Physician Assistants (O*NET 29-1071.00) Significant Points * The typical physician assistant program lasts about 2 years and usually requires at least 2 years of college and some healthcare experience for admission. * Earnings are high and job opportunities should be good. Nature of the Work Physician assistants (PAs) provide healthcare services under the supervision of 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 healthcare services, as delegated by a physician. Working as members of the healthcare team, they take medical histories, examine and treat patients, order and interpret laboratory tests and x rays, make diagnoses, and prescribe medications. 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 47 States and the District of Columbia, physician assistants may prescribe medications. PAs also may have managerial duties. Some order medical and laboratory supplies and equipment and may supervise technicians and assistants. Physician assistants work under the supervision of a physician. However, PAs may be the principal care providers in rural or inner city clinics, where a physician is present for only 1 or 2 days each week. In such cases, the PA confers with the supervising physician and other medical professionals as needed or as required by law. PAs also may 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 in which 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 postoperative care, and may work as first or second assistants during major surgery. Working Conditions 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. These workers also may be on call. PAs in clinics usually work a 40-hour week. Employment Physician assistants held about 58,000 jobs in 2000. 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 40,469 certified PAs in clinical practice as of January 2000. Almost 56 percent of jobs for PA's were in the offices and clinics of physicians, dentists, or other health practitioners. About 32 percent were in hospitals. The rest were mostly in public health clinics, temporary help agencies, schools, prisons, home healthcare agencies, and the U.S. Department of Veterans Affairs. According to the American Academy of Physician Assistants, about one-third of all PAs provide healthcare to communities with fewer than 50,000 residents, in which physicians may be in limited supply. Training, Other Qualifications, and Advancement All States require that new PAs complete an accredited, formal education program. As of July 2001, there were 129 accredited or provisionally accredited educational programs for physician assistants; 64 of these programs offered a master's degree. The rest offered either a bachelor's degree or an associate degree. Most PA graduates have at least a bachelor's degree. Admission requirements vary, but many programs require 2 years of college and some work experience in the healthcare field. Students should take courses in biology, English, chemistry, math, psychology, and social sciences. More than two-thirds of all applicants hold a bachelor's or master's degree. Many applicants are former emergency medical technicians, other allied health professionals, or nurses. PA programs usually last at least 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, pathology, human anatomy, physiology, microbiology, clinical pharmacology, clinical medicine, geriatric and home healthcare, 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. All States and the District of Columbia have legislation governing the qualifications or practice of physician assistants. All jurisdictions require physician assistants to pass the Physician Assistants National Certifying Examination, administered by the National Commission on Certification of Physician Assistants (NCCPA)- open 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 PA's pursue additional education 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, clinically practicing PAs always are supervised by physicians. Job Outlook 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 2010 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 to assist with medical and surgical procedures because PAs are cost-effective and productive members of the healthcare team. Physician assistants can relieve physicians of routine duties and procedures. Telemedicine-using technology to facilitate interactive consultations between physicians and physician assistants-also will 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. Earnings Median annual earnings of physician assistants were $61,910 in 2000. The middle 50 percent earned between $47,970 and $73,890. The lowest 10 percent earned less than $32,690, and the highest 10 percent earned more than $88,100. Median annual earnings of physician assistants in 2000 were $64,430 in offices and clinics of medical doctors and $61,460 in hospitals. According to the American Academy of Physician Assistants, median income for physician assistants in full- time clinical practice in 2000 was about $65,177; median income for first-year graduates was about $56,977. Income varies by specialty, practice setting, geographical location, and years of experience. Related Occupations Other health workers who provide direct patient care that requires a similar level of skill and training include occupational therapists, physical therapists, and speech- language pathologists and audiologists. Sources of Additional Information For information on a career as a physician assistant, contact: * American Academy of Physician Assistants Information Center, 950 North Washington St., Alexandria, VA 22314-1552. Internet: http://www.aapa.org For a list of accredited programs and a catalog of individual PA training programs, contact: * Association of Physician Assistant Programs, 950 North Washington St., Alexandria, VA 22314-1552. Internet: http://www.apap.org For eligibility requirements and a description of the Physician Assistant National Certifying Examination, contact: * National Commission on Certification of Physician Assistants, Inc., 157 Technology Pkwy., Suite 800, Norcross, GA 30092-2913. Internet: http://www.nccpa.net