision of students or other mental health professionals

In practice, clinical psychologists might work with individuals, couples, families, or groups in a variety of settings, including private practices, hospitals, community mental health centers, schools, businesses, and non-profit agencies.

Most clinical psychologists who engage in research and teaching do so within a college or university setting. Clinical psychologists may also choose to specialize in a particular field.

Prescriptive Authority for Psychologists (RxP)

Psychologists in the United States campaigned for legislative changes to enable specially-trained psychologists to prescribe psychotropic medications. Legislation in Idaho, Iowa, Louisiana, New Mexico, and Illinois has granted those who complete an additional master's degree program in clinical psychopharmacology authority to prescribe medications for mental and emotional disorders. As of 2019, Louisiana is the only state where the licensing and regulation of the practice of medical psychology by medical psychologists (MPs) is regulated by a medical board (the Louisiana State Board of Medical Examiners) rather than a board of psychologists. While other states have pursued prescriptive authority, they have not succeeded. Similar legislation in the states of Hawaii and Oregon passed through their respective legislative bodies, but in each case the legislation was vetoed by the state's governor.

In 1989, the U.S Department of Defense was directed to create the Psychopharmacology Demonstration Project (PDP). By 1997, ten psychologists were trained in psychopharmacology and granted the ability to prescribe psychiatric medications.

Licensure

The practice of clinical psychology requires a license in the United States and Canada. Although each of the U.S. states is different in terms of requirements and licenses (see and for examples), there are three common requirements:

  1. Graduation from an accredited school with the appropriate degree
  2. Completion of supervised clinical experience
  3. Passing a written and/or oral examination

All U.S. state and Canada provincial licensing boards are members of the Association of State and Provincial Psychology Boards (ASPPB) which created and maintains the Examination for Professional Practice in Psychology (EPPP). Many states require other examinations in addition to the EPPP, such as a jurisprudence (i.e., mental health law) examination or an oral examination. Nearly all states also require a certain number of continuing education credits per year in order to renew a license. Licensees can obtain this through various means, such as taking audited classes and attending approved workshops.

There are professions whose scope of practice overlaps with the practice of psychology (particularly with respect to providing psychotherapy) and for which a license is required.

Ambiguity of title

To practice with the title of "psychologist", in almost all cases a doctoral degree is required (PhD, PsyD, or EdD in the U.S.). Normally, after the degree, the practitioner must fulfill a certain number of supervised postdoctoral hours ranging from 1,500 to 3,000 (usually taking one to two years), and passing the EPPP and any other state or provincial exams. By and large, a professional in the U.S. must hold a doctoral degree in psychology (PsyD, EdD, or PhD), and/or have a state license to use the title psychologist. However, regulations vary from state to state. For example, in the states of Michigan, West Virginia, and Vermont, there are psychologists licensed at the master's level.

Differences with psychiatrists

Although clinical psychologists and psychiatrists share the same fundamental aim—the alleviation of mental distress—their training, outlook, and methodologies are often different. Perhaps the most significant difference is that psychiatrists are licensed physicians, and, as such, psychiatrists are apt to use the medical model to assess mental health problems and to also employ psychotropic medications as a method of addressing mental health problems.

Psychologists generally do not prescribe medication, although in some jurisdictions they do have prescription privileges. In five U.S. states (New Mexico, Louisiana, Illinois, Iowa, and Idaho), psychologists with clinical psychopharmacology training have been granted prescriptive authority for mental health disorders.

Psychologists receive extensive training in psychological test administration, scoring, interpretation, and reporting, while psychiatrists are not trained in psychological testing. In addition, psychologists (particularly those from PhD programs) spend several years in graduate school being trained to conduct behavioral research; their training includes research design and advanced statistical analysis. While this training is available for physicians via dual MD/PhD programs, it is not typically included in standard medical education, although psychiatrists may develop research skills during their residency or a psychiatry fellowship (post-residency). Psychologists from PsyD programs tend to have more training and experience in clinical practice (e.g. psychotherapy, testing) than those from PhD programs.

