This Scope of Practice is specific to the duties and responsibilities of he/she who is; authorized to practice with a defined level of autonomy (see defined Levels of Autonomy below) and to exercise independent medical decision making within his/her scope of practice while in collaboration with a physician.

Duties

Full Autonomy(FA) is appropriate for an experienced PA in primary care, other outpatient, or inpatient settings where sufficient clinical competence has been demonstrated in carrying out assigned patient care responsibilities. This level may also be used when the PA performs lower: risk outpatient therapeutic and diagnostic procedures common to the area of the PA's practice. The PA at this level practices with a high level of autonomy on a day-to-day basis and requires infrequent consultation with the collaborating physician. When consultation with the physician does occur, it must be documented in the patient record by the PA. The physical presence of the collaborating physician at the site of PA practice is not required. The collaborating physician's oversight responsibilities for this level of PA practice include periodic monitoring of the PA's clinical activities through retrospective review of patient charts, regular communication with the PA, and reviewing reports from the PA OPPE committee to ensure the presence of ongoing competency and medical appropriateness. In addition, the collaborating physician and PA will be in contact at least weekly to discuss any difficult or unusual clinical management issues. The PA will notify the collaborating physician of any significant change in an inpatient's condition. The collaborating physician will concur with continuing this level of autonomy or recommend changes when the PA's Scope of Practice is renewed or interim changes are requested. This level of autonomy is appropriate for the majority of PA practice settings (e.g. inpatient, outpatient, Community Based out patient Clinics {CBOC), Community Living Centers {CLC), Long Term Care, Home Based Primary Care (HBPC), Telemedicine, or remote sites). Limited Autonomy (For Newly Appointed PA's)(LANA) is to be used for newly appointed entry level PAs until such time as the collaborating physician can determine that the PA is sufficiently competent to function with lesser degree of oversight. PAs functioning at this level require more frequent oversight, consultation, and assistance from the collaborating physician. The collaborating physician's oversight responsibilities for this level include initial close monitoring by a review of at least five randomly selected patient encounter notes per week and daily contact to discuss patient management issues. The collaborating physician for a PA at this level should be available for frequent consultations with the goal of a graduated progression towards less frequent oversight and greater autonomy. This level of autonomy may be used for a PA who is currently learning a new procedure and is undergoing proctoring. Limited Autonomy (For Higher Risk Patient Care) (LAHR) is appropriate for PAs authorized to perform higher risk procedures in critical care areas or in highly specialized areas. Examples of PA activities appropriate for this level of autonomy include, but are not limited to, performing procedures or providing patient care in endoscopy, general radiology or intensive care areas. A designated physician with appropriate clinical privileges must be in close proximity to the site of care and be able to intervene or assist the PA in a short period of time should significant complications or medical emergencies arise. PAs authorized to! perform procedures or provide inpatient - care described above have demonstrated clinical competence las well as procedural technical proficiency. The collaborating physician's oversight responsibilities for this level include a review of at least five randomly selected patient progress or procedure notes per week and daily contact with the PA to discuss patient management issues. Other monitoring methods used may include direct observation, review of procedure logs, and review of FPPE, OPPE, and other evaluative data. Supervised Autonomy{SA) requires that a collaborating physician with appropriate clinical privileges to perform a procedure be in immediate proximity (in the same room) to the procedure being performed by the PA and is able to intervene immediately if necessary. Examples of PA activities at this level include assisting in high risk operative procedures performed by a physician led team, assisting in procedures performed by an interventional radiology specialist or when a PA is undergoing training for specialized procedures. Work Schedule: 0700-1730, or depending on service needs. Financial Disclosure Report: Not required

