WHAT IS A PA?

​I'm sure a lot of my readers already know what a physician assistant is or have the capability of googling it themselves, but my blog just won't feel complete without a decent explanation. It's basically a PA student's obligation to inform the world whenever given the opportunity. According to the American Academy of PAs (AAPA), a physician assistant (PA) is a nationally certified and state-licensed medical professional who practices medicine on a healthcare team with physicians and other providers.
 
PAs are vital to healthcare. The Affordable Care Act, which was enacted in 2010, recognized PAs for the first time as one of three primary care providers (PAs, NPs, and Physicians). The law also empowered PAs to lead patient-centered medical teams. Team-based care is at the core of a PAs training. PAs can practice autonomously or in a collaborative relationship with other members of a patient’s healthcare team. This combination is a major source of their strength.
 
PAs are experts in general medicine. They undergo rigorous medical training. PAs must take a test in general medicine in order to be licensed and certified. They must graduate from an accredited PA program and pass a certification exam. Like physicians and NPs, PAs must complete extensive continuing medical education throughout their careers.
 
PAs diagnose, treat, and prescribe medicine. Thanks to an education modeled on the medical school curriculum, PAs learn to make life saving diagnostic and therapeutic decisions while working autonomously or in collaboration with other members of the healthcare team. PAs are certified as medical generalists with a foundation in primary care. Over the course of their careers, many PAs practice in two or three specialty areas, giving them deep experience and the flexibility to meet the changing needs of their patients, employers, and communities.
 
PAs are trusted healthcare providers. Studies have shown that when PAs practice to the full extent of their abilities and training, hospital readmission rates and lengths of stay decrease and infection rates go down. A Harris Poll found extremely high satisfaction rates among Americans who interact with PAs. The survey found that 93% regard PAs as trusted healthcare providers, 92% said that having a PA makes it easier to get a medical appointment and 91% believe that PAs improve the quality of healthcare.
 
PAs are in heavy demand. The US is currently still facing a shortage of health care professionals and PAs are a cost-effective way to fill this void. The profession has grown by 44% in the last year alone, keeping the workforce fairly young, and the demand for PAs has increased by 300% from 2011-2014. The BLS projects 30% growth from 2014-2024 creating over 28,7000 new jobs for the profession. Three quarters of PAs receive multiple job offers upon passing their initial licensing and certification exams. Studies show that the most financially successful hospitals maximize their use of PAs. The PA profession has been named by several top media outlets as the most promising job in America. As of January 2016, there were more than 115,547 certified PAs nationwide who interact with patients upwards of 350 million times annually.
 
How did the PA profession first begin?
The PA profession was created to improve and expand healthcare by addressing a shortage of primary care physicians. Eugene A. Stead Jr., MD, of the Duke University Medical Center, put together the first class of PAs in 1965. He selected four Navy Hospital Corpsmen who had received considerable medical training during their military service. Stead based the curriculum of the PA program on his knowledge of the fast-track training of doctors during World War II. The first PA class graduated from the Duke University PA program on October 6, 1967. Every year, PAs celebrate PA week from October 6th- October 12th in honor of the first graduating class.  Several of these graduates went to work at the Durham VA. The VA was the first employer of PAs and to this day is the single largest employer of PAs in the country. The PA concept gained federal acceptance and backing as early as the 1970s as a creative solution to the physician shortage. The medical community helped support the new profession and quickly developed accreditation standards, a national certification process, and continuing medical education requirements.
 
How are PAs educated and trained?
Students must first acquire a bachelor's degree followed by a master's degree from an accredited PA program. Most physician assistant programs are approximately 26 months (three academic years) in length and require the same prerequisite courses as medical schools. Students take courses in basic sciences, behavioral science, medical ethics, clinical research, and clinical medicine. Some programs are only 2 years long, foregoing the first year of basic science courses and jumping right into clinical medicine. Most programs also require students to have about three years of healthcare training and experience before applying. Students then complete a total of more than 2,000 hours of clinical rotations.
 
How are PAs certified and licensed?
Before PAs can practice, they must graduate from an accredited program, pass the PA National Certifying Exam (PANCE) administered by the National Commission on Certification of PAs, and get licensed by the state they wish to practice in. In order to maintain certification, PAs must complete a recertification exam every 10 years and complete 100 hours of continuing medical education (CME) every two years. The PA-C after a PAs name means they are currently certified.
 
What can a PA do?

• Take your medical history
• Conduct physical exams
• Diagnose and treat illnesses
• Order and interpret tests
• Develop treatment plans
• Counsel on preventive care
• Assist in surgery
• Write prescriptions
• Make rounds in hospitals and nursing homes
• Do clinical research

PA specific duties depends upon setting, level of experience, specialty, and state laws.
 
