What Is a Physician Assistant?
A physician's assistant (PA) is an integral part of healthcare service. Working with a supervising physician, the PA plays a key role in offices, hospitals, and care facilities across the country. While medical assistants complete routine administrative, clinical, and clerical duties, physician assistants undertake formal training to provide a comprehensive range of clinical services.
With the support of the delegating physician, PAs provide preventative healthcare as well as therapeutic and diagnostic services. Physician assistants take medical histories and update charts. They conduct physical examinations of patients and treat them. They order and interpret diagnostic tests so they can diagnose patients and initiate therapy. A PA also treats minor injuries such as sprains, lacerations, or simple fractures.
Conferring with physicians and nurses on treatment plans, physician assistants develop and implement programs of treatment and they advise patients on prevention and therapy. They are also expected to oversee medical emergencies that may arise during their work. In all but three states, physician assistants may prescribe medication to patients.
In addition, a PA may do inventory and order supplies for an office, hospital, or laboratory; many also supervise medical assistants and lab technicians. Finally, a physician assistant's job may entail making house calls, visitation to hospitals and nursing home facilities, and being on call.
While the supervising physician defines the role of a physician assistant in the clinical setting, all states have laws governing the range and scope of PA practice. As regulation and legislation vary from one state to another, an aspiring PA should look into the laws specific to the state in which s/he hopes to practice.
Physician Assistant Career Education
All states require PAs to complete formal training from an accredited school. Although criteria vary from program to program, most courses for physician assistants take about two years to complete. Most such programs require at least two years of college and some experience in healthcare. Although the school does not always require them, most applicants to PA programs already hold a bachelor's or master's degree.
There are a wide variety of career education programs from which to choose. At last count, according to the American Academy of Physician Assistants, there were 137 accredited programs for PAs in the United States alone. There were 51 programs for earning a Bachelor of Science, six for associate degrees, and over 50 certificate programs. Some programs or schools offer more than one of these options, and several offer dual degree programs.
Most of these educational programs are offered by universities, four-year colleges, medical centers, or academic health centers. Some confer associate or bachelor's degrees; others are specific to physician assisting. The latter can be found in hospitals, community colleges, or the military. Many accredited PA programs team up with medical schools for the clinical part of the curriculum. In preparation for a physician assistant college degree program, students should take biology, chemistry, psychology, English, and courses in the social sciences. Experience in healthcare is a plus, but is not necessarily a prerequisite.
A PA curriculum is generally divided into two categories. Classroom instruction typically includes biochemistry, anatomy, pathology, pharmacology, physiology, and microbiology. Further study is comprised of classes in medical ethics, disease prevention, geriatrics, and home healthcare. In the experiential learning phase of most programs, students receive hands-on clinical training in a variety of areas, such as pediatrics, psychology, emergency care and medicine, obstetrics and gynecology, inpatient care, primary care medicine and surgery.
Online Degrees in Physician Assisting
Because of the hands-on nature of the work, online physician assistant programs are rare, but they do exist primarily at the master's level. Online master's degrees in physician assistant studies are designed for certified PAs who already have the clinical training they need. They offer managerial-level coursework and training in specialized topics such as health education and leadership, family medicine, emergency medical services and forensic medicine.
Dual Degree Programs
Some schools offer dual degree programs that provide an accelerated track through bachelor's and master's-level coursework, culminating in a BS/MSPA. Because the student is starting at a baccalaureate level, GRE scores are not required, although schools may require other standardized test scores, such as the SAT. Most programs ask that students have competed Advanced Biology, General and Organic Chemistry, and a class in Biostatistics.
Types of Physician Assistant Careers
More than half of all clinically practicing PAs work in the private offices of doctors or other healthcare practitioners. Most jobs yield competitive salaries, compensation packages, and excellent benefits; many also offer an allowance for continued education. Generally, working conditions are good, as the medical environment must be clean, well lit, and temperature controlled.
Some specific career paths include:
- Bureau of Prisons Physician Assistant. The physician assistants who work for the Bureau of Prisons are responsible of the diagnosis and care of inmates in the federal prison program. PAs in this environment assist in the observation and evaluation of patients, take medical histories, perform physical examinations, and order lab tests. Because of the broad range of medical issues that may arise in the prison system setting, strong background knowledge is needed, as well as knowledge of appropriate treatment in surgical and medical emergencies. The job requires a bachelor's degree and/or three to four years of clinical experience. Applicants must be NCCPA certified.
- Clinical Advisor. Working as a clinical advisor in a private clinic or family practice often requires considerable medical knowledge combined with excellent communication and computer skills. A clinical advisor must be flexible, capable of working independently with little supervision, and collaborative. In this capacity, a PA, in conjunction with the delegating physician, oversees the management of continuing/long-term medical care and the management of chronic or acute conditions. The clinical advisor analyzes the efficiency and effectiveness of healthcare, assesses medical conditions, and proposes and implements plan revisions.
