PA Medicine Education

Clinical preceptors allow PA students into their practice’s and spend time educating them on the proper way to diagnose and treat patients in their specific area of expertise. Preceptors can include licensed PAs, physicians, NPs or midwives.

Preceptors are role models and teachers that help students to improve their skills in history taking, patient examinations, diagnostic assessments, treatment, performing key clinical procedures, demonstrate collaborative approach to health care delivery, preventative medicine and patient education.

Being a preceptor can be very rewarding. The main reward derived from precepting is knowing that you are shaping future PAs to be competent health care providers. Students give back to the preceptors in the form of up-to-date medical knowledge to their clinical training site, which can enhance the preceptors’ educational base. PA students bring an energy and enthusiasm to a clinical site that could lead to possible employment.

There are perks to being a preceptor to PA students:

• A great way to give back to and promote your profession
• PA programs could give you access to medical libraries or award preceptors adjunct faculty status
• As a preceptor, you can earn Cat I CME credit for precepting, if the PA program is a CME provider through AAPA, or you can obtain Cat II CME credit on an hourly basis and this does not require documentation

If you are interested in becoming a preceptor, please contact one of the program directors at Michigan's PA programs.

For more information on precepting and obtaining CME for precepting, please visit www.aapa.org.

This section contains information for PA students who are near graduation or recent graduates. The contents will help guide you through the steps you will need to prepare for your certifying exam and help transition you from PA school to begin practicing medicine as a new PA.

To obtain a license to practice medicine as a PA in Michigan, you must FIRST - graduate from an accredited PA program and SECOND - have a passing score on the Physician Assistant National Certifying Examination (PANCE). The PANCE is given by the National Commission on the Certification of Physician Assistants (NCCPA). The NCCPA is the only nationally recognized certifying body for PAs in the U.S. dedicated to assuring the public that certified PAs meet professional standards of knowledge and skills. You can register for the PANCE and apply for a temporary/permanent Michigan PA license prior to graduation.

PANCE Registration

You will need to visit the website for NCCPA at www.nccpa.net to register for the exam.

The earliest you can register for the exam is 90 days prior to your expected PA program completion date and the earliest you can sit for the exam is seven days after your program completion. You will have 180 days from the beginning of your exam time frame to take the exam. There is a blackout testing period at years’ end, typically December 19 - January 1.

The exam fee is $475 which will need to be paid at the time of registration. Under the Certification Information Release, you will need to give permission to release your exam score to the State of Michigan for licensing. The address for the Michigan PA Task Force to submit your score is:

Michigan Department of Licensing and Regulatory Affairs
Bureau of Health Care Services
Task Force on Physician’s Assistants
PO Box 30670
Lansing, MI 48909

NCCPA will send you a scheduling number, which is used to schedule the exam location and date. You will be directed to the Pearson VUE Testing Centers website for a testing site closest to you to take the exam. 

PANCE Exam Information

There are 5 blocks of 60 questions (300 total exam questions) with 5 hours to complete. The questions cover Knowledge & Skills Areas and Diseases, Disorders & Medical Assessments of body systems. View the PANCE Content Blueprint.

PANCE Preparation/Review Resources

Appleton & Lange Review; Step Up to Medicine

NCCPA Practice Exams ($50 each)

Formal Review courses

NCCPA Content Blueprint Task and Organ Areas

Davis PANCE review

ROSH

HIPPOED.com (discounted through AAPA)

PANCE Exam Results

Graduates usually receive NCCPA PANCE scores within two weeks of their exam date. Please refer to the NCCPA website if you do not pass the PANCE for remediation rules.

Licensing (Temporary and Permanent)

You cannot practice medicine in Michigan as a PA unless you have a license. There are two types of licenses - temporary and permanent. A temporary license lets you work as a PA until your PANCE scores are available and until your permanent license is granted. If you fail the PANCE, your temporary license is revoked; a temporary license is valid for not more than 18 months. You will be issued a permanent license number for practicing as a PA in Michigan after you pass the PANCE and this license is good for use within the state borders. If you plan to practice in a state other than Michigan, you will need to contact that state for their processes and procedures.

