Physician assistants

Occupational Outlook Handbook, 2004-05 Edition

U.S. Department of Labor | Bureau of Labor Statistics | Bulletin 2540

Physician Assistants

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 care facilities to check on patients, after which they 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 specialties, such as general internal medicine, pediatrics, and family medicine. Others specialty areas include general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PAs specializing in surgery provide preoperative and postoperative 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 the practice setting, and often depend on the hours of the supervising physician. The workweek of hospital-based PAs may include weekends, nights, or early morning hospital rounds to visit patients. These workers also may be on call. PAs in clinics usually work a 40-hour week.

Physician assistants held about 63,000 jobs in 2002. 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, almost 90 percent of certified PAs were in clinical practice in 2003.

More than half of jobs for PAs were in the offices of physicians or other health practitioners. About a quarter were in hospitals. The rest were mostly in outpatient care centers, the Federal government, educational services, and employment services.

All States require that new PAs complete an accredited, formal education program. In 2002 there were about 133 accredited or provisionally accredited education programs for physician assistants. Sixty-eight of these programs offered a master’s degree, and 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, mathematics, psychology, and the social sciences. Most applicants to PA programs hold a bachelor’s or master’s degree. Many PAs have backgrounds as registered nurses, while others come from varied backgrounds, including military corpsman/medics and allied health occupations such as respiratory therapists, physical therapists, and emergency medical technicians and paramedics.

PA programs usually last at least 2 years and are full time. 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. The 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) and open to graduates of accredited PA education programs. Only those successfully completing the examination may use the credential “Physician Assistant-Certified.” 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 alternative program combining learning experiences and a take-home examination.

Some PAs pursue additional education in a specialty 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.

Employment of PAs is expected to grow much faster than the average for all occupations through the year 2012, due to anticipated expansion of the health services industry and an emphasis on cost containment, resulting in increasing utilization of PAs by physicians and healthcare institutions.

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. Job opportunities for PAs should be good, particularly in rural and inner city clinics, because those settings have difficulty attracting physicians.

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 as the number of hours physician residents are permitted to work is reduced, encouraging hospitals to use PAs to supply some physician resident services. Opportunities will be best in States that allow PAs a wider scope of practice.

Median annual earnings of physician assistants were $64,670 in 2002. The middle 50 percent earned between $49,640 and $77,280. The lowest 10 percent earned less than $35,410, and the highest 10 percent earned more than $90,350. Median annual earnings of physician assistants in 2002 were $65,910 in general medical and surgical hospitals and $64,170 in offices of physicians.

According to the American Academy of Physician Assistants, median income for physician assistants in full-time clinical practice in 2003 was about $72,457; median income for first-year graduates was about $63,437. Income varies by specialty, practice setting, geographical location, and years of experience.

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, contact:

Suggested citation: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2004-05 Edition, Physician Assistants, on the Internet at http://www.bls.gov/oco/ocos081.htm (visited July 09, 2004).