Psychiatrists, as licensed physicians, have been trained more intensively in other areas, such as internal medicine and neurology, and may bring this knowledge to bear in identifying and treating medical or neurological conditions that present with primarily psychological symptoms such as depression, anxiety, or paranoia (e.g., hypothyroidism presenting with depressive symptoms, or pulmonary embolism with significant apprehension and anxiety).

Mental health professions

Comparison of mental health professionals in the US
Occupation Degree Common licenses Prescription privilege Mean 2020
income (USD)
Clinical psychologist PhD/PsyD/EdD Psychologist Varies by state $89,290
Counseling psychologist (doctorate) PhD/PsyD/EdD Psychologist No $65,000
Counselor (master's) MA/MS/MEd MFT/LPC/LHMC/LPA No $47,660
School psychologist PhD/EdD/MS/EdS School psychologist No $74,000
Psychiatrist MD/DO Psychiatrist Yes $217,100
Clinical social worker PhD/DSW/MSW LCSW No $51,760
Psychiatric nurse MSN/BSN RN No $75,330
Psychiatric and mental health nurse practitioner DNP/PhD/MSN APRN/APN/PMHNP Yes (varies by state) $117,670
Expressive/Art therapist MA ATR No $55,900
  • Marriage and Family Therapist (MFT). An MFT license requires a doctorate or master's degree. In addition, it usually involves two years of post-degree clinical experience under supervision, and licensure requires passing a written exam, commonly the National Examination for Marriage and Family Therapists, which is maintained by the American Association for Marriage and Family Therapy. In addition, most states require an oral exam. MFTs, as the title implies, work mostly with families and couples, addressing a wide range of common psychological problems. Some jurisdictions have exemptions that let someone practice marriage and family therapy without meeting the requirements for a license. That is, they offer a license but do not require that marriage and family therapists obtain one.
  • Licensed Professional Counselor (LPC). Similar to the MFT, the LPC license requires a master's or doctorate degree, a minimum number of hours of supervised clinical experience in a pre-doc practicum, and the passing of the National Counselor Exam. Similar licenses are the Licensed Mental Health Counselor (LMHC), Licensed Clinical Professional Counselor (LCPC), and Clinical Counselor in Mental Health (CCMH). In some states, after passing the exam, a temporary LPC license is awarded and the clinician may begin the normal 3000-hour supervised internship leading to the full license allowing to practice as a counselor or psychotherapist, usually under the supervision of a licensed psychologist. Some jurisdictions have exemptions that allow counseling to practice without meeting the requirements for a license. That is, they offer a license but do not require that counselors obtain one.
  • Licensed Psychological Associate (LPA) Twenty-six states offer a master's-only license, a common one being the LPA, which allows for the therapist to either practice independently, or, more commonly, under the supervision of a licensed psychologist, depending on the state. Common requirements are two to four years of post-master's supervised clinical experience and passing a Psychological Associates Examination. Other titles for this level of licensing include psychological technician (Alabama), psychological assistant (California), licensed clinical psychotherapist (Kansas), licensed psychological practitioner (Minnesota), licensed behavioral practitioner (Oklahoma), licensed psychological associate (North Carolina) or psychological examiner (Tennessee).
  • Licensed behavior analysts

Licensed behavior analysts are licensed in five states to provide services for clients with substance abuse, developmental disabilities, and mental illness. This profession draws on the evidence base of applied behavior analysis and the philosophy of behaviorism. Behavior analysts have at least a master's degree in behavior analysis or in a mental health related discipline, as well as having taken at least five core courses in applied behavior analysis. Many behavior analysts have a doctorate. Most programs have a formalized internship program, and several programs are offered online. Most practitioners have passed the examination offered by the Behavior Analyst Certification Board The model licensing act for behavior analysts can be found at the Association for Behavior Analysis International's website.

Employment

In the United States, of 181,600 jobs for psychologists in 2021, 123,300 are employed in clinical, counseling, and school positions; 2,900 are employed in industrial-organizational positions, and 55,400 are in "all other" positions.

The median salary in the U.S. for clinical, counseling, and school psychologists in May 2021 was US$82,510 and the median salary for industrial-organizational psychologists was US$105,310.

