Military Officer - January 2008 - (Page 54) askthedoctor Teamwork Working with doctors and independently, nurse practitioners and physician assistants are two essential components of a medical care team. By Rear Adm. Joyce Johnson, D.O. N Bringing Military Skills to Civilians ■ The first physician as- sistants were corpsmen and medics who served in the Vietnam War; their curriculum was based on the training offered to military doctors in World War II. urse practitioners (NPs) and physician assistants (PAs) make significant contributions to our nation’s health. They are probably best known for their work in primary care, but their areas of responsibility have expanded to include almost every specialty. NPs and PAs provide a complete range of primary care, including preventive, diagnostic, and treatment services. They can order and interpret laboratory tests and X-rays and write prescriptions for medications. They also perform many procedures such as removing warts and suturing minor wounds. NPs and PAs manage patients with heart disease, lung problems, and gastrointestinal symptoms; they see newborns, infants, and children as well as elderly patients, including those in nursing homes. In most office settings, it is difficult to tell an NP or a PA from a physician — if there even is an on-site physician in the office; many NPs and PAs practice in satellite clinics, and some NPs practice independently. PAs evolved from the hospital corpsmen and medics of the Vietnam War. The accomplishments of these corpsmen were well-recognized, but despite a shortage of primary care physicians, there was no civilian profession that readily could use corpsmen’s skills. In 1965, to fill this void, Duke University developed the first PA program. Today most PA training programs offer a master’s degree that includes two to three years of classroom and clinical experience. More than 60,000 PAs are in practice nationwide — about half in medical offices, nearly half in hospitals, and a few in public health, nursing home, and other settings. PAs practice in both primary care and a range of specialties under the supervision of a physician — though the supervising physician often might be off-site. NPs came into being because many nurses (often those who had many years of experience working with physicians in general practice offices) wanted expanded roles and more clinical responsibility. The first NP training program began in 1965 at the University of Colorado, with a family and prevention focus. NPs are RNs, and today most NP degree programs offer a master’s. There are about 100,000 NPs in the U.S., practicing independently or with a physician. About 40 percent are family NPs and 10 percent are pediatric NPs. Two-thirds work in a primary care setting, while others practice in a range of specialty areas. Additionally, there are specially trained nurse-midwives and nurse anesthetists. MO — Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. James Calderwood Jr. (contributor) attends the University of Pennsylvania’s Nursing and Wharton Schools. Find more health and wellness resources at www.moaa.org/wellness. For submission information, see page 20. PHOTO: STEVE BARRETT 54 MILITARY OFFICER JANUARY 2008 http://www.moaa.org/wellness
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