Sara Wilchowski PA-C and Lauren Leavitt PA-C
Edited by Paul M. Graham, DO
Many people feel slightly confused when visiting the doctor’s office as in many cases you’re not actually seeing the doctor. You may be seeing the physician assistant, also known as a PA. The landscape of healthcare is rapidly evolving and there are other providers with broad medical training available and ready to meet your needs in a doctor’s office. Do not be fooled by the term “assistant” as PA’s are far from that. It is an antiquated term that was awarded to the Navy corpsmen who returned from Vietnam with extensive medical training. They were not physicians but had more medical training than a nurse at that time. The first physician assistant degree was awarded in 1967. Additionally, PAs are not the same as a medical assistant (MA) or a nurse practitioner (NP), who you may often see in the doctor’s office.
PAs come from many backgrounds such as physical therapist, exercise physiologist, nurses, paramedics, and even teachers among many others. In order to become a PA, one must have at least a bachelor’s degree. Many PAs work for several years in other careers prior to returning to school.
What are the requirements for PA school?
For many, it is a direct step from undergraduate studies to PA school. Unlike physicians, PAs obtain core medical sciences during undergraduate years, which allows PA students to focus on the “meat and potatoes” of being a provider while in graduate school. High grades are often required to gain admittance to PA school. According to the Physician Assistant Education Association, the average GPA in 2013 for acceptance was a 3.5. Furthermore, clinical health care hours are often required prior to acceptance. The national average of direct patient care for PA applicants was 3,000 hours. The Graduate Record Examination (GRE) is often required for the majority of PA schools across the United States. PA applicants must meet a minimum GRE score requirement, which can vary by program.
What does PA training entail?
PAs are trained in the medical model, just like physicians and in most cases by physicians. The didactics and clinical rotations are similar to those of our physician counterparts which include core rotations in emergency medicine, family medicine, internal medicine, surgery, pediatrics, psychiatry, obstetrics, and gynecology as well as an elective rotation. Many of the lectures are given by physicians and most PA schools have a physician as the Medical Director. PAs are full-time students in the classroom for the first year followed by full-time students on clinical rotations the second year.
|Category||Medical Assistant||Nurse (RN, BSN)||Nurse Practitioner||Physician Assistant||Physician|
|Prereq Education||None||None||Bachelor Degree in Nursing & clinical hours||Bachelor Degree & clinical hours for most||Bachelor Degree|
|Time in Classroom||134 hrs||Varies greatly by program||500 hrs||1000 hrs||2 years|
|Time in Clinic||160 hrs||Varies greatly by program||500-700 hrs||2000 hrs||2 years|
High School Education
|1-2 years||2-4 years||6-8 years||4-6 years||8 years|
|Residency||None||None||None||Optional 1-2 yrs (depends on specialty)||3-8 years|
|Degree Awarded||Certificate or Associate Degree||Associate or Bachelor Degree||Master’s Degree (NP)
Clinical Doctorate (DNP)
|Physician Assistant Certified (PA-C)
Most also award Master’s Degree
|Doctor of Medicine (M.D.)
Doctor of Osteopathy (D.O.)
|Recertification||60 education points or exam every 5 years||1000 hours practicing in area of certification specialty OR exam every 5 years||1000 professional practice hours AND ~15 CE credits/year OR exam every 5 years||100 education hours every 2 years
Exam every 10 years
|MD: 50 education hrs every year
DO: 120 education hrs every 3 years
PLUS ABMS certification every 6-10 yrs
|Base Salary U.S. National Median 2015||$33,038||$70,163||$97,807||$95,751||$208,881|
How does a PA become licensed?
After graduating from PA school, which requires at least a B average to pass, they are then required to pass the Physician Assistant National Certification Exam (PANCE). This exam is similar to the United States Medical Licensure Exam that is taken by medical students to obtain specific residencies. After successfully passing this exam, PA’s can apply for state licensure.
What post-graduate programs are available for PA’s to further their training and education?
As more clinicians are needed to practice in our growing healthcare system, many PA’s are choosing to specialize in different fields. Some physicians and practices provide “on the job training” for their new-hire PA’s; however, other employers require experience in that specialty. Postgraduate training programs started in the PA profession in the 1970’s with a surgery residency program.  The Association of Postgraduate Physician Assistant Programs (APPAP) currently recognizes over 50 programs. Most of these curriculums are 12 months long with approximately 20 different specialties offered. In 2007, accreditation of these programs began through the Accreditation Review Commission on the Education for Physician Assistants (ARC-PA). [2,3] At this time, 8 programs are currently accredited.
