Physician Assistants in Nephrology: Training, Pathway, and Scope

Sara KromeSara Krome, PA-C, is with the Durham VA Health Care System, Nephrology, Durham, NC.

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Physician assistants (PAs) have been colleague providers in health care since the late 1960s (1). PAs are trained at accredited PA programs across the country in the “medical” model of instruction, in contrast to nurse practitioners trained by the nursing instruction model (2). Most PA programs offer graduate-level education, with a degree such as Master of Health Science or Master of Physician Assistant Studies. A few programs remain that offer PA degrees or certificates at the baccalaureate level. Most graduate programs are 27 months (3). PAs are not required to and do not routinely complete a post-graduate residency, although there are some 1-year residencies offered in fields such as cardiology, critical care, cardiothoracic surgery, and hematology or oncology (4), although not in nephrology (3). Most PAs are required to be board certified. (An exception is with the Department of Veterans Affairs, in which PAs can be licensed and/or certified.) The certification is offered in internal medicine, general surgery, or family practice. Even PAs in specialty care are required to have certification in one of the above fields to practice.

PA certification lasting 10 years requires passing a certification exam and 100 hours of continuing medical education (CME; at least 50 hours must be category 1) completed every 2 years with an accompanying fee.

For PAs interested in a career in nephrology, they can begin by exploring nephrology in their elective rotations during PA student instruction. Some graduates enter nephrology upon graduation from their PA program; others elect to pursue working for a period of time in an internal medicine field to hone their clinical skills.

After at least 1 year in nephrology practice, the PA can consider pursuing a certificate of expertise in nephrology, called the Certificate of Added Qualifications. This is pursued through the PA-certifying body, the National Commission on Certification of Physician Assistants. Candidates must meet the following requirements: current PA certification, license for unrestricted practice in their state (or unrestricted privileges at a government agency), 2 years’ experience (1 year of which must be nephrology), 75 hours of category 1 nephrology CME (25 hours of which must be obtained 2 years before the exam date), attestation from a colleague, and passing a nephrology specialty exam (5).

PAs in nephrology work in all areas, including inpatient nephrology management and coverage, outpatient clinic general nephrology (chronic kidney disease and transplant), dialysis care, home therapy, and even taking calls. Although PAs are dependent providers, much of their work is autonomous with highly effective relationships with their collaborating physician partners. PAs have prescriptive privileges in all 50 states, and many PAs perform procedures such as line placement (temporary dialysis catheters and central line placements) and percutaneous biopsies (including the kidney) (6).

A career as a nephrology PA is rewarding, and many different models of incorporation exist. As the nephrology workforce continues to expand, and more PAs join nephrology groups, it is important to know the educational pathway of this unique group of health care providers. There is also an important opportunity to develop unique resources to enrich educational opportunities.