Psychologists can work in applied or academic settings. Academic psychologists educate higher education students, as well as conduct research, with graduate-level research being an important part of academic psychology. Academic positions can be tenured or non-tenured, with tenured positions being highly desirable.

Physician assistant

From Wikipedia, the free encyclopedia

A Physician Assistant or Physician Associate (PA) is a type of healthcare professional. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes between smaller jurisdictions such as states or provinces. Depending on location, PAs practice semi-autonomously under the supervision of a physician, or autonomously performing a subset of medical services classically provided by physicians.

The educational model was initially based upon the accelerated training of physicians in the United States during the shortage of qualified medical providers during World War II. Since then, the use of PAs has spread to at least 16 countries around the world. In the US, PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and serve as a principal healthcare provider. In many states PAs are required to have a direct agreement with a physician. In the UK, PAs were introduced in 2003. They support the work of the healthcare team, but are dependent clinicians requiring supervision from a physician. They cannot prescribe medications nor request ionising radiation investigations (e.g. x-ray) in the UK. PAs are widely used in Canada. The model began during the Korean war and transitioned to the present concept in 2002. Skills and scope of privileges are similar to those in the US.

Nomenclature

The occupational title of physician assistant and physician associate originated in the United States in 1967 at Duke University. The role has been adopted in the US, Canada, UK and Ireland, each with their own nomenclature. The role has been adopted in the US, Canada, United Kingdom, Republic of Ireland, Netherlands, Australia, New Zealand, India, Israel, Poland, Bulgaria, Myanmar, Switzerland, Liberia, Ghana, and by analogous names throughout Africa, each with their own nomenclature and education structure.

Jurisdiction Title Abbreviation Test
Certifying Authority

Services

Physician assistants or associates may:

  • conduct patient interviews and take medical histories
  • conduct physical examinations
  • order and interpret diagnostic tests and exams (in some countries)
  • diagnose illnesses
  • formulate treatment plans
  • coordinate and manage care
  • perform medical procedures
  • prescribe medications (in some countries)
  • conduct clinical research
  • provide patient counselling
  • offer advice on preventative health care
  • first assist in surgery

Workplaces

Physician assistants or associates train to work in settings such as hospitals, clinics and other types of health facilities, or virtually via telemedicine. PAs are commonly found working in teaching and research as well as hospital administration and other clinical environments. PAs may practice in primary care or medical specialties, including emergency medicine, surgery and cardiology.

Training

Physician assistant (or associate) education is shorter than a medical degree required to become a physician. It also typically does not involve residency training, although this is increasingly offered in a variety of specialties.

Renewal of certification is usually required every few years, varying by jurisdiction.

History

In 1961 Charles Hudson recommended that the American Medical Association create new medical provider certifications. Eugene A. Stead of the Duke University Medical Center assembled the first class of physician assistants in 1965, composed of four former US Navy Hospital Corpsmen. He based the curriculum of the PA program on his first-hand knowledge of the fast-track training of medical doctors during World War II. Two other physicians, Richard Smith at the University of Washington, and Hu Myers at Alderson-Broaddus College launched their own programs in the mid-late 1960s. J. Willis Hurst started the Emory University Physician Assistant Program in 1967.

The Liberian model of PAs was a curriculum intended for graduates to work in areas absent of physicians as physician substitutes. Advisors for this program included UNICEF, American physicians and Agnes N. Dagbe, MS, RN, a Liberian nurse educated in the US. Additional training was in the USSR. The Liberian government inaugurated the program in 1965 with Dagbe as PA program.

Beginning in January 1971, the US Army produced eight classes of physician assistants, at 30 students per class, through the Academy of Health Sciences, Brooke Medical Center (academically accredited by Baylor University).

In 2017, approximately 68% of physician assistants in the United States identified as women and approximately 32% identified as men.

The profession expanded globally. It can now be found in Afghanistan, Australia, Canada, Germany, Ghana, India, Israel, Liberia, the Netherlands, New Zealand, Saudi Arabia, and the United Kingdom. As a profession physician assistants have greatly influenced the theory and conceptualization of socially accountable health professional education.

