What is an OPA-C?
This article provides a brief definition of the OPA-C, with a lengthy discussion of the OPA-C's functions and duties as a physician extender.

What is the difference between an OPA-C and a PA-C?
This article provides an explanaton of the clear distinctions between orthopaedic physician's assistants and physician's assistants.

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What is an OPA-C?

Definition:

The certified Orthopaedic Physician's Assistant is a professional physician extender who has met the criteria set forth by the National Board for Certification of Orthopaedic Physician's Assistants and has successfully passed the certification examination as such, and maintains certification by complying with the bylaws of the NBCOPA. The Certified Orthopaedic Physician's Assistant may use the short title OPA-C.

Design:

These guidelines are not intended as a complete textbook, but are designed to direct and cue the Certified Orthopaedic Physician's Assistant to assist the orthopaedic physician toward complete assessment of signs, symptoms, analysis, treatment, and care for the orthopedic patient. Passage of the certification examination signifies an entry level of knowledge of the following categories in the specialty of orthopaedic medicine and surgery.

1. Anatomy & Physiology
2. Pharmacology
3. Assessment and treatment of Adult and Pediatric Orthopaedic Diseases and Injuries
4. Principals and Techniques of Operative Procedures
5. Functions and Applications of Instrumentation and Equipment Utilized in Operative Orthopaedic Procedures
6. Principals and Techniques of Traction, Casting, and Splint Applications
7. Evaluation and Interpretation of Laboratory, Radiological, and other Diagnostic Studies
8. Clinical Evaluation and Physical Assessment

Functions, Prerogatives, and Responsibilities:

The Certified Orthopaedic Physician's Assistant should practice in accordance with any existing applicable state rules or regulations that govern the practice of professional physician extenders.

1. The Certified Orthopaedic Physician's Assistant shall function in practice under the supervision of the orthopaedic physician in accordance with established policies and procedures.
2. The Certified Orthopaedic Physician's Assistant shall function as part of the supervision of the orthopaedic patient involving the whole management of are requiring the application of principles based upon the biological, physical, and social sciences.
3. The Certified Orthopaedic Physician's Assistant shall be responsible for the accurate recording and reporting of any facts, including evaluation and treatment of the whole care of the patient.
4. The Certified Orthopaedic Physician's Assistant may assist with patient education involving the whole patient care and plan of treatment.
5. The Certified Orthopaedic Physician's Assistant may assist with application and execution of orthopaedic procedures and services and execute the legal orders of the supervising orthopaedic physician concerning the whole care of the patient.
6. Follow-up care and services may be rendered by the Certified Orthopaedic Physician's Assistant commensurate with education and experience. All entries into the patient chart must be reviewed and signed by the supervising physician.
7. The Certified Orthopaedic Physician's Assistant may perform the following duties after proficiency has been demonstrated and in accordance with established policies and procedures.
1. In the event of an emergency situation, administration of all recognized first aid procedures.
2. Performance of History and Physical Assessment.
3. Aspirations and Injections.
4. Application and removal of all types of traction, casts, splints, and other immobilization devices and equipment.
5. Assist with and perform digital blocks, hematoma blocks and the use of local anesthetics.
6. Assist with the reduction of fractures and dislocations.
7. Assist with and perform the removal or excision of superficial orthopedic hardware.
8. The Certified Orthopaedic Physician's Assistant may perform the following pre-operative duties:
1. Pre-admission patient evaluation and work-up, including history and physical assessment, patient education, and the institution of routine orders, all of which are to be reviewed by the supervising physician.
2. Institute admission, in-house, transfer and discharge orders, all of which are to be reviewed by the supervising physician.
3. Evaluation of patient status by:
1. Routine daily rounds.
2. Evaluation of laboratory parameters, radiological and other diagnostic studies.
3. Progress Notes.
4. Routine Orders.
9. The Certified Orthopaedic Physician's Assistant may perform the following intra-operative duties in accordance with established policies and guidelines:
1. Assist in setting orthopaedic instrumentation and equipment.
2. Assist with patient preparation to include draping and positioning.
3. First and second assist with all procedures to include tissue retraction, suturing of tissues, cutting of suture, closing of the operative case, and application of any appropriate appliance.
10. The Certified Orthopedic Physician's Assistant may perform the following post-operative duties:
1. Removal of sutures.
2. Application of casts, splints, traction, and other orthopaedic devices and equipment.
3. Cast and splint changes, dressing changes with routine wound care as necessary.
4. Institute and execute routine post-operative orders of the supervising physician.
5. Chart progresses and other notes as necessary.
6. Dictate noted and discharge summaries

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

The certified Orthopaedic Physician's Assistant is a professional physician extender who works solely with and in the field of orthopedic medicine. To be called an Orthopaedic Physician's Assistant, this individual must have passed the certification examination and/or attended a program for Orthopaedic Physician's Assistants. The orthopaedic physician's assistant now comes from a variety of mid-level and entry-level health fields. In a study commissioned by the American Society of Orthopaedic Physician's Assistants in 1996, it was found that most OPA-Cs have at least a bachelor's degree or higher and at least 5 years experience in health care. The most common entry or cross-training fields were: orthopedic nurse, paramedic, orthopedic technologist, military corpsmen/corpswomen, particularly those that were trained in orthopaedics in the service.

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

Currently most OPA practices are governed by the medical staff and credentials committees of the hospitals where they perform many of their duties. 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.

The Physician's Assitant (PA-C):

Physician's Assistants (PA-C) are professional physician extenders who have been trained in "Primary Care Medicine." This area includes: Family Medicine, Internal Medicine, Pediatrics, and Obstetrics and Gynecology. The average length of the PA curriculum is 108 weeks 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 and an additional 6-week elective or smaller length electives that total 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.

The PA-C is trained to function in a pseudoindependent role in the health care community to allow for the extension of physician services to rural and under-served areas in each state. This concept was brought about by a perceived physician shortage that was to occur in the late 1970s and 1980s. The plan for better health care access was a good one but it has not completely come to fruition. Many PA-Cs were and still are not desirous of practicing in rural or under-served areas. This has caused them to seek employment in areas of higher density population bases. Many managed care groups have now determined that utilization of PA-Cs as mid-level practitioners in primary medicine can help to reduce expenditures and have begun to give these programs strong support as a means to keep payments to physicians low. Currently there are only 7-12% of the PA graduates practicing in surgical subspecialties, with less than 4% in the field of Orthopaedic Medicine.

The Distinctions:

Despite the similarity in titles, Physician's Assistants are not Orthopaedic Physician's Assistants. PA-Cs are trained in primary medicine with the option of a 6-week or less training in orthopedics if they choose. They are certified by the NCCPA with an examination for generalist physician extenders. The NCCPA currently does not offer any type of specialty training examinations. There is currently only one post-graduate training program in the United States for PA-Cs in Orthopaedic Medicine.

The OPA-C is trained in the basic medical and behavioral sciences, however very little time is spent in Family Medicine or other "primary care" areas to allow for specialized training in Orthopaedic Medicine. This allows a greater degree of training in the areas of surgery, fracture care, immobilization techniques, radiological interpretation, orthopedic conditions and treatment, and pharmacology. The individual is then eligible to take the NBCOPA exam if they meet all of the prerequisite criteria. Passing the National Board of Certification for Orthopedic Physician's Assistants Examination demonstrates that this individual has achieved a specified level of competence in Orthopaedic Medicine. The OPA-C is uniquely suited to practice within the area of orthopaedics just as the PA-C is suited to practice in primary care. Being one or the other of these individuals does not mean that either is directly suited for cross-over.