The History of the OPA-C | Read White Paper on this topic

The concept for physician extenders began in the midst of the Vietnam War. Diverse and highly skilled men and women from the armed forces medical corps who had extensive on the job training were returning from active duty unable to be utilized to their full potential. This along with a projected physician shortage led to the creation of the medical extender programs (MEDEX) in the middle 1960s. These MEDEX programs were started in 1966 and 1967 to recruit military trained medics and corpsmen for additional training that would enable them to practice as Physician Extenders in the civilian sector as they had in the military. One of the first programs to be established was at Duke University in North Carolina. Soon after this, other programs began to be established across the country. At this same time orthopedic surgeons were looking for help with a variety of duties in their practice which included first assistants at surgery, application of immobilization devices, and general patient care.

Due to the fact that the MEDEX or "primary care" physician assistant programs did not provide focused education with regard to orthopedics the American Academy of Orthopaedic Surgeons began to look at ways in which to train physician extenders for their field. In 1967 the American Academy of Orthopaedic Surgeons accredited the first program for "Orthopedic Assistants." The AAOS committee developed a curriculum for the program to present to the AMA's commission. Elaborate plans for accreditation and certification procedures were outlined and reviewed prior to approval by the AMA and the AAOS in 1970. Following this, other programs began to open, and a total of nine programs of education for orthopedic assistants were opened in the civilian sector. A 10th program was opened in the US Army.

In May of 1971, the Council on Health Manpower of the American Medical Association encouraged the title change of the "Orthopedic Assistant" to Orthopedic Physician's Assistant. This was done to bring uniformity to the names of physician extenders while at the same time identifying the specialty that they were trained in. This was also done with Urology Assistants by calling them Urology Physician's Assistants. The Executive Committee of the American Academy of Orthopaedic Surgeons adopted this change and awarded the title accordingly.

Programs for training the Orthopedic Physician's Assistant continued with both AMA and AAOS accreditation until 1974 when a review by the Board of Directors of the AAOS determined that it did not have the "manpower" to continue to accredit these programs and recommended that this be completely undertaken by the AMA and the American College of Surgeons. When this occurred, the AMA and the American College of Surgeons were developing and supporting "generic" physician assistant, and with the withdrawal of the AAOS as an accrediting body the AMA felt that it wanted to continue to train only "generic" physician assistants. The last accredited AMA OPA program was in 1977; the last AAOS-supported OPA program was in 1976.

The demand for trained orthopedic help continued even though the AMA and AAOS were no longer accrediting programs, and in 1979 the National Board of Certification for Orthopedic Physician's Assistants was created. This board consisted of seven OPA members, four orthopedic surgeons who were certified by the American Board of Orthopaedic Surgery, and the examination administrator Ms. Sally Anne Henry, Ph.D., of the Professional Testing Corporation. This board and exam were created following numerous communications with the National Commission on Certification of Physician Assistants (NCCPA). In 1977, a communication from David Glazer, Executive Director for NCCPA, indicated that the NCCPA was interested in establishing a specialty physician assistant certification examination. When this was not established by 1979, the American Society of Orthopedic Physician's Assistants voiced their support for the creation of an independent certifying body for OPA's.

The first certification exam for orthopedic physician's assistants was given in the fall of 1980 at Tulane University in New Orleans, LA. The examination is still given annually at sites across the United States. Individuals who meet the criteria for taking the examination and receive a passing score are awarded the short title "OPA-C" (Orthopedic Physician's Assistant, Certified). Certification is then maintained by voluntary participation in continuing medical education programs meeting the AMA guidelines. Certification is "good" for four years at which time the OPA must have achieved 120 hours of continuing education or they must retest and pass the examination. The National Board for Certification of Orthopedic Physician's Assistants meets annually to review the examination, thus keeping it current with trends in orthopedic medicine.

Even with these decisions, OPA educational programs continued. Slowly because of difficulty finding program coordinators, these programs began to close. In 1990, the Kirkwood program graduated the last class of program trained OPAs during that era.  Recent graduates from University of St Augustine in Florida will have it's last class of graduating Orthopedic Assistants in 8/2016.  The university was purchased by an International Invest group that chose to not continue with any start up programs.  We are currently working with other schools to establish another OA school.

