What Everyone Should Know About Physician Assistants (PAs)
By Savanna Perry, PA-C
Since the PA profession was created in the 1960s, it has continually been recognized as one of the quickest growing and top jobs for work satisfaction in the United States. Coming in at #3 for Best Jobs by the U.S News & World Report in 2020, it’s no surprise that there is growing interest in how physician assistants fit into the current healthcare model and what that role will look like in the future.
PAs were originally created out of a need for more medical providers, particularly in rural settings and primary care areas. Dr. Eugene Stead saw a need for accessible healthcare in certain areas and recognized that hospital corpsmen had received great training to do many of the things their physician counterparts were doing, but once they left the military, they were unable to use that experience for anything meaningful in civilian life. By creating an accelerated program built on the medical model with a focus on primary care and a collaborating relationship with a physician, the PA profession was born at Duke University. (Source: PAHx.com)
While the career is somewhat in its infancy, there are over 140,000 PAs practicing in the US today. (Source: AAPA.com) Many PAs continue to work in primary care fields, including family medicine, pediatrics, and women’s health, but it’s not uncommon to find PAs in almost every specialty! I personally work in dermatology, but there are surgical, orthopedic, neurology, and psychiatry PAs as well. Anesthesia and pathology are specialties that have different dedicate programs outside of traditional PA programs.
When it comes to education, pre-PAs start by completing a Bachelor’s degree while taking very focused courses and gaining hands-on patient care experience. Many PAs work as EMTs, paramedics, medical assistants, or nurses before they begin grad school. There are various other requirements including shadowing, volunteering, and standardized tests like the GRE and PA-CAT. PA school is a Master’s program that is typically 24-36 months long with minimal breaks. The first didactic year is spent mainly in the classroom with some integrated clinical time. This part of the education is dedicated to cementing the knowledge portion before jumping into rotations. Having class from 8 AM to 5 PM every day with almost weekly tests was certainly intense, but the clinical medicine is the focus, along with classes on pharmacology, ethics, biostatistics, genetics, and various other topics.
The second clinical year of PA school consists of rotations in multiple areas for patient experience, PA school flies by. This is usually at least a year with a variety of clinical sites and specialties ranging from 4-6 weeks. Some of the common rotations include family medicine, OB/GYN, pediatrics, emergency medicine, surgery, psychiatry, and internal medicine. Electives also help PA students figure out what areas they may want to work in or get more experience in weaker areas.
Following PA school, there are optional residency or fellowship programs to gain more focus and experience in a specific area. These are common for emergency medicine, critical care, and surgery among others. The majority of PAs choose to go straight into their positions and receive additional training on the job from their collaborating physicians, making for a great team atmosphere when everyone is on the same page. One of the main benefits of training as a PA is that PAs are able to switch specialties if desired. This is called lateral mobility. For example, even though I work in dermatology now, I could move into a role in surgery or cardiology if needed at some point.
By taking a team-based approach to patient care, PAs can work with doctors, nurses, and other healthcare professionals to make sure the patient is the most important priority. When it comes to responsibilities, PAs will function differently based on their area of expertise, but they can do many of the same things physicians do. We evaluate patients, take a history, complete a physical exam, determine what labs or imaging may be needed and evaluate the results, develop a diagnosis and treatment plan, and prescribe medication. PAs work with a physician and will have varying levels of supervision. A PA in surgery may be less autonomous than a family medicine PA with years of experience, but the doctor is still available for a consult if needed. With a relationship built on trust and respect, every member of the healthcare team can contribute to better patient experience.
In my daily job as a dermatology PA, I have a schedule of patients who are coming in to see me specifically. The majority of the time, my physician does not also see those patients because she has her own schedule and I’m seeing issues within my comfort level and scope of practice. If a problem arises or I recognize a problem as being out of my comfort zone or knowledge skillset, she’s available and will come in so we can put our heads together. It’s great to have someone else to bounce thoughts off of and keep each other up to date on the latest in medicine.
A common misconception is that many PAs used this path as a back-up to medical school. They are really just different professions though, and the majority of PAs specifically chose to pursue PA instead of medical school for various reasons. For me, I saw the teamwork and collaboration as a huge benefit to patient care and loved the PA role when I shadowed a great PA/physician team. It just seemed like the perfect fit for me. That’s why I encourage anyone interested in medicine to explore different careers and see what makes the most sense.
By increasing access to patient care PAs fill an essential role in healthcare settings. The PA profession will continue to grow. The most important thing you can do is have conversations about PAs and educate people about how PAs can help with their healthcare needs.
Savanna Perry PA-C is a practicing dermatology physician assistant living and working in Augusta, GA. In her free time, Savanna enjoys exploring her town and traveling with her husband, who is currently an internal medicine resident. She is also the founder of The PA Platform, a popular website for Pre-PA and current PA students.