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Nature of the Work | Working Conditions | Employment | Training, Other Qualifications, and Advancement | Job Outlook | Earnings | Related Occupations | Sources of Additional Information
Physician assistants (PAs) provide health care services with supervision by physicians. They should not be confused with medical assistants, who perform routine clinical and clerical tasks. (Medical assistants are discussed elsewhere in the Handbook.) PAs are formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. Working as members of the health care team, they take medical histories, examine patients, order and interpret laboratory tests and x rays, and make diagnoses. They also treat minor injuries by suturing, splinting, and casting. PAs record progress notes, instruct and counsel patients, and order or carry out therapy. In 46 States and the District of Columbia, physician assistants may prescribe medications. PAs may also have managerial duties. Some order medical and laboratory supplies and equipment and may supervise technicians and assistants.
Physician assistants always work with the supervision of a physician. However, PAs may provide care in rural or inner city clinics where a physician is present for only 1 or 2 days each week, conferring with the supervising physician and other medical professionals as needed or required by law. PAs may also make house calls or go to hospitals and nursing homes to check on patients and report back to the physician.
The duties of physician assistants are determined by the supervising physician and by State law. Aspiring PAs should investigate the laws and regulations in the States where they wish to practice.
Many PAs work in primary care areas such as general internal medicine, pediatrics, and family medicine. Others work in specialty areas, such as general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PAs specializing in surgery provide pre- and post-operative care and may work as first or second assistants during major surgery.
Although PAs usually work in a comfortable, well-lighted environment, those in surgery often stand for long periods, and others do considerable walking. Schedules vary according to practice setting and often depend on the hours of the supervising physician. The workweek of PAs in physicians offices may include weekends, night hours, or early morning hospital rounds to visit patients. They may also be on-call. PAs in clinics usually work a 40-hour week.
Physician assistants held about 66,000 jobs in 1998. The number of jobs is greater than the number of practicing PAs because some hold two or more jobs. For example, some PAs work with a supervising physician, but also work in another practice, clinic, or hospital. According to the American Academy of Physician Assistants, there were about 34,200 certified PAs in clinical practice, as of January 1999.
Sixty-seven percent of jobs for PAs were in the offices and clinics of physicians, dentists, or other health practitioners. About 21 percent were in hospitals. The rest were mostly in public health clinics, nursing homes, prisons, home health care agencies, and the Department of Veterans Affairs.
According to the American Academy of Physician Assistants, about one-third of all PAs provide health care to communities having fewer than 50,000 residents where physicians may be in limited supply.
All States require that new PAs complete an accredited, formal education program. As of July 1999, there were 116 accredited or provisionally accredited educational programs for physician assistants; 64 of these programs offered a bachelors degree or a degree option. The rest offered either a certificate, an associate degree, or a masters degree. Most PA graduates have at least a bachelors degree.
Admission requirements vary, but many programs require 2 years of college and some work experience in the health care field. Students should take courses in biology, English, chemistry, math, psychology, and social sciences. More than half of all applicants hold a bachelors or masters degree. Many applicants are former emergency medical technicians, other allied health professionals, or nurses.
PA programs usually last 2 years. Most programs are in schools of allied health, academic health centers, medical schools, or 4-year colleges; a few are in community colleges, the military, or hospitals. Many accredited PA programs have clinical teaching affiliations with medical schools.
PA education includes classroom instruction in biochemistry, nutrition, human anatomy, physiology, microbiology, clinical pharmacology, clinical medicine, geriatric and home health care, disease prevention, and medical ethics. Students obtain supervised clinical training in several areas, including primary care medicine, inpatient medicine, surgery, obstetrics and gynecology, geriatrics, emergency medicine, psychiatry, and pediatrics. Sometimes, PA students serve one or more of these "rotations" under the supervision of a physician who is seeking to hire a PA. These rotations often lead to permanent employment.
As of 1999, 49 States and the District of Columbia had legislation governing the qualifications or practice of physician assistants; Mississippi did not. All jurisdictions required physician assistants to pass the Physician Assistants National Certifying Examination, administered by the National Commission on Certification of Physician Assistants (NCCPA)open openly to graduates of accredited PA educational programs. Only those successfully completing the examination may use the credential "Physician Assistant-Certified (PA-C)." In order to remain certified, PAs must complete 100 hours of continuing medical education every 2 years. Every 6 years, they must pass a recertification examination or complete an alternate program combining learning experiences and a take-home examination.
Some PAs pursue additional education in order to practice in a specialty area such as surgery, neonatology, or emergency medicine. PA postgraduate residency training programs are available in areas such as internal medicine, rural primary care, emergency medicine, surgery, pediatrics, neonatology, and occupational medicine. Candidates must be graduates of an accredited program and be certified by the NCCPA.
Physician assistants need leadership skills, self-confidence, and emotional stability. They must be willing to continue studying throughout their career to keep up with medical advances.
As they attain greater clinical knowledge and experience, PAs can advance to added responsibilities and higher earnings. However, by the very nature of the profession, individual PAs are always supervised by physicians.
Employment opportunities are expected to be good for physician assistants, particularly in areas or settings that have difficulty attracting physicians, such as rural and inner city clinics. Employment of PAs is expected to grow much faster than the average for all occupations through the year 2008 due to anticipated expansion of the health services industry and an emphasis on cost containment.
Physicians and institutions are expected to employ more PAs to provide primary care and assist with medical and surgical procedures because PAs are cost-effective and productive members of the health care team. Physician assistants can relieve physicians of routine duties and procedures. Telemedicineusing technology to facilitate interactive consultations between physicians and physician assistantswill also expand the use of physician assistants.
Besides the traditional office-based setting, PAs should find a growing number of jobs in institutional settings such as hospitals, academic medical centers, public clinics, and prisons. Additional PAs may be needed to augment medical staffing in inpatient teaching hospital settings if the number of physician residents is reduced. In addition, State-imposed legal limitations on the numbers of hours worked by physician residents are increasingly common and encourage hospitals to use PAs to supply some physician resident services. Opportunities will be best in States that allow PAs a wider scope of practice, such as the ability to prescribe medication.
Median annual earnings of physician assistants were $47,090 in 1998. The middle 50 percent earned between $25,110 and $71,450 a year. The lowest 10 percent earned less than $18,600 and the highest 10 percent earned more than $86,760 a year. Median annual earnings of physician assistants in 1997 were $41,100 in offices and clinics of medical doctors and $57,100 in hospitals.
According to the American Academy of Physician Assistants, median income for physician assistants in full-time clinical practice in 1998 was about $62,200; median income for first-year graduates was about $54,000. Income varies by specialty, practice setting, geographical location, and years of experience.
Other health workers who provide direct patient care that requires a similar level of skill and training include nurse practitioners, physical therapists, occupational therapists, clinical psychologists, nurse anesthetists, nurse midwives, clinical nurse specialists, speech-language pathologists, and audiologists.
Disclaimer: Links to non-BLS Internet sites are provided for your convenience and do not constitute an endorsement.
For information on a career as a physician assistant, contact:
For a list of accredited programs and a catalog of individual PA training programs, contact:
For eligibility requirements and a description of the Physician Assistant National Certifying Examination, write to:
An industry employing physician assistants that appears in the 2000-01 Career Guide to Industries: Health services
Last Updated: March 30, 2000
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