THE DIFFERENCES BETWEEN OPA-C/OA-CS AND PA-CS

The Orthopaedic Physician's Assistant (OPA-C)/Orthopaedic Assistant (OA-C):

The certified Orthopaedic Physician's Assistan/Orthopaedic Assistant is a professional, mid-level physician extender who works strictly in the field of orthopaedic medicine under the supervision of an orthopaedic surgeon(s). The title, Orthopaedic Physician's Assistant Certified/Orthopaedic Assistant Certified (OPA-C/OA-C) can be used only after an individual has successfully passed the certification examination set forth by the National Board for Certification of Orthopaedic Physician's Assistants/National Board for Certification of Orthopaedic Assistants (NBCOPA/NBCOA).

To be eligible to sit for the examination, candidates must have a solid background with a minimum of five years in orthopaedic medicine encompassing anatomy, physiology, pharmacology and knowledge of musculoskeletal disease process and treatment. Furthermore, candidates to become an OPA-C/OA-C must have demonstrated proficiency with technical skills related to patient care, casting, bracing, splinting, and surgical assisting. Candidacy to becoming a certified OPA/OA can be achieved through completion of a formal, recognized OPA-C/OA-C program or in some cases through cross-training of other health care personnel who are already certified or licensed. In a study commissioned by the American Society of Orthopaedic Assistants (ASOA) most certified OPA-C/OA-C's have a bachelor's or more advanced educational degree and have formal training as such an orthopaedic nurse, certified orthopaedic technologist, or military corpsman.

An OPA-C/OA-C works within the scope of practice as defined by his or her supervising physician. The employing physician takes into account the OPA/OA's experience and expertise in delegating duties to the OPA-C/OA-C. The American Society of Orthopaedic Assistants in conjunction with the National Board for Certification of Orthopedic Physician's Assistant/National Board for Certification of Orthopedic Assistants has drafted a Standardized Guidelines of Practice for certified OPA/OAs, which lists duties the OPA-C/OA-C should be competent performing based on the areas covered by the certifying examination.

Currently, the scope of an OPA-C/OA-C's practice is governed by the medical staff and credential committees of the hospitals where they perform many of their duties and by applicable state laws. However, due to the high demand for these individuals, some states such as Tennessee, California, and New York have adapted practice guidelines for these physician extenders. Many more states are currently reviewing these guidelines and establishing uniform criteria with the help of the orthopaedic community and the OPA/OA.

The Physician Assistant (PA-C):

Physician Assistants (PA-C) are professional physician extenders who have received generalist training in medicine and work under the supervision of a physician. This training includes: Family Medicine, Internal Medicine, Pediatrics, and Obstetrics and Gynecology. The average length of the PA curriculum is 26 months of didactic and clinical training. This is provided at many levels, from the diploma-producing level to the post-graduate level. However, the curriculum is essentially the same regardless of that level. Training consists of didactic (classroom and laboratory) instruction in the basic medical and behavioral sciences (anatomy, physiology, pharmacology, pathophysiology, clinical medicine, and physical diagnosis), followed by clinical rotations in Internal Medicine, Family Medicine, Pediatrics, Obstetrics and Gynecology, Emergency Medicine, and Geriatric Medicine. The student can then choose to take an elective rotation in General Surgery or Orthopaedics that is often no longer than 6 weeks. Upon completion of the training program, the student may sit for the NCCPA Examination. Even though many will deny its existence, the NCCPA had a clause that allowed for " informally " trained individuals to take the examination up until 1986.

In general, the PA-C is trained to provide diagnostic and therapeutic health care services in a variety of settings including rural and under-served areas. The original concept was brought about by a perceived physician shortage that was to occur in the late 1970 and 1980s.

The Distinctions

Despite the similarity in titles, Physician Assistants (PA-C) are not Orthopaedic Physician's Assistants/Orthopaedic Assistants (OPA-C/OA-C). While Physician Assistants are required to complete an intensive formal educational program covering primary care medicine, training in orthopaedics is limited to a short elective rotation. Physician Assistants can become certified by passing the NCCPA examination. Orthopaedic Physician's Assistants/Orthopaedic Assistants on the other hand are required to have a solid background in clincial and surgical orthopaedics with additional technical skills that are not commonly taught in formal PA-C programs. The current model of OPA-C/OA-C learning is similar to that of hands-on residency training by a physician.

While there is some overlap in regards to scope of practice for PA's and OPA/OA's, OPA/OA's by definition have specialty training within the field of orthopaedics and provide an invaluable service to their supervising physician(s).

OPA History - Whitepaper
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