Guidelines of the Roles of PAs in Occupational Medicine
This guideline is sponsored by the American Academy of Physician Assistants in Occupational Medicine to assist its members, employing physicians, health care administrators, and others who are charged to identify and integrate roles of physician assistant professionals into their mission.
A Physician Assistant (PA) is a health professional who practices medicine with physician supervision. As a member of the health care team, the PA provides a broad range of medical diagnostic, therapeutic, and health promotion/disease prevention services. PAs are qualified by graduation from an accredited PA educational program and certification by the National Commission on Certification of Physician Assistants (NCCPA) to exercise a level of autonomy in the performance of clinical responsibilities within state medical practice-authorized scope of practice and the supervisory relationship (HRSA, 1994, p. 17).
A physician assistant in occupational and environmental medicine is one who, by training and experience in the specialty, observes all applicable state laws and regulations, complies with appropriate recordkeeping requirements and helps develop and implement health services and programs to provide for safety and health of exposed populations. The role of the physician assistant is centered on patient care responsibilities, but may include educational, research, and administrative activities.
Working on a team with the occupational and environmental physician as team leader, PAs participate in the essential components of the occupational and environmental health program: preplacement examinations; periodic medical surveillance; post-illness reevaluations; referrals to alcohol, drug, mental health professionals; or on-the-job injury.
Preplacement or pre-assignment requires a health status examination including evaluation of emotional status to ensure that the individual can perform essentials of the job safely and without endangering the safety of others. Other components of the examination are: the occupational history; assessment of the organs or systems likely to be affected by their work; evaluation of the description keyed demands of the job to which assignment is being considered per job demands narrative as developed by the human resources department. These job descriptions should be in compliance with pertinent regulations such as the Occupational Safety and Health Act, the Environmental Protection Agency, the Mine Safety and Health Act, the Department of Transportation, the Nuclear Regulatory Commission, and the Americans with Disabilities Act.
Periodic medical surveillance is a review of an employee's health status when there is likelihood that workplace exposures or activities could have an adverse health effect. The review may be focused on the target organ.
Post-illness or injury reevaluation follows prolonged work absence due to injury or illness. The goal is to ensure that the recovery is sufficient to resume the job without undue risk of adverse health or safety effects to the individual or others. A return to work physical examination may help determine whether the individual can return to the workplace on full duty, on a restricted basis with a planned follow up, or with a recommendation to the manager that he/she should be relocated.
The occupational physician/PA team diagnoses and treats occupational and environmental injuries or illnesses, and may direct rehabilitation. This team is uniquely qualified to diagnose occupational and environmental illnesses and injuries such as repetitive strain based on knowledge of worksites, ergonomic factors, and the environment. This knowledge of medicine and work requirements and possible toxins or bodily harms is linked to other specialists such as toxicologists, industrial hygienists, and environmental engineers. Treatment and prevention modalities connect the occupational and environmental health team to the employee. The network of business links used may include professionals from human resource or employee health and safety, an on-site occupational health PA or nurse, physical and occupational therapist, a foreign health department counselor, insurance coordinator, case manager, or quality control professional.
A PA should work clinically with the supervision of his/her designated physician who assumes ultimate responsibility for the patient. The number of PAs whose clinical work can be supervised by one occupational and environmental physician depends on medical practice legislation in each state. Credentialing procedures must be specifically stated. All PAs should be nationally board certified and/or meet the requirements of the state or federal jurisdiction in which they function.
Physician assistants working in occupational and environmental medicine should have or should acquire specific experience or specialty training in occupational and environmental medicine (OEM). PAs' knowledge of specific office policies and procedures make it possible to consult meaningfully with a worker's manager to identify light duty during post-illness or injury convalescence. Tasks that PAs perform include work-place surveys, translating job descriptions and work functions into screening programs to assess those at risk of exposure to potential hazards; establishing surveillance programs to examine employees exposed to a known hazard (e.g., asbestos); and tailoring the program to meet federal or state requirements. Other tasks that concern PAs are ensuring patient confidentiality and effective communication between the health care provider and the manager.
Education of employees regarding jobs with specific potential hazards should be done routinely to prevent possible adverse health effects and to make the employee a partner in primary prevention. OSHA Hazard Communication Standard or "Right to Know" stresses importance of employee knowledge of chemical usage. Material Safety Data Sheets (MSDS) should be available to each employee. The OEM team may give assistance to employers regarding protective measures needed to prevent exposure to a potentially dangerous chemical or substance.
Use of indicated personal protective devices such as ear muffs or plugs, safety glasses, respirators, gas-impermeable suits, steel toed shoes, harnesses, or other equipment may be necessary for those exposed to noise or other workplace hazards.
Other issues are medical record maintenance for each occupationally exposed employee, immunization against possible occupational infections; periodic evaluation of the occupational or environmental health program; disaster preparedness planning for the workplace and the community; assistance in rehabilitation of alcohol and drug-dependent employees.
Harris, J. S. (1997) "Development, Use, and Evaluation of Clinical Practice Guidelines" Journal of Occupational and Environmental Medicine, 39, 1, January.
HRSA (1994), Health Resources and Services Administration U.S. Department of Health and Human Services, Public Health Service, Bureau of Health Professions, Division of Medicine, Special Projects & Data Branch, pp. 16-18.
Ramos, M. (2000) "Occupational and Environmental Medicine for PAs" in Physician Assistant, A Guide to Clinical Practice, Ballweg, R., Stolberg, S., & Sullivan, E. M. (Eds.) Philadelphia: W. B. Saunders, pp. 684-711.
Maryann Ramos, PA-C, M.P.H.
May 8, 2000; Revised November 17, 2002