PAs work in all settings.

• Hospitals
• Medical offices
• Rural and urban community health centers
• Nursing homes
• Retail clinics
• Schools and university-based facilities
• Workplace clinics
• Correctional institutions
• The uniformed services and other federal government agencies

 
PAs work in all specialties.
The #1 most common specialty for a PA to work in is surgery.
Breakdown by specialty:
Surgery 21.5%
        Surgical subspecialty 18.5%
             Orthopedic surgery 10.9%
             Cardiothoracic surgery 3.4%
             Neurosurgery 2.2%
             Other 2%
        General surgery 3%
Family medicine 20.6%
Emergency medicine 13.2%
Internal medicine 5.2%
Dermatology 3.9%
Cardiology 2.9%
Pediatrics 2.0%
OBGYN 1.6%
Gastroenterology 1.6%
Occupational medicine 1.5%
Critical care 1.3%
Psychiatry 1.3%
Oncology 1.3%
Neonatology 1.1%
Urology 1.1%
Otolaryngology 0.9%
Neurology 0.8%
Rehabilitation 0.8%
Radiology 0.7%
Pain Management 0.6%
Anesthesiology 0.4%
Preventative medicine 0.2%
Radiation oncology 0.2%
Ophthalmology 0.1%
Palliative care <0.1%
 
PAs work in all US states.
Top 20 states with the most practicing PAs:
New York 8,717
California 7,053
Texas 6,275
Pennsylvania 6,108
Florida 5,574
North Carolina 4,512
Michigan 3,806
Georgia 2,742
Colorado 2,550
Illinois 2,472
Ohio 2,394
Virginia 2,378
Massachusetts 2,303
Washington 2,248
Maryland 2,192
Arizona 2,027
Wisconsin 2,015
New Jersey 1,982 (yay!)
Minnesota 1,958
Connecticut 1,629
 
The PA profession was ranked #1 "Best Master's Degree for Jobs" in 2014 and #1 "Most Promising Jobs" in 2015 by Forbes. This type of recognition year after year has helped spread awareness tremendously.
 
The PA profession is ranked #3 "Top 100 Best Jobs" in 2017 by US News. They looked as jobs that pay well, challenge you year after year, match your talents and skills, aren't too stressful, offer room to advance throughout your career, and provide a satisfying work-life balance. Here's how the PA profession ranked on a scale of 1-10 in these categories placing them as best job #3.
     Salary 7.8
     Job market 10
     Future growth 6
     Stress 4
     Work life balance 8
     Total Score: 35.8/50
 
NCCPA Statistical Profile from 2016:
Number of certified PAs: 115,547
Gender:     67.7% Female
                  32.3% Male
Age:     12.2%    <30
             37.6%   30-39
             23.2%   40-49
             13.7%    50-59
             8.3%     60+
Average age: 38 years old
Average number of patients seen per week: 74 patients
Unemployment rate: 0.6%
 
How much money does a PA make?
Average salary: $104,131
Breakdown by mean salary:
Pathology $119,000
Dermatology $118,145
Emergency medicine $116,661
Critical care $114,235
Surgical subspecialty $113,752
General surgery $106,504
Radiology $103,932
Pain management $103,154
Urology $102,197
Occupational medicine $101,924
Psychiatry $101,630
Radiation oncology $100,211
Neonatology $98,733
Anesthesiology $98,435
Palliative care $97,778
Cardiology $97,245
Gastroenterology $97,245
Oncology $97,245
Internal medicine $96,575
Family medicine $96,468
Otolaryngology $96,451
Rehabilitation $96,231
Neurology $95,606
Ophthalmology $94,545
Preventative medicine $93,231
OBGYN $89,942
Pediatrics $88,764
 
PA Myth Busting:

​​So what does all of this mean to me?
There are a lot of false perceptions about what PAs can and cannot do in a health care setting. It's important for our patients and for the public in general to become better educated on our abilities, so we can provide them with the highest quality of care. My class had a surgical PA specializing in spinal surgery come in and speak on a panel one day, and I like to share what he said with people to better paint the picture. "I work on the right side of the spine while the doctor does the left." PA's have much more autonomy and responsibility than some people realize. It is very natural for your attending to trust you with greater and greater responsibilities the more years you work with them. Share this quote with others when they question what a PA is actually capable of. Spread the word to a family member or friend, a college roommate or a grandparent, and little by little this up and coming profession will soon hold the full recognition it so deserves.
 
Sources: AAPA, NCCPA Statistics Profile 2016, Forbes, US News