Jurisdictions

Australia

In 2011, Health Workforce Australia began developing the role of physician assistant throughout the country culminating with registration and a PA Program based out of James Cook University. Despite all initial indicators showing that the new profession would be successfully integrated into the health care system, in 2013 it was reported that the progress had floundered resulting in the majority of PAs in Australia being unemployed. However, by 2023 it was reported that the number had grown to about 159,000 PAs nationwide. Currently they are educated at the master's degree level and must graduate from an accredited physician assistant program to obtain licensure. They may work in all types of healthcare facilities as advanced practice. professionals. Priviledges may vary by state, similar as that in the US.

Canada

As of October 2018, there are approximately 800 physician assistants working in healthcare settings in Canada. The first formally trained physician assistants graduated in 1984 from the Canadian Forces Medical Services School at Borden, Ontario. The Canadian Medical Association (CMA) recognized physician assistants as a health professional in 2003. Physician assistants are able to perform medical functions such as ordering tests, diagnosing diseases, prescribing medications, treating patients, educating patients and performing various medical and surgical procedures. Physician assistants are labeled under the federal government national occupational classification code 3124: allied primary health practitioners.

Education and certification (Canada)

The first civilian physician assistant education programs were launched in 2008 at the University of Manitoba and McMaster University. In 2010, a third civilian program was launched by the consortium of physician assistant education (University of Toronto, Northern Ontario School of Medicine, and The Michener Institute). In Canada, the education of a physician assistant generally consists of three years of professional post-graduate university education. The education is delivered over a two calendar year time-frame by completing fall, winter and summer semesters for both years of the program in either a master level university physician assistant program or post-graduate professional university bachelor level physician assistant program. Physician assistant graduates become eligible for the certification exam by being a graduate of a Canadian physician assistant program that is recognized by the Physician Assistant Certification Council of Canada (Canadian Armed Forces physician assistant program, University of Manitoba, McMaster University and the consortium of physician assistant education all of which are accredited by the Canadian Medical Association).

Scope of practice (Canada)

Physician assistants resemble and provide many of the functions of Physician Assistants (PA) are academically prepared and highly skilled health care professionals who provide a broad range of medical services. PAs are physician extenders and not independent practitioners; they work with a degree of autonomy, negotiated and agreed on by the supervising physician(s) and the PA. PAs can work in any clinical setting to extend physician services. PAs complement existing services and aid in improving patient access to health care. A relationship with a supervising physician is essential to the role of the PA. " Physician assistants may be compared to the role of nurse practitioner by the general public and may be confused as the same profession. Nurse practitioners in Canada practice under an advanced nursing model. Physician assistants practice under a medical model, similarly modeled after medical school (physician) education. Nurse practitioners practice within their defined specific scope of practice autonomously and sometimes collaboratively. The defined scopes of a nurse practitioner include the areas of (family care, adults and paediatrics). Physician assistants are permitted to practice in all medical specialties by mirroring the practice of a physician with a full range of skills and scope by practicing both autonomously as a clinician and collaboratively with physicians when required. Some examples of practice areas for physician assistants include (emergency medicine, critical care medicine, cardiology, psychiatry, community and family medicine, neurology, surgery, orthopaedics, internal medicine, oncology, gastroenterology, military medicine, respirology, dermatology, women's health and many more specialities). Physician assistants may perform certain roles which have been traditionally only provided by physicians in clinical practice, making the PA's medical training over other providers unique in this regard.

Compensation (Canada)

Physician assistant salaries in civilian practice in Canada are relatively new and can range from approximately $80,000 CAD for entry level positions to $142,000 CAD a year for experienced providers which are not on call and up to $178,000 CAD for experienced providers which are on call. The physician assistant profession is newer to civilian practice in Canada. The compensation report published in 2019 by the Canadian Association of Physician Assistants outlines the typical salaries across Canada being an entry median salary of approximately $80,000 CAD and an experienced median salary of approximately $105,000 CAD.

