Nature of the Work:
PA's are trained to perform many of the essential but time consuming tasks involved in patient care. They take medical histories, perform physical examinations, order laboratory tests, make preliminary diagnoses, prescribe appropriate treatments, and recommend medications and drug therapies. In a growing number of States, physician assistants prescribe certain medications. They also treat minor problems such as lacerations, abrasions, and burns. Some physician assistants provide pre-operativeand post-operative care and work as first or second assistants during major surgery.
Physician assistants always work under the supervision of a licensed physician. Alternative titles sometimes used are MEDEX, surgeon's assistant, child health associate, and physician associate.
PA'sassist physicians in a variety of practice settings and specialty areas. The most important practice setting is physicians' offices. They also work in hospitals and clinics. Specialties using PA's are family practice, internal medicine, general and thoracic surgery, emergency medicine, pediatrics, and various medical subspecialties.
Some work in rural or inner city clinics, where a physician may be available just 1 or 2 days each week. For the rest of the week, a PA working with one or more nurses, technicians, or medical assistants independently provides all health care services. This is done, however, only after consulting with the supervising physician by telephone.
Working Conditions:
Although PA's generally work in a climate controlled, well-lighted environment, those in surgery often stand for long periods, and others do considerable walking.
The workweek and schedule vary according to practice setting and are often comparable to the hours of their supervising physician. A few emergency room PA's work 24-hour shifts twice weekly, and others work three 12-hour shifts each week. The workweek of PA's in physicians' offices may include weekends, night hours, or early morning hospital rounds to visit patients. PA's in clinics usually work a 5-day, 40-hour week.
Employment:
Physician assistants most commonly work in office-based medical practices; others work in hospitals. A small but growing number work for health maintenance organizations (HMO's), public health clinics, and institutions such as prisons, rehabilitation centers, nursing homes, and facilities for the mentally retarded or disabled.
Quite a few PA's provide health care to communities having fewer than 50,000 residents and where physicians may be in limited supply.
Training, Other Qualifications, and Advancement:
Almost all States require that new PA's complete an accredited, formal education program. Some educational programs for physician assistantsand for surgeon assistants offered a baccalaureate degree or a degree option. The remainder 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. A growing number of programs, however, have no work experience requirement for admission. About half of all applicants hold a bachelor's or master's degree.
PA programs are generally 2 years in length. Most are located in medical schools, schools of allied health, or 4-year colleges; a few are sponsored by community colleges or are hospital based. Many accredited PA programs have clinical teaching affiliations with medical schools or medical school faculties.
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. During the final 9 to 15 months of PA training, students obtain supervised experience in clinical practice. Clinical training, which may be given completely within the first 6 to 12 months or integrated throughout the 24 months of instruction, is given in several areas. These areas include family medicine, inpatient and ambulatory medicine, general surgery, obstetrics and gynecology, geriatrics, emergency medicine, internal medicine, ambulatory psychiatry, and pediatrics. Sometimes, one or more of these rotations are served under the supervision of a physician who is seeking to hire a PA. This learning experience often leads to a permanent position.
PA postgraduate residency training programs, as yet unaccredited, are available in emergency medicine, 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.
In some States, the duties of a physician assistant are determined by the supervising physician; in other States, they are determined by the State's regulatory agency. There is variation in State practice laws and regulations; therefore, aspiring PA's should investigate the laws and regulations in the States where they wish to practice.
Individuals interested in becoming a physician assistant should exhibit leadership, self-confidence, and emotional stability. They should also be conscientious and willing to continue studying throughout their career to keep up with medical advances.
Some PA's pursue additional education 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 of PA's is expected to grow faster than the average for all occupations due to anticipated expansion of the health services industry and greater reliance on PA's to provide primary care and assist with medical and surgical procedures. Prospects for newly trained PA's appear excellent since educational programs are not expected to produce enough PA's to fill all job openings.
Public acceptance of PA's, the high quality of PA services, and cost savings that result from physicians' ability to delegate routine tasks should contribute to employment growth. Additional growth is projected as the PA's role expands further into institutional settings such as hospitals, academic medical centers, and rural health clinics and prisons.
The growth of HMO's and group medical practices should also lead to more jobs since PA's are used in these settings. Employment opportunities may also be enhanced by a change in Medicare which allows physicians to bill Medicare for services provided by their PA's to hospital and nursing home patients. This change is expected to foster use of PA's by physicians' offices and hospitals.
Hospitals will also employ more PA's to assist at surgery, perform diagnostic procedures and comprehensive patient assessments, and aid in clinical research.
For a number of years, use of PA's has been constrained by barriers to reimbursement by insurers, State laws restricting the kind of services they may perform, and physicians' reluctance to alter customary practice patterns. The situation has changed a great deal, although some State laws regulating PA practice remain a constraint Reimbursement barriers have begun to come down, however, and physicians' attitudes have become more supportive.
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, and speech and hearing clinicians.