The advantages and disadvantages of residency programs for PA’s have recently been evaluated further. New PA graduates have an average starting salary of approximately $82,000. PA’s who initially work within a residency will make substantially less.  One study determined that PA’s who completed a postgraduate training program were more competitive on the job market and were able to negotiate higher salaries. Approximately 95% of those who graduated from a PA residency program would recommend this training to other PAs, based on their perceived utility and efficacy of the program.  One drawback of these residencies is that they may cause a shift away from general medicine, further increasing demand for primary care PAs. Furthermore, PA’s may also have a delayed entry into clinical practice if additional training is pursued. 
What do PAs do?
PAs are respected and trusted medical professionals who are recognized as one of three primary health care providers (PAs, Nurse Practitioners, and Physicians). PAs diagnose and treat health conditions and prescribe medications. They are trained to take medical histories and conduct physical examinations in both clinic and hospital settings. Additional duties include ordering and interpreting tests, counseling on preventative care, assisting in surgery, and conducting rounds in hospitals and nursing homes.  In 2003, the National Commission on Certification of Physician Assistants (NCCPA) formally defined the roles of PAs in healthcare: PAs demonstrate proficiency in medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and improvement, and systems-based practice. 
PAs work in all fifty states, with approximately 90% practicing in urban areas.  Over 50% of PAs are in private practice, less than 33% are in a hospital group, and less than 6% work in a government or federally qualified health center. The average PA in the United States is a 38-year-old female who sees 15 patients per day and 60 patients per week. 
While the focus of a PA’s training is general medicine, PAs treat patients in many diverse specialties. In 2015, the most commonly practiced fields by PAs were family medicine, orthopedic surgery, emergency medicine, urgent care, general internal medicine, hospital medicine, dermatology, general surgery, cardiology internal medicine, and cardiovascular/cardiothoracic surgery.  As the demand for PAs grows with the Affordable Healthcare Act, the trend of PAs in the workplace is moving to subspecialty practice.  Since the late 1990’s, the amount of PAs leaving family medicine has surpassed the number of PAs entering. 
Some PAs see patients independently, while others collaborate with a medical team. While state laws require PAs to practice under the supervision of a licensed physician, many PAs have autonomy with their medical decision making as they gain experience.  PA’s foundation in primary medicine and their close relationship with physicians allow them the unique flexibility to switch specialties during their careers. The American Academy of Physician Assistants (AAPA) data shows that half of clinically active PAs have changed fields during their careers, and 25% had practiced in at least two different specialties. 
PAs have extended their roles to the nonclinical side of medicine as well. They can become leaders in healthcare administration and management. Major responsibilities in this setting include interviewing, hiring, and orienting new staff.  Additional opportunities are available in research, recruiting, consulting, writing and medical communications, and education.  PAs also have the capacity to start their own practice or other healthcare business. 
Eighty-four percent of PAs are satisfied with their career choice. This may be a reflection of their successes with patient care. Studies show that fully trained PAs are capable of decreasing hospital readmission rates and lengths of stay.  Patients rated PAs highly in terms of their technical competence, professionalism, quality of care, and access to services.  Fortunately, the Bureau of Labor Statistics expects the profession to expand 30% by 2024. 
- Hooker RS. Assessing the value of physician assistant postgraduate education. JAAPA. 2009;22(5):13
- Association of Postgraduate PA Programs. PA program quick reference chart. http://appap.org/post-graduate-pa-programs/ pa-program-quick-reference-chart/. Accessed February 1, 2016.
- Accreditation Review Commission on Education for the Physician Assistant. Accredited clinical postgraduate PA programs. www.arc-pa.com/acc_programs. Accessed August 29, 2016.
- American Academy of Physician Assistants. AAPA salary report: new graduate PAs. https://www.aapa.org/WorkArea/ DownloadAsset.aspx?id=2147484855&loggedIn=True [requires subscription]. Accessed August, 29 2016.
- Will KK, Williams J, Hilton G, et al. Perceived efficacy and utility of postgraduate physician assistant training programs. JAAPA. 2016 Mar;29(3):46-8
- Colleti, TP. Physician assistant postgraduate education.JAAPA. 2016 Mar;29(3):19
- A Patient’s Guide to the Physician Assistant Career. RN, PA, NP, MD…What? Accessed September 17, 2016. Available: http://www.pg2pa.org/PA_NP.html
- Physician Assistant Education Association. Twenty-Ninth Report: Physician Assistant Programs in the United States. Accessed: September 2016, Available: http://www2.paeaonline.org/index.php?ht=a/GetDocumentAction/i/161974
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