Regulation (Canada)

Physician assistants are currently practicing across Canada in the Canadian Armed Forces as commissioned officers in domestic and international environments and have been in practice since the 1960s. Physician assistants outside of the Canadian Armed Forces practice usually in the public health care system in the provinces of Manitoba, Ontario, New Brunswick, Nova Scotia, and Alberta. Physician assistants have been regulated in Manitoba since 1999 and in New Brunswick since 2009 and are registrants of their respective provincial college of physicians and surgeons. In Ontario, Alberta and Nova Scotia the profession is not regulated at this time. Physician assistants in Ontario were introduced in 2007 to the public health system as a joint venture between the Ontario Ministry of Health and the Ontario Medical Association. In Alberta, a registry has been established for physician assistants under the College of Physicians and Surgeons of Alberta with future regulation underway. In Ontario, future regulation has been discussed by the Ontario Ministry of Health in which physician assistants would be members of the [[College of Physicians and Surgeons of Ontario|College of Physicians and Surgeons of Ontario.]] Physician assistants are represented by the Canadian Association of Physician Assistants, which originally was formed in October 1999. As of 2023, PAs scope of practice in Canada is described at their website:

The PA's scope of practice is determined on an individual basis and formally outlined in a practice contract or agreement between the supervising physician(s), the PA and often the facility or service where the PA will work. Activities may include conducting patient interviews, histories and physical examinations; performing selected diagnostic and therapeutic interventions or procedures; and counseling patients on preventive health care.

Germany

In Germany the Physician Assistant is called de:Arztassistent. It was introduced in 2007.

India

The first PA program in India was established in 1992 with a focus on expanding cardiovascular surgery. Since then, eight additional programs have developed (in total seven baccalaureate and two master's level programs).

Ireland

Physician Associates were introduced by the Health Service Executive in the mid-2010's. The Royal College of Surgeons has offered a PA postgraduate degree since 2016, with 28 graduating by January 2021. PAs may not write prescriptions.

Israel

Physician Assistants were introduced in Israel in May 2016 to help augment a shrinking physician workforce. The initial training programs have been overseen by the ministry of health directly, but transition to academic training is planned. Israeli PA education is modeled after United States' and Netherlands' approaches, and has focused on former paramedics with bachelor's degrees. As of 2022, the 100 or so PAs in Israel work exclusively within Emergency Departments. While PA scope of practice includes many emergency procedures, Israeli PAs are not currently allowed to prescribe or administer medicine in non-emergency settings.

New Zealand

In February 2015, Health Workforce New Zealand completed a Phase-2 trial of PAs who worked for a period of two years (2013–2015) in four clinical settings. Specifically, the sites included one rural emergency department and three primary care settings (two rural and one urban) located on the North and South Islands of New Zealand. At conclusion of the trial, several clinics continued to employ PAs while the process of health regulation makes its way through the government bureaucracy.

United Kingdom

The position of physician associate was established in the United Kingdom in 2005. It evolved from that of physician assistant, developed in the US in the 1960s. In 2012, the profession voted to change the name to physician associate to distinguish it from another with the same name within the NHS. Hillingdon Hospitals NHS Foundation Trust was asked to manage the recruitment of 200 physician associates who are expected to come from the US for 40 NHS trusts in September 2015.

In 2022 it was reported that private company Operose Health, owned by US company Centene Corporation, which had acquired many UK National Health Service (NHS) GP practices, was using many PAs—at less than half the cost of a GP—and allowing them essentially to act as GPs, without required supervision. A BBC reporter worked undercover at an Operose practice for six weeks, reporting on many problems. A senior GP said that the company was prioritising profit, putting patients at risk.

Faculty of Physician Associates, Royal College of Physicians (UK)

The Faculty of Physician Associates is the professional body for Physician Associates working in the United Kingdom. A joint venture between the Royal College of Physicians of London and the previous professional body, the United Kingdom Associate of Physician Associates, the Faculty officially launched in July 2015, taking over all professional responsibilities. The Faculty oversee the managed voluntary register, which all practising associates are encouraged to join, as well as setting and running the National Assessment Examination and National Recertification Examination.

