The physician assistant career is growing rapidly, but is still fairly new. No one ever asks, “what is a doctor?” or “what is a nurse?” However, people are constantly asking, “what is a physician assistant?” Let’s dive into that question. I wrote this article to explain the career to those who are new to the physician assistant field and those who are trying to explain the field to a friend or family member.
What is a PA?
According to Webster, a physician assistant is a healthcare professional who practices medicine as a part of a healthcare team with collaborating physicians and other providers. In laymen’s terms, a physician assistant is a healthcare provider, like a physician and nurse practitioner. Physician assistants can evaluate patients, order tests, diagnose, perform procedures, assist in surgery and prescribe medications or other therapies to treat patients. They can do just about anything that a physician can do. However, these professionals work in collaboration with physicians. The term “collaboration” differs depending on where you work. On one end of the spectrum, some physicians will see patients directly side by side with physician assistants, especially in surgeries. On the other end of the spectrum, some PAs will see patients entirely by themselves and the physician will be available to answer questions should they arise and provide a second opinion when needed. There are varying degrees of autonomy and varying responsibilities depending on the specialty and practice.
History of the PA profession
The physician assistant profession started during World War II. At that time, there was a shortage of doctors. Physicians need to go to college for 4 years, medical school for 4 years and then undergo a residency. With a desperate need for health care providers and limited time for training, the physician assistant career was born, creating a health care provider with most of the rights and responsibilities of a physician, but with less required medical education and some supervision. In a time of need, the United States now had health care providers available in only a few years.
Education and Certification required to be a PA
When the career was initially developed, physician assistants only required an associate’s degree. Now physician assistants require a master’s degree. There are several different masters’ degrees someone can get to become a physician assistant such as Master of Science, Master of Physician Assistant Studies, etc. The important thing is that physician assistants go to a specialized physician assistant program/school, learn the skills to become a physician assistant and graduate from their PA program with a master’s degree. The physician assistant schools can be a 5 year combined bachelor’s and master’s program or a 2 years master program after graduating with a bachelor degree and prerequisites. Traditionally PA programs will require their students to have one year of didactic training and one year of clinical training. The didactic year is a challenging year packed with traditional school work including lectures, tests, essays, research, labs, projects and the like. During the clinical experiences, students will work full time at many different medical facilities, like family practices, hospitals, operating rooms, pediatric offices, emergency rooms etc. They will also complete some school work and exams at that time. After graduation from PA school, physician assistants can sit for their boards, known as the Physician Assistant National Certifying Exam or PANCE for short. You may notice that physician assistants sign their name “John Doe, PA-C.” You get that PA-C, from passing the PANCE. The “C” stands for certified. After the initial certification, PAs will need to maintain their certification by taking the Physician Assistant National Recertifying Exam or PANRE for short every 10 years. To get a better idea what is on these exams, check out our PANCE PANRE question bank here.
Physician assistants are eligible to work nearly anywhere a medical professional is needed. Some PAs work in an office, operating room, hospital and for a specialist. They can do anything from delivering babies, to resuscitating patients in an ICU, to family practice checkups, to brain surgery. Occasionally, PAs even own their own practice. PAs do not have to do any special training to have these opportunities. There are residency programs for PAs, but they are not required or even very common for that matter. For the most part, PAs learn when they arrive day 1 at their job. Exactly what they do on a day to day basis depends on the practice and the state they work. If a doctor can do it, there’s a good chance a physician assistant can do it too. For example, physician assistants can evaluate patients, order tests, interpret results, diagnose diseases, educate patients, perform procedures, assist in surgery and prescribe medications and other therapies. There should always be a physician available as a resource for physician assistants, but the degree of collaboration between PAs and doctors depends on the state, the practice and the physician’s comfort with the physician assistant. In some cases, the physician will see patients directly with the physician assistant. Sometimes, the physician will see patients before or after the physician assistant. Sometimes, the physician will be almost completely hands off and will simply be available if the physician assistant has any questions or concerns about a specific patient.
