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A Day in the Life of a Physician Assistant

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.

Paying Your Dues

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.

Present and Future

In 1965 Eugene Stead, M.D., of Duke University Medical Center, assembled the first class of PAs to address the shortage and uneven distribution of primary care physicians. This first class was comprised of a Navy corps that had received medical training during their military service in Vietnam and came home to discover a lack of comparable civilian employment. Physicians quickly warmed to the new profession; PAs provided them with knowledgeable, efficient, and much needed help. Since then PAs have become a staple of the medical work force. There are now 31,000 PAs working in the U.S., practicing in every field of medicine. Job growth in the field of physician assistants is expected to outpace total employment growth by 9 percent over the next eight years. Even now, the majority of PAs are concentrated in primary care areas, leaving a lot of room for PAs in other fields. Less than 1 percent of PAs work in the fields of anesthesiology, pathology, psychiatry, and pediatric endocrinology, which means that demand for PAs is currently great, and will only become greater in the years to come. Demand is greatest in rural areas and inner cities.

Quality of Life

PRESENT AND FUTURE

In the early years of their careers, PAs will still be on a learning curve, gaining valuable experience in techniques for dealing with patients and the intricacies of applied medicine. They will also be discovering fields they might want to specialize in as their careers continue. As with most professions, incomes for PAs tend to increase with years of experience, but it is important to note that larger increases in income tend to come near the beginning of a PA’s career. In a 1997 report on PA salaries, those with one to three years of experience saw their income increase an average of 4.4 percent. PAs also won’t have the same potentially immense debt that medical students will have accrued, making their dollars stretch farther.

FIVE YEARS OUT

As the profession requires, PAs will have had an ongoing medical education throughout their career and by now should be approaching the time where they will have to take the certification exam a second time to keep their licenses. At this point, many PAs have had enough hands-on experience (hopefully backed up with good old-fashioned book learning) that they can now specialize. A PA’s specialty has a significant impact on earnings. Currently, the highest paid PA specialists are in surgical subspecialties (earning $70,000 or more). Many may also find themselves managing other PAs. They have experience and are enjoying the benefits of managerial status.

TEN YEARS OUT

An experienced PA, whether a specialist in emergency medicine or in general pediatrics, is a valuable PA, and his income will reflect this. Without a doubt, PAs can act in a managerial capacity for any health care organization that employs PAs and would also be a valued asset to any private practice. In short, PAs are a commodity in demand and in whatever way they are pursuing their career, most PAs will be in a good position, both in terms of choosing where to work and the remuneration they can expect.