Scope of practice (UK)

In the United Kingdom, PAs are dependent practitioners, and they must practice under the supervision of a physician. Physician Associates/Assistants are trained under the medical model, similarly to physicians, to deliver medical care in primary, secondary, and tertiary care settings. Upon graduation, they can specialize in any area of medicine, typically including primary care, emergency medicine, surgery, and psychiatry. PAs are held to the same standards of care as physicians. They perform tasks including diagnosis, taking medical histories, ordering and interpreting labs, treatment, and complex medical procedures. PAs cannot request ionising radiation investigations such as a CT scan or radiograph, they also cannot prescribe any medications.

Voluntary register (UK)

The title physician associate is not a protected medical profession. PAs in the U.K. are not able to prescribe or request ionising radiation imaging. No regulatory body governs PAs. Since June 2010, physician associates have been able to obtain membership of the Managed Voluntary Register for physician associates. This database, run by PAs for PAs, aims to identify all qualified PAs who are able to practise. Its intent is to maintain high standards. To remain on the register, physician associates are required to re-certify every 5–6 years and maintain up-to-date practice through accumulating continuous professional development hours, which must be completed on an annual basis.

In 2018 Matt Hancock announced a plan regulate PAs, details of which have not been announced. The General Medical Council agreed to be the regulatory body for PAs, with regulation beginning in 2022.

Training (UK)

Training is through a two-year training programme (MSc or Postgraduate Diploma) in Physician Associate Studies. As of 2017 at least 32 universities offered these programs:

Entry requirement vary; Barts and the London School of Medicine and Dentistry, Queen Mary University of London requires candidates to hold a minimum of 2:2 or above in a Life Science, Biomedical Science, or Healthcare subject.

Aberdeen requires a science-based degree with a minimum 2:1 grade achieved while St George's requires a science-based degree with a minimum 2:2 grade. This includes sport science, biology, psychology and biomedical degrees. Applicants should preferably have healthcare experience. Applications from other professionals such as nurses, radiographers and paramedics will also be considered.

University of Bradford requires a 2:1 (or above) undergraduate degree in a Life Science, Biomedical Science, or Healthcare subject. Under exceptional circumstances, extensive experience in healthcare practice may contribute/compensate absent the above requirements.

Compensation (UK)

The average starting salary of a PA-R is Band 7 (£37,000), and can vary based on locations. In London, the average salary is around £43,000 and goes up to 50k with experience, particularly with lead PAs. PAs are also able to do locum shifts on top of their full-time job. Compensation of physician associates in the United Kingdom remains lower than in the United States and Canada. However, compensation of physician associates is on the same pay band as other advanced care providers such as nurse practitioners.

United States

Nomenclature (US)

In accordance with the American Academy of Physician Associates (AAPA), the official title of the profession in the United States is "Physician Associate". While this is the official title nationally, utilization of this title may vary on the state level based on state bylaws and policies.

A physician assistant may use the initials "PA", "PA-C", "APA-C", "RPA" or "RPA-C", where the "-C" indicates "Certified" and the "R" indicates "Registered". The "R" designation is unique to a few states, mainly in the Northeast. APA stands for aeromedical physician assistant and indicates that a physician assistant successfully completed the US Army Flight Surgeon Primary Course. During training, PA students are designated PA-S. The use of "PA-C" is limited to certified PAs who comply with the regulations of the National Commission on Certification of Physician Assistants and who have passed PANCE.

Students undertaking physician assistant or associate training may refer to themselves as a physician assistant student, physician associate student, student physician assistant or student physician associate. PA students may add "S" at the end of their student designation (PA-S). Students may also use the corresponding year of their training in their student designation. For example, students in the second year of their physician assistant or physician associate training may use (PA-S2) as their student designation.

The American Academy of Physician Associates has spent over $22 million since 2018 campaigning to change the word "assistant" to "associate" in the title of physician assistant. The campaign has been heavily criticized by physicians. There are opposing views which see this change more accurately reflects the clinician's role on the patient care team Physician assistants want to be called physician associates, but doctors cry foul.

