What is an OPA-C

This page contains the following information:

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.

The Differences Between OPA-Cs and PA-Cs
This article provides an explanaton of the clear distinctions between orthopaedic physician's assistants and physician's assistants.

The History of the OPA-C
Read about the history of orthopaedic physician's assistants, which began during the Vietnam War.

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.

Anatomy & Physiology

Pharmacology

Assessment and treatment of Adult and Pediatric Orthopaedic Diseases and Injuries

Principals and Techniques of Operative Procedures

Functions and Applications of Instrumentation and Equipment Utilized in Operative Orthopaedic Procedures

Principals and Techniques of Traction, Casting, and Splint Applications

Evaluation and Interpretation of Laboratory, Radiological, and other Diagnostic Studies

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.

The Certified Orthopaedic Physician's Assistant shall function in practice under the supervision of the orthopaedic physician in accordance with established policies and procedures.

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.

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.

The Certified Orthopaedic Physician's Assistant may assist with patient education involving the whole patient care and plan of treatment.

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.

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.

The Certified Orthopaedic Physician's Assistant may perform the following duties after proficiency has been demonstrated and in accordance with established policies and procedures.

In the event of an emergency situation, administration of all recognized first aid procedures.
Performance of History and Physical Assessment.
Aspirations and Injections.
Application and removal of all types of traction, casts, splints, and other immobilization devices and equipment.
Assist with and perform digital blocks, hematoma blocks and the use of local anesthetics.
Assist with the reduction of fractures and dislocations.
Assist with and perform the removal or excision of superficial orthopedic hardware.

The Certified Orthopaedic Physician's Assistant may perform the following pre-operative duties:

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.
Institute admission, in-house, transfer and discharge orders, all of which are to be reviewed by the supervising physician.
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.

The Certified Orthopaedic Physician's Assistant may perform the following intra-operative duties in accordance with established policies and guidelines:

Assist in setting orthopaedic instrumentation and equipment.
Assist with patient preparation to include draping and positioning.
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.

The Certified Orthopedic Physician's Assistant may perform the following post-operative duties:

Removal of sutures.
Application of casts, splints, traction, and other orthopaedic devices and equipment.
Cast and splint changes, dressing changes with routine wound care as necessary.
Institute and execute routine post-operative orders of the supervising physician.
Chart progresses and other notes as necessary.
Dictate noted and discharge summaries.

General Summary:

The Certified Orthopaedic Physician's Assistant (OPA-C) shall function in practice under the authority of the supervising orthopaedic physician. Functions shall include performing skilled services and procedures within the clinical setting, out-patient and in-patient facilities where privileges have been granted accordingly. The Certified Orthopaedic Physician's Assistant may function as a part of the whole patient treatment and management team. Services may be performed by the Certified Orthopaedic Physician's Assistant in primary orthopaedic care, pre-operative care, intra-operative care, and post-operative care for the orthopaedic patient in accordance with established policies and procedures. The Certified Orthopaedic Physician's Assistant reports to the supervising orthopaedic physician the complete patient status and shall notify accordingly of any abnormal findings, problems, or complaints regarding the whole care of the patient.

The Differences Between OPA-Cs and PA-Cs

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.

For more information about OPA-'C's, and the American Society of Orthopedic Physician Assistants. Please visit American Society of Orthopedic Physician Assistants

The History of the OPA-C

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 of 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 Kirkwwod program graduated the last class of program trained OPAs.

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