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Professional Practice

~6% of blueprint

A cross-cutting NCCPA content area — not an organ system. These four pillars mirror how didactic year actually teaches it. Scannable, high-yield, and exam-focused.

Medical Ethics
The Big Four principles and how to apply them at the bedside.

The Big Four Principles

  • Autonomy: The patient's right to make informed decisions about their own care — including the right to refuse treatment.
  • Beneficence: Act in the patient's best interest; promote their wellbeing.
  • Nonmaleficence: "First, do no harm" — weigh the risks of an intervention against its benefits.
  • Justice: Fair, equitable distribution of healthcare resources; treat similar patients alike.

Capacity & Consent

  • Capacity vs. competence: Capacity is a clinical, decision-specific judgment (understand, appreciate, reason, communicate a choice). Competence is a global legal determination made by a court.
  • Surrogate decision-making: When a patient lacks capacity: follow advance directives / healthcare proxy → substituted judgment → best-interest standard.
  • Minors: Generally require parental consent. Exceptions (state-dependent): emancipated minors, the Mature Minor Doctrine (an older adolescent judged capable of consenting on their own), and care for STIs, contraception, pregnancy, substance use, and mental health.
  • Implied consent: In an emergency with an incapacitated patient and no available surrogate, consent to perform life-saving care is legally implied.
High-Yield Pearl

A patient WITH decision-making capacity may refuse any treatment — even life-saving treatment. Autonomy trumps beneficence.

Legal & Regulatory
Privacy, consent, mandated reporting, and malpractice essentials.

Confidentiality

  • HIPAA: Protects identifiable health information (PHI). Disclosure WITHOUT patient authorization is permitted for Treatment, Payment, and Operations (TPO).
  • Duty to warn / protect (Tarasoff): State laws vary on whether it is a mandate or a permission, but the general standard lets a provider breach confidentiality to protect an identifiable third party from a patient's imminent, credible threat of physical harm.

Mandated Reporting & Consent

  • Mandated reporting: Suspected child / elder / dependent-adult abuse and specified communicable diseases must be reported. Triggered by reasonable suspicion — not proof — and good-faith reporters have legal immunity.
  • Informed consent: Disclose the diagnosis, the proposed intervention, its risks and benefits, and the alternatives (including no treatment). Exceptions: true emergencies, patient waiver, therapeutic privilege.

Liability

  • Negligence — the 4 D's: Duty, Dereliction (breach of the standard of care), Direct causation, and Damages — all four are required.
  • EMTALA: Medicare-participating emergency departments must provide a medical screening exam and stabilize an emergency condition regardless of ability to pay.
High-Yield Pearl

Mandated reporting is triggered by reasonable suspicion, not certainty — and good-faith reports are legally protected.

PA Profession & Scope
Licensure, certification, scope of practice, and the basics of billing.

Licensure vs. Certification

  • License: Granted by the STATE medical/PA board — the legal authority to practice in that state.
  • Certification (PA-C): Granted by the NCCPA via the PANCE — the national credential. Maintained with CME, logging, and PANRE.
  • Maintenance: NCCPA: 100 CME every 2 years (≥50 Category 1) plus PANRE on a 10-year cycle. State license renewal is separate.

Scope & Prescribing

  • Scope of practice: Defined by state law plus the practice agreement; PAs practice in collaboration with / under supervision of a physician (supervisory, collaborative, or Optimal Team Practice models).
  • Prescriptive authority: PAs may prescribe, including controlled substances, with a DEA registration; specifics vary by state. Schedule II authority (e.g., oxycodone, ADHD stimulants) is especially state-variable — often carrying day-supply caps or co-signature rules.

Billing Basics

  • ICD-10 vs. CPT: ICD-10 codes the diagnosis (the why); CPT codes the procedure/service performed (the what).
  • "Incident-to" billing: PA services normally reimburse at 85% of the physician fee schedule under Medicare. "Incident-to" billing allows 100% (billed under the physician's NPI) only if the physician is physically on-site, established the care plan via the initial evaluation, and the visit is for an established patient/problem — not a new complaint.
High-Yield Pearl

License ≠ certification: the STATE board lets you practice; the NCCPA (via the PANCE) makes you a "PA-C."

Biostatistics & EBM
Evidence hierarchy, test characteristics, and study design — the tricky stuff.

Levels of Evidence (strongest → weakest)

  • Meta-analysis / systematic review of RCTs → RCT → cohort → case-control → case series/report → expert opinion.

Test Characteristics

  • SnNOUT: A highly SENSITIVE test, when NEGATIVE, rules a disease OUT (few false negatives).
  • SpPIN: A highly SPECIFIC test, when POSITIVE, rules a disease IN (few false positives).
  • Predictive values: PPV and NPV depend on prevalence: as prevalence rises, PPV rises and NPV falls. Sensitivity and specificity are intrinsic to the test and do NOT change with prevalence.

Study Designs & Risk Measures

  • Cohort: Follows exposure → outcome; yields Relative Risk (RR). Prospective or retrospective.
  • Case-control: Works backward from outcome → exposure; yields an Odds Ratio (OR). Best for rare diseases.
  • NNT: Number Needed to Treat = 1 / Absolute Risk Reduction, where ARR = control event rate − experimental event rate. On exams, always round any decimal UP to the next whole integer (e.g., 7.2 → 8) — you cannot treat a partial patient.
High-Yield Pearl

Sensitivity and specificity stay constant; predictive values shift with prevalence. Remember SnNOUT / SpPIN.