Application

Licensing of health professionals (including Physician Assistants) in Michigan is overseen by the Licensing and Regulatory Affairs (LARA) department. Click here and follow the cues to apply for your license.

The application will need to be completed along with fees for either/both a temporary/permanent license ($35 temporary /$90 permanent or $125 for both).

There is also a fingerprint submission and a criminal background check.

You will need NCCPA to send your exam results directly to the Task Force office listed above.

Your official transcript from your PA program is needed for the application.

It can take several weeks for a temporary license to be granted and 30-90 days for a permanent license to be processed. It is recommended that you apply for both a temporary and permanent license at the same time, so that you can begin and continue practicing without a delay. 

A permanent license is good for two (2) years from date of application; renewal fees are $110/2 years.

National Provider Identifier (NPI)

The NPI is a Health Insurance Portability and Accountability Act (HIPPA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. It is issued by the Centers for Medicare and Medicaid Services (CMS) and once assigned; a provider’s NPI number is permanent and remains with the provider, regardless of job or location changes. The unique 10-digit NPI number is portable, is used to help bill for the services you provide and is free to obtain. You should apply for your NPI number once you have a PA license and a practice location.

To apply for your unique NPI number, visit www.nppes.cms.hhs.gov and follow the directions. It can take up to three weeks for you to receive your NPI number, but likely only 1-3 days. 

Practice Agreement

Previously, Michigan PAs had to work with a supervising physician and have delegated duties. This meant that they also had to have a Supervision/Delegation Agreement as pursuant to the Public Health Code. This is no longer the case and with the passage of the Michigan law PA 379, this Supervision/Delegation Agreement has been replaced with a Practice Agreement. This new Practice Agreement gives direction and a working relationship between a PA and a participating physician. Click here to download a sample Practice Agreement.

Drug Enforcement Administration (DEA) Registration

A DEA registration is a two-letter seven-digit unique identifier that is assigned to a health care provider by the U.S. Drug Enforcement Administration, allowing that person to write prescriptions for controlled substances. It is a federal (not state) requirement that you must have a DEA registration to prescribe controlled substances.

You must have your permanent Michigan PA License to apply for a DEA registration.

For new applicants visit www.deadiversion.usdoj.gov and you can apply on-line using Form 224, which includes mid-level practitioners (PAs). The DEA field office for Michigan is located in Detroit. New applications take about 4-6 weeks to process. Of note: on the electronic application form, it asks for your ‘State Controlled Substance License Number’- leave this and the date ‘BLANK’; despite the warning about a delay that will pop up; Michigan PAs are now allowed to have a Controlled Substance License (CSL) and can be applied for, but you need to have a DEA registration first.

The fee for a DEA registration is $731 and is due at the time of application via credit card; this DEA registration is good for three (3) years and it is portable within the state of Michigan.  A CSL can be obtained after a DEA registration is granted. Your CSL is renewed at the same time as your Michigan PA License. A PA's DEA registration used in Michigan will allow you to write prescriptions for Schedule 2, 2N, 3, 3N, 4 and 5 controlled substances. Michigan PAs cannot prescribe Schedule 1 substances.

Michigan Rules for Writing a Controlled Substance Prescription

The state of Michigan statute states that a prescription written by a PA for controlled substances must contain the name of the delegating physician, the physician’s DEA number and the mid-level practitioner’s name and DEA number. The Michigan Board of Pharmacy Administrative Rule §338.3161 requires that a prescription issued for a controlled substance shall include the prescriber’s DEA registration number, prescriber’s printed name, medical address and prescriber’s professional designation. Therefore, it is best to have yours and your physician’s printed name, professional designation and DEA number(s), along with your practice address on the controlled substance prescription; plus, the number of pills being dispensed should have both the numeric amount and the written amount included on the prescription- to avoid alteration of the prescribed amount of pills.

Controlled Substance License (CSL)

With the passage of the Michigan law PA 379, the "delegating of prescribing controlled substances for PAs" is no longer necessary and neither is the previous form for this process. Michigan PAs are now described as "independent prescribers within a practice agreement." This allows Michigan PAs to obtain a Controlled Substance License (CSL) and prescribe Schedule II - V controlled substances independent of a physician.

