Like the physicians they serve, physician assistants (PAs) can follow many career paths, including university hospital work, private practice, and jobs with health maintenance organizations (HMOs). Basically, wherever there are doctors, there are physician assistants. University hospital work means working alongside doctors and other PAs, splitting time between treatment, aiding in research and instruction (more experienced PAs manage less experienced PAs). Depending on the size of the private practice, PAs are more likely to spend the majority of their time working directly with doctors, handling patients, lab tests, and paper work. PAs who work for an HMO are part of the large corporate medicine machine that not only provides the patients, but also most likely assigns PAs to the physicians they will assist.
Currently, 50 percent of all PAs practice primary care medicine, which is family medicine, internal medicine, pediatrics, and obstetrics and gynecology. Just more than 20 percent focus their talents in surgery or the surgical subspecialties. Although family and emergency medicine attract the most PAs, many also specialize in dermatology, psychiatry, radiology, and pathology.
The physician’s assistant license allows licensees to practice medicine only under supervision, while always working for at least one physician and carrying a significant portion of the physician’s massive work load. Although a 1997 American Academy of Physician Assistants survey found that the median number of work hours was forty-two, this number nearly almost doubled, to eighty hours per week, for those PAs on call. Work in this profession is rewarding, but can be very demanding. Common services provided by PAs include taking medical histories, performing physical exams, ordering and interpreting lab tests, diagnosing and treating illnesses, assisting in surgery, prescribing and dispensing medication, and counseling patients.
Competition is tough: Nurses, emergency medical technicians (EMTs), and paramedics most commonly apply to PA programs in order to become certified physician assistants. The typical applicant to a PA program has a bachelor’s degree (they also need to have followed a premed track as an undergraduate) and more than four years of health care experience. For those interested in becoming PAs but who haven’t followed the traditional science route in college, a post-baccalaureate program may be the answer. Many universities have programs where students can take all the undergraduate sciences courses in one post-baccalaureate program.
Because PAs are going to be in a close working relationship with physicians, they are educated in a medical model designed to complement physician training. Once candidates have been accepted to a PA program the average curriculum stretches over 108 weeks of intensive medical study, compared with 153 weeks for medical school. During that time PA students will be sharing many classes and rotations in clinical medicine with medical students who are going for an M.D., and the work is stressful and difficult. The education itself consists of classroom and laboratory instruction in basic medical and behavioral sciences (such as anatomy, pharmacology, and clinical medicine), followed by rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine. After completing the coursework required in a PA program, graduates still have to pass a national certification exam. Graduation from an accredited physician assistant program and passage of the certifying exam are required for state licensure.
All that and they still aren’t done. PAs are required to take ongoing medical education classes (at least 100 hours of classroom time every two years) and must retake the certification test every six years to maintain their national certification.
PAs are not full-fledged doctors, but in medicine there are plenty of careers that don’t require an M.D. Some PAs consider nursing, working as paramedics or EMTs, lab technicians, pharmacologists, or biologists. All of these careers require long hours of study and all come with a great deal of responsibility, as any medical professional’s decisions directly affect the lives of the patients she is caring for.