Requirements

Qualifications

Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Physician Assistant Basic Requirements Master's degree in any discipline or a bachelor's degree in any discipline with one year of experience as a Physician Assistant ~AND~ Successfully passed the PA National Certifying Exam (PANCE) (or are you in the process to taking the exam) ~AND~ Currently hold, or will hold, a full and unrestricted license to practice in a State, Territory, or Commonwealth of the United States or in the District of Columbia. Preferred Experience: 1 year as a PA Grade Determinations: Physician Assistant-II. a. Experience and Education. The PA at this grade is at the intermediate grade level and has had progressively increasing responsibility and experiences as indicated in the KSAs listed below. Individuals will have demonstrated the ability to analyze and solve more complex medical problems than at the entry level grade and can utilize their training in the successful practice of patient care and participate in team problem solving. Individuals demonstrate the KSAs of PA-II intermediate level by: Two years of successful practice as a PA; OR Successful completion of a PA post-graduate residency program sponsored by VHA Office of Academic Affiliations or other postgraduate residency programs accredited by VA, ARC-PA, U.S. Armed Forces, or another accrediting agency; OR A doctoral degree in a health-related field from an accredited college or university recognized by the U.S. Department of Education b. Demonstrated Knowledge, Skills, and Abilities (KSAs). PAs at this level are not required to meet each individual KSA listed below to qualify, but should be able to demonstrate, develop, or acquire those not met upon appointment for PA-II: Skills to analyze and solve complex medical problems. Ability to function autonomously and make independent medical decisions. Skill to incorporate training and experience into the successful practice of patient care including telehealth medical care. Ability to work effectively in an interdisciplinary environment for improvement of services for patient care. Ability to practice with colleagues and peers collaboratively. Physician Assistant III & IV. Grade IV is at full performance level. a. Experience and Education. PAs at the PA-III grade will lead and organize patient care independently, practice within multi-disciplinary teams, and coordinate all aspects of patient care across the health care system. They utilize advanced clinical knowledge and judgment in decision-making and evaluating outcomes. They function as experts in clinical practice and/or in areas related to the assigned roles and responsibilities, may serve as mentors for transitioning PAs, and may provide training for health care students. Individuals can demonstrate the KSAs for the full performance level by: Three years of successful practice as a PA; AND Four years for Physician Assistant IV. Successful completion of a PA post-graduate residency program sponsored by VHA Office of Academic Affiliations or other postgraduate residency programs accredited by VA, ARC-PA, U.S. Armed Forces, or another accrediting agency and one year of professional practice as a PA; OR A doctoral degree in a health-related field from an accredited college or university recognized by the U.S. Department of Education and one year of professional practice as a PA. (b) Demonstrated Knowledge, Skills, and Abilities. PAs at this level are not required to meet each individual KSA listed below to qualify, but should be able to demonstrate, develop, or acquire those not met upon appointment for PA-III & PA-IV: Ability to clinically evaluate facility patient care delivery systems and validate or identify barriers to safe and effective patient care. Skill to consistently demonstrate an elevated level of expertise and autonomy in diagnosing and treating seriously ill, multi-symptomatic patients through facility Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE). Ability to present clinical findings and recommendations to appropriate management officials. Ability to clinically facilitate the delivery of patient care in collaboration with health professionals, health managers, and other health care personnel. Ability to implement and initiate clinical changes to established treatment protocols based upon new medical literature research findings to enhance patient delivery care for improved patient outcomes. Ability to participate clinically in the development of the PA patient care audit processes involving in-depth review and analysis of medical records. References: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-8 Physician Assistant Qualification Standard. This can be found in the local Human Resources Office. The full performance level of this vacancy is 4. The actual grade at which an applicant may be selected for this vacancy is in the range of 2 to 4. Physical Requirements: Heavy lifting (45 lbs and over); Heavy carrying (45 lbs and over): Straight pulling and pushing; reaching above shoulder; use of fingers; both hands required; walking and standing up to 8 hours; repeated bending; Ability for rapid mental and muscular coordination simultaneously; hearing aid permitted.

Education

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address Jerry L Pettis Memorial Veterans Hospital 11201 Benton Street Loma Linda, CA 92357 US
• Name: Robin Sandoval
• Phone: (909) 583-6138
• Email: [email protected]