If a Michigan PA will be prescribing Schedule II - V controlled substances, the PA must have their own state of Michigan CSL, along with a DEA registration. A CSL will expire on the same date as your Michigan PA License; the fee for a CSL is $161.60 for 13-24 months.  Click here for a link to the CSL application.

Finding a Job as a PA

To find a job as a PA, you need to prepare a Professional Portfolio that highlights your accomplishments and has supporting material, such as references. The old adage of: “You can never make a second first impression” is still true today. Putting your best foot forward on introductory paperwork or on an interview is important. Forbes recently noted that the PA profession is the best master’s degree for the money, with the best employment outlook for years to come. There are plenty of job opportunities available for PAs, whether as a generalist, in a specialty or even in a sub-specialty.

Expectations

New PA graduates (0 – 2 years out) nationally and across all areas and specialties earn between $80,000 and $84,200/year; this range can be higher with bonus pay.

New PA graduates who find a job in Michigan (not adding in bonus pay) can expect to have an average salary of $83,000-$87,000/year. 

All jobs have expenses that the new PA will incur and incentives that will make the position more appealing.  Whether you are in a private practice or employed in a health system, one of the key incentives to secure is a healthy CME budget. The CME budget will allow you to attend conferences and draw from this allotment to offset costs to you. More hospitals and some practices are requiring PAs to use their CME budget for more than just conference expenses. You may have to use your CME budget for licensing fees and membership dues. So you should find out what this budgeted amount is and test the waters for increasing this amount.

Job Search

There are multiple avenues for new PA graduates to use to find a position that is right for them. You will find that some times while on a particular rotation, you made a lasting impression on someone and they are now interested in you. Other times, just asking a preceptor or lead physician can garner a positive outcome prior to you finishing a rotation or your clinical year. These contacts are very valuable, because they are asking about you and not the opposite. MAPA's Job Central is a great resource for MI PA openings.

Accepting a Position

Many steps are involved when you accept a position as a PA; they differ from a private practice to a hospital/health system. Below is a brief summary of items you should review with your potential employer prior to accepting a position.

• Private Practice
  • Contract negotiation and review- you may want a lawyer to review

  • Delegation Agreement and Controlled Substances Prescribing Delegation paperwork

  • Malpractice Insurance and Disability Insurance

  • Benefits review and retirement planning

  • Reimbursement for job related expenses

  • Profit Sharing, percentage of fees billed

  • Apply for privileges/credentialing if you will be rounding at a hospital

• Hospital/Health System

  • Delegation Agreement and Controlled Substances Prescribing Delegation paperwork

  • Malpractice Insurance and Disability Insurance

  • Benefits review and retirement planning

  • Reimbursement for job related expenses

  • Apply for privileges/credentialing (this can take up to 3 months for approval)

The Cost of Education
As you have likely come to find out, PA education is expensive and you will most undoubtedly end up with student loans that can be sizable.  A recent survey performed by AAPA revealed that nationally, the average debt incurred by a PA student at the end of their studies is $105,400.  Costs accrue from tuition, books and supplies, travel and lodging for rotations and exams.

Options
After graduation, you may have a six month grace period before the start of monthly payments on your student loan(s).  Depending on the overall loan amount, the payments can be sizeable and last for many years after graduation.  There are several avenues through which a PA program graduate can refinance their student loan(s) or work to have the loan(s) repaid.

Work to repay loan(s):

MSLRP- One program is called the Michigan State Loan Repayment Program (MSLRP) and is under the umbrella of the Michigan Department of Health and Human Services (MDHHS).  This program assists employers in the recruitment and retention of health care providers who commit to building long-term primary care practices in underserved communities designated as Health Professional Shortage Areas (HPSA’s).  MSLRP will assist selected individuals by providing up to $200,000 in tax-free funds to repay their educational debt over a period of up to eight years.

 Graduating PA students can apply during the open application period from Jan 1 thru April 30; once they have an employment agreement to start work no later than Oct 1 of that year.  The MSLRP application process is competitive.  To gain more information and requirements needed to apply and receive their assistance visit the website at: www.michigan.gov/mdhhs/0,5885,7-339-71551_2945_40012-135399--,00.html