One of the enduring myths about the PA profession is the notion that PAs, perhaps more than other health professionals, are interested and engaged in preventive medicine. How many times have we heard that PAs are clinicians who are more likely to integrate preventive approaches in their practice?

In truth, as attractive and complimentary as this concept sounds, it is debatable whether PAs actually engage in prevention-related activities in their clinical practices, and it is dubious as to whether they do these things to a greater degree than their clinical counterparts.

Little evidence supports the assertion that PAs are more interested or engaged in preventive medicine. In making that judgment, there are two broad areas in which we would look: PA education (Is preventive medicine taught?) and in clinical practice (Is it done?).

Prevention in PA Education

While there is some evidence that PA programs teach preventive medicine, the degree to which this is uniform is uncertain.

Healthy People 2010, the Department of Health and Human Services' goal-setting document in preventive medicine,¹ encourages all health professions educational programs to teach concepts of prevention. Objective 1.7 is to "increase the proportion of schools of medicine, schools of nursing and other health professional training schools whose basic curriculum for health care providers includes the core competencies in health promotion and disease prevention."

In PA education, one recent study provides encouraging evidence. Perkin and colleagues found that a large majority of PA educational programs present instruction in health promotion and wellness.² And historically, several noted PA educational programs have incorporated prevention into their curricula. Nevertheless, even today, not all PA educational programs teach all areas of preventive medicine and health promotion, as these subjects are not explicitly required to be covered in the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) Accreditation Standards for Physician Assistant Education.

Unfortunately, earlier this year ARC-PA missed the opportunity to strengthen provisions in preventive medicine in the recent revision of the Standards. The new third edition of the Standards, makes only a passing reference to prevention in the broad rubric (section B3.04) that reads, "The program must provide instruction in the important aspects of patient care including preventive, acute, chronic, rehabilitative and end-of-life."³ One wonders why ARC-PA could not have included stronger language encouraging PA programs to include concepts of prevention, health promotion and public health in this key blueprint for PA educational curricula.

Prevention in PA Practice

In terms of the clinical practice area, relevant data are more difficult to come by. The AAPA Census provides an estimated number of the most common conditions seen by PAs; most of these are acute medical conditions (respiratory infections, allergic disorders, UTIs, etc.). Visits related to preventive medicine do not appear on the list. A past study of PA practice activities does indicate some integration of prevention-related practice activities but the specific amount was not quantified.⁴ Thus, there is an underwhelming amount of evidence in support of PA engagement in preventive medicine.

There are several likely reasons why PAs, like other health professionals, have difficulty in incorporating preventive medicine elements into their clinical practice. The barriers to the incorporation of clinical preventive services into the medical encounter have been well described.⁵ They range from the disease-oriented structure of the U.S. health care system to the practical factor that many preventive services are not eligible for reimbursement. It is also theorized that in terms of clinical practice activities, PAs typically take their cues from physicians. It is well known that physicians do not do a particularly good job at including preventive elements into their patient encounters. It follows that if physicians fail to incorporate these services, PAs may function in a similar manner.

The key point of this commentary is not so much to expose the myth of PAs engaging inor not engaging inpreventive medicine, but instead to encourage the profession to live up to this reputation. PAs, like all health care professions, could do a better job of teaching preventive concepts in educational programs and in incorporating these aspects into daily practice. Recently a joint task force comprising representatives from seven major health professions educational organizations have developed a model curriculum for population health.⁶ Through these and similar initiatives promoting preventive approaches, the hope is that PAs will be rightfully seen as being on the forefront of medical education and practice.

James F. Cawley is director of the PA/MPH program and professor and vice chair of the Department of Prevention and Community Health, School of Public Health and Health Services at The George Washington University in Washington. He also is professor of health care sciences at the university's School of Medicine and Health Science.

References

1. US Dept of Health and Human Services. Healthy People 2010. 2nd ed. Washington DC: U.S. Government Printing Office; November 2000: Vol 1:1-24.

2. Perkin JE, Rahr RR, Kurial M. Health promotion and wellness in physician assistant programs. Perspective on Physician Assistant Education. 2001;12(1):5-12.

3. Accreditation Standards for Physician Assistant Education. Duluth, Ga: Accreditation Review Commission on Education for the Physician Assistant; March 31, 2005:12. Available at: http://www.arcpa.org/General/standards/newStandards3.31.05.pdf3. Accessed August 11, 2005.

4. Cawley JF, Andrews MD, Barnhill GC, Webb L, Hill IK. What Makes the Day: An Analysis of the Content of Physician Assistants' Practice. JAAPA. 2001;14(5):41-56.

5. Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force. 2nd ed. Baltimore, Md: Lippincott Williams and Wilkins; 1996.

6. Healthy People Curriculum Task Force. Available at: http://www.atpm.org/taskforce/HPC_Taskforce.html. Accessed August 11, 2005.