In the United States, the profession is represented by the American Academy of Physician Associates. All PAs must graduate from a nationally accredited ARC-PA program as well as passing the national certification exam. In 1970 the American Medical Association passed a resolution to develop educational guidelines and certification procedures for PAs. The Duke University Medical Center Archives had established the Physician Assistant History Center, dedicated to the study, preservation, and presentation of the history of the profession. The PA History Center became its own institution in 2011, was renamed the PA History Society, and relocated to Johns Creek, Georgia.

Education and certification (US)

As of May 2019, 243 accredited PA programs operated in the United States, with dozens more in development. Most educational programs are graduate programs leading to the award of master's degrees in either Physician Assistant Studies, Health Science (Master of Health Science), or Medical Science (MMSc), and require a bachelor's degree and Graduate Record Examination or Medical College Admission Test scores for entry. The majority of PA programs in the United States employ the CASPA application for selecting students. Professional licensure is regulated by state medical boards. PA students train at medical schools and academic medical centers across the country.

Physician Assistant Program at ODU

PA education is based on medical education; it typically requires 2 to 3 years of full-time graduate study like most master's degrees. (Medical school lasts four years plus a specialty-specific residency.) Training consists of classroom and laboratory instruction in medical and behavioral sciences, followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine, as well as elective rotations. PAs are not required to complete residencies after they complete their schooling (unlike physicians). Postgraduate training programs are offered in certain specialties for PAs, though these are optional and shorter in length than medical residency.

PA clinical postgraduate programs are clinical training programs that differ from on the job training given their inclusion of education and supervised clinical experience to meet learning objectives. Montefiore Medical Center Postgraduate Surgical Physician Assistant Program was established in 1971 as the first recognized clinical postgraduate PA program. 49 programs address specialties such as Neurology, Trauma/Critical Care and Oncology. 50 programs joined the Association of Postgraduate Physician Assistant Programs to establish educational standards for postgraduate PA programs.

In the United States, a graduate from an accredited PA program must pass the NCCPA-administered Physician Assistant National Certifying Exam (PANCE) before becoming a PA-C; this certification is required for licensure in all states. The content of the exam is covered in the PANCE BLUEPRINT. In addition, a PA must log 100 Continuing Medical Education hours and reregister his or her certificate with the NCCPA every two years. Every ten years (formerly six years), a PA must also recertify by successfully completing the Physician Assistant National Recertifying Exam (PANRE) There is a growing number of doctoral programs for certified PAs leading to a Doctor of Medical Science (DMSc) but there is no requirement for one to have a doctorate in order to practice. "National Physician Assistant Week" is celebrated annually in the US from October 6 through October 12. This week was chosen to commemorate the anniversary of the first graduating physician assistant class at Duke University on October 6, 1967. October 6 is also the birthday of the profession's founder, Eugene A. Stead, Jr., MD.

Scope of practice (US)

Physician assistants have their own licenses with distinct scope of practice. Each of the 50 states has different laws regarding the prescription of medications by PAs and the licensing authority granted to each category within that particular state through the Drug Enforcement Administration (DEA). PAs in Kentucky and Puerto Rico are not allowed to prescribe any controlled substances. Several other states place a limit on the type of controlled substance or the quantity that can be prescribed, dispensed, or administered by a PA. Depending upon the specific laws of any given state board of medicine, the PA must have a formal relationship on file with a collaborative physician. The collaborating physician must also be licensed in the state in which the PA is working, although he or she may physically be located elsewhere. Physician collaboration can be in person, by telecommunication systems or by other reliable means (for example, availability for consultation). In emergency departments the laws governing PA practice differ by state, generally allowing a broad scope of practice and limited direct supervision.

During the COVID-19 pandemic, several state governments changed regulations regarding PA scope of practice, including:

  • On May 21, 2020, the law S.B. 1915 was signed by Oklahoma Governor Kevin Stitt. This law allows Physician Assistants to become primary care providers and receive direct pay from insurers. The reference of "supervision" was changed to "delegating" in regards to physician responsibility. This law also allows PAs to legally volunteer in the case of disaster or emergency.
  • On May 27, 2020, Governor Tim Walz signed into Minnesota law the Omnibus Healthcare Bill S.F. 13. This law removes references to physician responsibility of supervision and delegation of care provided by PAs. The law also removes delegated prescriptive authority.

