Physician Assistants

• Nature of the Work

  As their title suggests, physician assistants (PA's) support physicians. However, they should not be confused with medical assistants (see separate statement elsewhere in the Handbook). PA's are formally trained to provide routine diagnostic, therapeutic, and preventive health care services under the direction and supervision of a physician. They take medical histories, examine patients, order and interpret laboratory tests and X-rays, and make preliminary diagnoses. They also treat minor injuries by suturing, splinting, and casting. PA's record progress notes, instruct and counsel patients, and order or carry out therapy. In 39 States and the District of Columbia, physician assistants may prescribe medications. PA's may have managerial duties too. Some order medical and laboratory supplies and equipment; others supervise technicians and assistants.

  Physician assistants always work under the supervision of a physician. The extent of supervision, however, depends upon the location. For example, PA's working in rural or inner city clinics, where a physician may be available just 1 or 2 days each week, may provide most of the health care for patients and consult with the supervising physician by telephone. Other PA's may make house calls or go to hospitals and nursing homes to check on patients and report back to the physician.

  In some States, the duties of a physician assistant are determined by the supervising physician; in others, they are determined by the State's regulatory agency. Aspiring PA's should investigate the laws and regulations in the States where they wish to practice.

  Many PA's work in primary care areas such as general internal medicine, pediatrics, and family practice. Others work in specialty areas, such as general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PA's specializing in surgery, also called surgeon assistants, provide pre- and post-operative care and may work as first or second assistants during major surgery.

• Working Conditions

  Although PA's generally 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 PA's in physicians' offices may include weekends, night hours, or early morning hospital rounds to visit patients. They may be on-call. PA's in clinics usually work a 5-day, 40-hour week.

• Employment

  Physician assistants held about 56,000 jobs in 1994. Most PA's work in physicians' offices and clinics. Others work in hospitals. The rest work for public health clinics, nursing homes, prisons, and rehabilitation centers.

  About one-third of all PA's provide health care to communities having fewer than 50,000 residents where physicians may be in limited supply, according to the American Academy of Physician Assistants. Many PA's work in primary care areas such as family medicine, general internal medicine, and pediatrics.

• Training, Other Qualifications, and Advancement

  Almost all States require that new PA's complete an accredited, formal education program. In 1995, there were 61 such educational programs for physician assistants, including three programs for surgeon assistants. Thirty-seven of these programs offered a baccalaureate degree or a degree option. The rest offered either a certificate, an associate degree, or a master's 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 bachelor's or master's degree. Many applicants are former emergency medical technicians, other allied health professionals, or nurses.

  PA programs generally last 2 years. Most programs are in medical schools, schools of allied health, or 4-year colleges; a few are in community colleges and in 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 family medicine, inpatient and ambulatory medicine, general surgery, obstetrics and gynecology, geriatrics, emergency medicine, internal medicine, ambulatory 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 1995, 49 States, the District of Columbia, and Guam had legislation governing the qualifications or practice of physician assistants. Mississippi did not. Forty-nine States required physician assistants to pass a certifying exam that is only open to graduates of an accredited educational program. Only those successfully completing the examination may use the credential "Physician Assistant-Certified (PA-C)." In order to remain certified, PA's must have 100 hours of continuing medical education every 2 years and pass a recertification examination every 6 years.

  PA postgraduate residency training programs, as yet unaccredited, are available in gynecology, geriatrics, surgery, pediatrics, neonatology, and occupational medicine. Candidates must be graduates of an accredited program and be certified by the National Commission on Certification of Physician Assistants.

  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.

  Some PA's pursue additional education in order to practice in a specialty area such as surgery, neonatology, or emergency medicine. Others—as they attain greater clinical knowledge and experience—advance to added responsibilities and higher earnings. However, by the very nature of the profession, individual PA's are always supervised by physicians.

• Job Outlook

  Employment opportunities are expected to be excellent for physician assistants, particularly in areas or settings that have difficulty attracting enough physicians, such as rural and inner city clinics.

  Employment of PA's is expected to grow faster than the average for all occupations through the year 2005 due to anticipated expansion of the health services industry and an emphasis on cost containment. Physicians and institutions are expected to employ more PA's to provide primary care and assist with medical and surgical procedures, thus freeing physicians to perform more complicated and revenue generating tasks. The public and third party payers also seem to approve of PA's use. For example, Medicare now allows physicians to bill the government for services provided by PA's in hospitals and nursing homes. Opportunities will be best in States that allow PA's a wider scope of practice, such as the ability to prescribe medication.

  Besides the traditional office-based setting, PA's should find a growing number of jobs in institutional settings such as hospitals, academic medical centers, public clinics, and prisons. The growth of managed care and group medical practices should also lead to more jobs since they use PA's to provide a wide variety of services because their salaries are lower than those of physicians.

• Earnings

  According to a University of Texas Medical Branch survey of hospitals and medical centers, the median annual salary of physician assistants, based on a 40 hour week and excluding shift or area differentials, was $48,264 in October 1994. The average minimum salary was $37,639 and the average maximum was $57,005.

  According to the American Academy of Physician Assistants, median income for all physician assistants in 1994 was $53,284; median income for first year graduates was $44,176. 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 nurse practitioners, physical therapists, occupational therapists, clinical psychologists, speech-language pathologists, and audiologists.

• Sources of Additional Information

  For information on a career as a physician assistant, contact:
  American Academy of Physician Assistants, 950 North Washington St., Alexandria, VA 22314.

  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.

  For eligibility requirements and a description of the Physician Assistant National Certifying Examination, write to:
  National Commission on Certification of Physician Assistants, Inc., 2845 Henderson Mill Rd. NE., Atlanta, GA 30341.

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