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Nature of the Work
* The typical physician assistant program lasts about 2 years and generally requires at least 2 years of college and some health care experience for admission.
* Earnings are high and job opportunities are expected to be excellent.
Physician assistants (PA's) provide health care services with supervision by physicians. They should not be confused with medical assistants, who perform routine clinical and clerical tasks (see separate statement elsewhere in the Handbook). PA's are formally trained to provide diagnostic, therapeutic, and preventive health care services under the direction of 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. 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 also have managerial duties. Some order medical and laboratory supplies and equipment, while others supervise technicians and assistants.
Physician assistants always work under the supervision of a physician. The extent of supervision, however, depends upon State law. For example, a PA 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. PA's may also 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 provide pre- and post-operative care and may work as first or second assistants during major surgery.
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 also be on-call. PA's in clinics usually work a 5-day, 40-hour week.
Physician assistants held about 64,000 jobs in 1996. Sixty-six percent were in the offices and clinics of physicians, dentists, or other health practitioners. Almost 20 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 PA's provide health care to communities having fewer than 50,000 residents where physicians may be in limited supply.
Almost all States require that new PA's complete an accredited, formal education program. In 1997, there were 96 such educational programs for physician assistants; 53 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. 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 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 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 1997, 49 States and the District of Columbia had legislation governing the qualifications or practice of physician assistants. Mississippi did not. Forty-nine States required physician assistants to pass the Physician Assistants National Certifying Examination 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 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.
Although they are not accredited, PA postgraduate residency training programs 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 usually supervised by physicians.
Employment opportunities are expected to be excellent for physician assistants, particularly in areas or settings that have difficulty attracting physicians, such as rural and inner city clinics. Employment of PA's is expected to grow much faster than the average for all occupations through the year 2006 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, because PA's are cost-effective and productive members of the health care team. Physician assistants can relieve physicians of routine duties and procedures. Telemedicine3/4using technology to facilitate interactive consultations between physicians and physician assistants3/4will also expand the use of physician assistants. 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. Additional PA's 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 PA's to supply some physician resident services. Opportunities will be best in States that allow PA's a wider scope of practice, such as the ability to prescribe medication.
According to the American Academy of Physician Assistants, the median income for physician assistants in full time clinical practice in 1996 was $60,687; median income for first year graduates was $52,116. Income varies by specialty, practice setting, geographical location, and years of experience.
According to a Hay Group survey of HMO's, group practices, and hospital-based clinics, the median annual base salary of full-time physician assistants was $54,100 in May 1996. The middle 50 percent earned between $49,100 and $60,000.
The average annual salary for physician assistants employed by the Federal Government was $48,670 in early 1997.
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.
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. Homepage: 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.
For eligibility requirements and a description of the Physician Assistant National Certifying Examination, write to:
National Commission on Certification of Physician Assistants, Inc., 6849-B2 Peachtree Dunwoody Rd., Atlanta, GA 30328.
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