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Physician Assistants

(D.O.T.  079.364-018)

Nature of the Work

As their title suggests, physician assistants (PA's) support
physicians.  However, they should not be confused with medical
assistants (see elsewhere in the Handbook).  PA's are formally
trained to perform many of the routine but time-consuming tasks
physicians usually do.  They take medical histories, examine
patients, order and interpret laboratory tests and x rays, and make
preliminary diagnoses.  They also treat minor injuries by suturing,
splinting, and casting.  PA's record progress notes, instruct and
counsel patients, and order or carry out therapy.  In 35 States and
the District of Columbia, physician assistants may prescribe
medications.  PA's may have managerial duties too.  Some order
medical and laboratory supplies and equipment; others supervise
technicians and assistants.

   Physician assistants always work under the supervision of a
physician.  The extent of supervision, however, depends upon the
location.  For example, PA's working in rural or inner city clinics,
where a physician may be available just 1 or 2 days each week, may
provide most of the health care for patients and consult with the
supervising physician by telephone.  Other PA's may make house calls
or go to hospitals to check on patients and report back to the
physician.

   In some States, the duties of a physician assistant are determined
by the supervising physician; in others, they are determined by the
State's regulatory agency.  Aspiring PA's should investigate the
laws and regulations in the States where they wish to practice.

   PA's assist physicians in specialty areas, such as general and
thoracic surgery, emergency medicine, and pediatrics.  PA's
specializing in surgery, also called surgeon assistants, provide
pre-and post-operative care and may work as first or second
assistants during major surgery.

   Most physician assistants work in physicians' offices and clinics.

Working Conditions

Although PA's generally work in a comfortable, well-lighted
environment, those in surgery often stand for long periods, and
others do considerable walking.  Schedules vary according to
practice setting and often depend on the hours of the 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 held about 58,000 jobs in 1992.  Most PA's work
in physicians' offices and clinics.  Others work in hospitals.  The
rest work for public health clinics, nursing homes, prisons, and
rehabilitation centers.

   About one-third of all PA's provide health care to communities
having fewer than 50,000 residents where physicians may be in
limited supply, according to the American Academy of Physician
Assistants.

Training, Other Qualifications, and Advancement

Almost all States require that new PA's complete an accredited,
formal education program.  In 1993, there were 57 such educational
programs for physician assistants, including three programs for
surgeon assistants.  Thirty-seven of these programs offered a
baccalaureate degree or a degree option.  The rest 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.  Students
should take courses in biology, English, chemistry, math,
psychology, and social sciences.  More than half of all applicants
hold a bachelor's or master's degree.  Many applicants are former
emergency medical technicians, other allied health professionals, or
nurses.

   PA programs generally last 2 years.  Most are located in medical
schools, schools of allied health, or 4-year colleges; a few are in
community colleges and in hospitals.  Many accredited PA programs
have clinical teaching affiliations with medical schools.

   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.  Students obtain supervised
clinical training in several areas, including 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.  These rotations often lead to permanent
employment.

   As of 1993, 49 States, the District of Columbia, and Guam had
legislation governing the qualifications or practice of physician
assistants.  Mississippi did not.  Forty-six States required
physician assistants to pass a certifying exam that is only open to
graduates of an accredited educational program.  Only those
successfully completing the examination may use the credential

   Physician Assistant-Certified (PA-C).  In order to remain certified,
PA's must have 100 hours of continuing medical education every 2
years and pass a recertification examination every 6 years.

   PA postgraduate residency training programs, as yet unaccredited,
are available in emergency medicine, gynecology, geriatrics,
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.

   Physician assistants need leadership skills, self-confidence, and
emotional stability.  They must be willing to continue studying
throughout their career to keep up with medical advances.

   Some PA's pursue additional education in order 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 opportunities are expected to be excellent for physician
assistants, particularly in areas or settings that have difficulty
attracting enough physicians, such as rural and inner city clinics.

   Employment of PA's is expected to grow faster than the average for
all occupations through the year 2005 due to anticipated expansion
of the health services industry and an emphasis on cost containment.
Physicians and institutions are expected to employ more PA's to
provide primary care and assist with medical and surgical
procedures, thus freeing physicians to perform more complicated and
revenue generating tasks.  The public and third party payers also
seem to approve of PA's use.  For example, Medicare now allows
physicians to bill the government for services provided by PA's in
hospitals and nursing homes.

   Besides the traditional office-based setting, PA's should find a
growing number of jobs in institutional settings such as hospitals,
academic medical centers, public clinics, and prisons.  The growth
of HMO's and group medical practices should also lead to more jobs
since they use PA's to provide a wide variety of services because
their salaries are lower than those of physicians.

Earnings

According to a University of Texas Medical Branch survey of
hospitals and medical centers, the median annual salary of physician
assistants, based on a 40 hour week and excluding shift or area
differentials, was $41,038 in October 1992.  The average minimum
salary was $32,466 and the average maximum was $49,782.

   According to the American Academy of Physician Assistants, the
average salary for all physician assistants in 1993 was between
$50,000 and $55,000.  Salaries vary by specialty, practice setting,
geographical location, and years of experience.

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.

Sources of Additional Information

   A free brochure, Physician Assistants, PArtners in Medicine,
available from:

   American Academy of Physician Assistants, 950 North Washington St.,
Alexandria, VA 22314.

   For a list of accredited programs and a catalog of individual PA
training programs, contact:

   Association of Physician Assistant Programs, 950 North Washington
St., Alexandria, VA 22314.

   For eligibility requirements and a description of the Physician
Assistant National Certifying Examination, write to:

   National Commission on Certification of Physician Assistants, Inc.,
2845 Henderson Mill Rd.  NE., Atlanta, GA 30341.