Physician Assistant: A Fast Track to Practicing Medicine

A female PA-C specializing in internal medicine hepatology making her daily rounds.

Being a physician assistant (PA) is one of the better career choices for people who are unable or unwilling to make the commitment in time and expense to become a physician. PAs practice medicine under the supervision of licensed D.O.s or M.D.s, providing various health services that until the late 20th century were exclusively the province of a physician. In 1970, there were fewer than 100 PAs; today that figure has increased nearly 1000 times!

Ultimately, the PA enables a competent extension of the functionality of a physician at a considerably decreased expense. The potential to become specialized in different areas such as cardiology, orthopedics or a primary care subspecialty offers a large degree of options to those interested in pursuing this field.

The PA: Created to Fill The Primary Care Void

In the 1960s, breakthroughs in immunology, including the introduction of vaccines for mumps, rubella and measles, as well as major developments in diagnostic and surgical procedures, enabled the treatment of more people than ever before. Health conditions that offered a poor prognosis could now be treated or even prevented.

During this time, doctors and health officials acknowledged there was a skewed allocation – and in some cases a complete lack – of primary care physicians (PCPs) in the United States. Throughout certain parts of the country, physicians seeking out a means to extend their care, in the face of a PCP shortage (which unfortunately remains a major concern today), established a new occupation to help manage some of the more general health ailments they doctored.

Requiring a reduced amount of schooling and training compared to that of physicians, this profession, born out of pure necessity would involve functioning as high-level assistants to physicians in treating their patient base.

Dr. Stead and Development of the PA Profession

Towards the end of his tenure as Chair of the Department of Medicine at Duke University in 1965, Eugene A. Stead, M.D. assembled the nation’s inaugural PA class (which graduated in 1967, Dr. Stead’s last year as Chair at Duke). He chose members of the U.S. Naval corps who received substantial medical training/experience over the course of their military service, including the Vietnam War, yet outside of the military had no medical job equivalent to which that experience could be formally accepted or transferred. Stead derived the PA program curriculum, to some extent, from his recognition of the accelerated training that physicians received during the Second World War.

Required Education

The preparation that physician assistants go through takes on average a period of 26 months and is generalized, covering a wide range of areas in medicine, with the main emphasis on primary care for every age population from pediatrics to geriatrics. Examples of key coursework in a PA master’s degree curricula include pathology, human anatomy, human physiology, physical diagnosis, and bioethics. A large number of accredited physician assistant programs have clinical training partnerships with med schools.

Primarily available at both public and private 4-year universities and colleges, PA degree programs are also offered at community colleges and through the armed forces. For most schools it’s mandatory that a student hold a bachelor’s degree prior to enrolling in their program; only 39 or so programs do not require a bachelor’s.

Almost all PA programs are on the master’s level with just under 10 still offering a bachelor’s. By 2020 all physician assistant schools will have the master’s in physician assisting degree available.

Following initial licensure by passing the PANCE exam around the time of graduation, as part of continuing education and upholding professional competence, physician assistants are required to recertify their license every ten years thereafter.

Scope of Practice

A PAs ability, aptitude, and in turn, responsibility will grow over the course of his or her career working for a doctor. Research suggests physician assistants, who are capable of providing primary care typically characteristic of a doctor, but at a lower cost, are a vital part of the health care systems of the United States, Canada, United Kingdom and Netherlands.

The physician assistant has a major responsibility in seeing patients to make diagnoses and determining how to most appropriately treat health conditions. PAs operate in close correspondence with physicians, completing the same types of diagnostic and clinical functions previously carried out only by doctors. While PAs are trained to perform many functions that a licensed physician performs, their scope of practice may be limited according to the supervising physician and state law.

These tasks can encompass a broad “A to Z” spectrum of patient care, including:

  • Opening a dialog with patients regarding their health status
  • performing a physical evaluation
  • arranging diagnostic lab assessment(s)
  • explicating the test data
  • determining the appropriate treatment(s)
  • and prescribing treatments, including medications.

In addition, they serve as patient educators by presenting explanations on the patient’s disease/condition, course of treatment implemented, and methods of averting or abating sickness for future’s sake. This level and range of care enables the medical group to care for a larger volume of patients and for the M.D. or D.O. to dedicate additional time to more complex medical cases, while the PA deals with the commonplace or routine disorders.

PA Perk: A Certain Degree of Autonomy

While PAs must work under the supervision of a physician, they are able to practice with some degree of autonomy – meaning their job does not always involve “direct” supervision. For example, a PA assigned to a non-urban, outlying location or any other geographical area where physicians are in short supply, may see the physician only once or twice a week with most communication occurring via phone or electronically, as needed or as required by local legislation. This remote PA placement provides an improved reach and range of medical care that can be delivered in rural or remote areas.

Growth and Specialty Distribution

Although the original objective of PAs placed an emphasis on primary care medicine, doctors who specialized also saw them as valuable to their practices, and consequently their utility has been extended over the years.

Based on data provided by the American Academy of Physicians in 2013, approximately 32 percent work in primary care specialties, with the following breakdown:

  • Family medicine (23 percent)
  • General internal medicine (5 percent)
  • Obstetrics/gynecology (2 percent)
  • General pediatrics (2 percent)

At 27 percent, surgical subspecialties represent the second highest distribution of clinical PAs – 10 percent of which are in orthopedic surgery. The remaining 40 percent can be found practicing within the numerous specialties and subspecialties of medicine. In the beginning, as in physician practice, there were a much higher number of men than women in the PA profession. Over time, the proportion has shifted significantly. Now, roughly 67 percent of PAs are female.

* Above distribution data taken from the AAPA’s 2013 Survey Report.

In the past couple of decades, with the PA occupation having gained exposure via press and word-of-mouth as a fulfilling, relatively high return-on-investment career, the profession has been quickly expanding. The number of ARC-PA accredited PA programs has climbed from 55 the mid-90s to almost 200 in 2015.

Currently, there are about 92,000 PAs practicing all across America.

Infograph: Physician Assistant Profile

PA-C infograph