Employment (US)

The first employer of PAs was the then-Veterans Administration, known today as the Department of Veterans Affairs. Today it is the largest single employer of PAs, employing nearly 2,000.

According to the AAPA, as of 2020 there are more than 148,560 certified PAs in the United States, up from 115,547 in 2016.

Money magazine, in conjunction with Salary.com, listed the PA profession as the "fifth best job in America" in May 2006, based both on salary and job prospects, and on an anticipated 10-year job growth of 49.65%. In 2010, CNN Money rated the physician assistant career as the number two best job in America. In 2012, Forbes rated the physician assistant degree as the number one master's degree for jobs. In 2015, Glassdoor rated physician assistant as the number one best job in America. In 2021, US News & World Report rated physician assistant as the number one best job in America.

The US Department of Labor Bureau of Labor Statistics report on PAs states, "...Employment of physician assistants is projected to grow 37 percent from 2016 to 2026, much faster than the average for all occupations..." This is due to several factors, including an expanding health care industry, an aging baby-boomer population, concerns for cost containment, and newly implemented restrictions to shorten physician resident work hours.

In the 2008 AAPA census, 56 percent of responding PAs worked in physicians' offices or clinics and 24 percent were employed by hospitals. The remainder were employed in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs Fifteen percent of responding PAs work in counties classified as non-metropolitan by Economic Research Service of the United States Department of Agriculture; approximately 17% of the US population resides in these counties.

For PAs in primary care practice, malpractice insurance policies with $100,000–300,000 in coverage can cost less than $600 per year; premiums are higher for PAs in higher-risk specialties.

Compensation (US)

According to Bureau of Labor Statistics, in 2020 the median pay for physician assistants working full-time was $115,390 per year or $55.48 per hour, and the highest 10 percent earned more than $162,470. Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn up to $200,000 per year.

Federal government, uniformed services, and US armed forces (US)

PAs are employed by the United States Department of State as foreign service health practitioners. PAs working in this capacity may be deployed anywhere in the world where there is a State Department facility. They provide primary care to US government employees and their families in American embassies and consulates around the world. An important part of their jobs is to get to know what resources are available locally that they can count on in an emergency. They have other important roles, such as advising their ambassadors on the health situation in the country and provide health education to the diplomatic community. In order to be considered for the position, these PAs must be licensed and have at least two years of recent experience in primary care.

Physician Assistant in the US Army

Military PAs serve in the White House Medical Unit, where they provide care to the president and vice president and their families as well as White House staff.

They are employed by several organizations with the intelligence community, specifically the Central Intelligence Agency. While much of the job description is classified, they work under the Directorate of Support and are deployed to "austere environments" where they provide medical care, including trauma stabilization, and teach in the fields of survival, field medicine, and tactical combat casualty care.

United States Army PAs serve as Medical Specialist Corps officers, typically within Army combat or combat support battalions located in the continental United States, Alaska, Hawaii, and overseas. These include infantry, armor, cavalry, airborne, artillery, and (if the PA qualifies) special forces units. They serve as the "front line" of Army medicine and along with combat medics are responsible for the total health care of soldiers assigned to their unit, as well as of their family members.

PAs also serve in the Air Force and Navy as clinical practitioners and aviation medicine specialists, as well as in the Coast Guard and Public Health Service. The skills required for these PAs are similar to that of their civilian colleagues, but additional training is provided in advanced casualty care, medical management of chemical injuries, aviation medicine, and military medicine. In addition, military PAs are also required to meet the officer commissioning requirements, and maintain the professional and physical readiness standards of their respective services.

The marine physician assistant is a US Merchant Marine staff officer. A certificate of registry is granted through The United States Coast Guard National Maritime Center located in Martinsburg, West Virginia. Formal training programs for marine physician assistants began in September, 1966 at the Public Service Health Hospital located in Staten Island, N.Y.

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