- Clinical Services Manager. For professionals with the spirit of an entrepreneur, a move into management might be the way to go. Generally employed by private family practices, a clinical services manager will be responsible for directing business and establishing clinical priorities for the healthcare team. Clinical services managers are in charge of hiring as well as recruitment strategies and supervising the work of others. Certified PAs will also need at least two to five years of experience to excel in this area.
- Emergency Room Physician Assistant. Working in the emergency room (ER) requires quick thinking and the ability to multitask. This is a mid-level PA job, assisting the ER physician in a variety of tasks, including taking histories, prioritizing arrivals, offering suggestion, examining patients, and giving and evaluating care. It is fast-paced, exciting work.
- Infection Control. Physician assistants are in high demand in organizations such as the Center for Disease Control and Prevention. These kinds of jobs require mid-level PAs with extensive previous experience. Responsibilities include overseeing infection control and ensuring that the standards of the Occupational Safety and Health Administration (OSHA) are being upheld in a variety of situations. There is generally minimal contact with patients. Consultation takes place with physicians and nursing staff as necessary. The hours are fairly regular compared to those of some other placements within the PA profession.
- Medical Practitioner. A medical practitioner usually works in a hospital setting. Performing physical examinations and triage, a medical practitioner also assumes staff nursing responsibilities as assigned by a supervisor. Treatment recommendations and healthcare plans are coordinated with hospital nursing personnel. Graduation from an accredited baccalaureate program in PA studies is expected, as well as two additional years of clinical experience.
- Military. In recent years, the military has been one of the biggest recruiters of physician assistants. The PA position has been an essential component of the Army Health Care team since its inception in 1973. In today's hierarchy, a PA serves as the primary source of healthcare for his or her unit. Within this capacity, the PA works closely with trainers, physical therapists, nurses, and other support personnel as needed.
- Rural Area Practitioner. This is one of the most rapidly expanding areas of growth for the health services industry. Although PAs generally work under the eye of a supervising physician, in some rural areas, the PA may act as the primary care provider. While federal laws require that a physician be available for consultation, the doctor is not required to be physically present. Consultations may take place by phone, radio, or via computer. The physician may visit the site only one or two days of the week.
These jobs generally require an experienced PA since the physician is often not immediately available. In addition, the PA does a little (or a lot) of everything. A rural PA may make house calls, or rounds, spend several nights a week on call in addition to other duties. A PA serving as a source of primary care for a rural community must be efficient, independent, resilient, and hard-working.
- Surgical Assistant. Jobs as a surgical assistant usually require extensive knowledge of surgical procedure as well as specialization within a specific area of PA studies. Of these, cardiovascular surgery is currently most in demand, although nearly all areas are in need. The Surgical Assistant performs clinical duties, makes rounds, attends to patients both pre-op and post-op, takes patient histories, and makes suggestions and recommendations. The most important role of the PA is to assist the doctor in surgical procedures. A minimum of two to three years of clinical and/or surgical experience is required.
A great many PAs choose to specialize in specific areas of primary care; some focus on general internal medicine, pediatrics, geriatrics, or family medicine. Other areas of specialization include emergency medicine, orthopedics, and general and thoracic surgery. Those physician assistants choosing to specialize in surgical procedures are responsible for care prior to surgery as well as postoperative care. During surgery, physician assistants may act as first or second assistants to the surgeon in charge of the procedure.
Postgraduate residency training programs are available for NCCPA-certified physician assistants who have graduated from an accredited program. These programs offer additional training for those interested in internal medicine, pediatrics, surgery, emergency medicine, neonatology, or rural primary care.
Aside from the usual career choices and opportunities afforded by a degree in physician assistant studies, many PAs use their expertise to help make a difference in the world. Instead of working the usual 40-hour office week, certified PAs can look at opportunities such as those offered by The Physician Assistant Foundation. Part of the AAPA, the PA Foundation is a philanthropic group, sponsoring medical missions to places such as Laos, Thailand, and Central America.
Career Outlook for Physician Assistants
Physician assistants held about 74,800 jobs in 2008, according to the U.S. Bureau of Labor Statistics, although some PAs hold two or more jobs. With the projected expansion of healthcare industries and increased reliance on PAs to hold down costs, employment of physician assistants is expected to grow by 39 percent from 2008 to 2018.
Certification, Licensure and Associations
A new PA is required by law in all 50 states to take and pass the Physician Assistant National Certifying examination, which is given by the National Commission on the Certification of Physician Assistants (NCCPA). Only graduates of accredited programs may take the examination, and only those receiving a passing score may use the credential "Physician Assistant - Certified."
A recertification exam or some other approved program must be completed every six years to maintain certified status. In addition, PAs are required to fulfill up to 100 hours of continuing medical study every two years. These requirements ensure a core capability of medical skills will be maintained by all working PAs.
Physician Assistant Associations and Certification Bodies