Physician Assistant vs Physician
How do physician assistants differ from physicians, nurses and nurse practioners? Physicians go to college for an average of 4 years and medical school for 4 years. Then they undergo a residency, which is a minimum of 3 years and perhaps even a fellowship, which is at least 1 year. They complete their entire education at least 5 years after physician assistants, but generally even more. This means they call themselves Dr. John Doe, when physician assistants call themselves John. The physician takes on more liability and in turn gets more respect than the physician assistant. Physicians can work completely independently and do not need to consult with anyone when making medical decisions; however physician assistants work alongside these physicians and will generally need to consult them in one way or another. When it comes to the PA scope of practice, this depends on each state and facility. For example, some PAs are not allowed to prescribe scheduled drugs, like narcotics, while some are. Most things a physician can do, a physician assistant can do however.
Physician Assistant vs Nurse
The nurse role is vastly different from that of a physician assistant. Nurses check on patients, check vital signs, administer medications, follow orders given by the physician assistant or physician and act as a liaison between the patient and the providers. Physician assistants spend less time with the patients than the nurses and rely on the nurses for updates. The physician assistant takes the responsibility of making changes to the treatment plan based on input from the nurses. These two work in tandem to care for the patient. Unlike physician assistants, nurses do not bill for their procedures. Also, unlike physician assistants, nurses tend to get more down and dirty, cleaning up patients after the vomit or have incontinent episodes. We both have to document what we do, but the documentation is different.
Physician Assistant vs Nurse Practitioner
Unlike nurses, nurse practitioners are very similar to physician assistants. They are both considered advanced practice providers. Their roles on a daily basis are extremely similar. There are small differences in scope of practice based on the state and facility, but for all intents and purposes they are nearly interchangeable in the work place. Nurse practitioners start their careers as nurses, work for at least 2 years and then apply to nurse practioner school, where they undergo a similar education to physician assistants. However, NP school can be less intensive. NPs are often able to keep their current nursing jobs and go to school online or part time. They do their clinical rotations as they are able throughout the 2 years they are in school, instead of taking 1 year and dedicating it exclusively to rotations full time. Physician assistants may have almost 4 times more clinical hours than nurse practitioners when they graduate. The model in which NPs are taught is more of a nursing model, with a focus on the patient. PAs are taught more of a physician model with a focus on the disease. Therefore, there are some differences in how PAs and NPs practice. Also, NPs take their boards once and never need to re-certify, they just do continuing education through conferences, etc. PAs on the other hand, recertify every 10 years and require less continuing education in the interim. In some areas, unlike, PAs, NPs are able to work without a collaborating physician. There are also different kinds of NPs, such as family, pediatric, women’s health, neonatal, acute care and psychiatric nurse practitioners. The family NP can practice in nearly any specialty, however the other types of nurse practitioners can only practice in the specialty in which they are trained. All physician assistants can practice in any specialty. Over all, these are very similar roles and I am merely splitting hairs by discussing the differences.
Salary and Outlook
The physician assistant career continues to grow significantly. More universities are developing PA programs. Meanwhile, there continues to be more jobs available than physician assistants to fill them. The reason for this is multifactorial. People continue to live longer. Unfortunately, people are always getting sick and need providers. As PAs gain more respect in the medical community, the scope of practice is expanding, allowing PAs to do more and more. Medical organizations can pay physician assistants half of what they pay physicians for nearly the same work. At this point in time, according to the US Bureau of Labor Statistics the average physician assistant makes $98,000 annually. Keep in mind, salary depends a lot on location. In areas where there are a lot of PA and NP schools, physician assistants are paid significantly less than areas where there are few PA and NPs available. I have seen PAs make anywhere from $65,000 to $125,000 at their first jobs.
The PA profession has gained a lot of interest. With its flexibility, versatility, job outlook, salary, short education, and rewarding nature, the PA career is arguably one of the best careers out there.