Physician assistant

History
The profession of physician assistant (PA) originated in the mid 1960s with leadership from Duke University, the University of Colorado, the University of Washington, and Wake Forest University. The early 1970s brought a rapid growth in the number of such educational programs, which were supported initially with $6.1 million appropriated under the authority of the Health Manpower Act of 1972. The funding also supported some of the initial organization and administration of the national program for the accreditation of educational ­programs in this field, specifically those designed to prepare ­individuals as assistants to primary care physicians. Since 1992, the number of accredited PA programs has more than doubled from 55 to 137.

Occupational description
The physician assistant is academically and clinically prepared to practice medicine with the direction and responsible supervision of a doctor of medicine or osteopathy. The physician-PA team relationship is fundamental to the PA profession and enhances the delivery of high-quality health care. Within the physician-PA relationship, PAs make clinical decisions and provide a broad range of diagnostic, therapeutic, preventive, and health maintenance services. The clinical role of PAs includes primary and specialty care in medical and surgical practice settings. PA practice is centered on patient care and may include educational, research, and administrative activities.

The role of the physician assistant demands intelligence, sound judgment, intellectual honesty, appropriate interpersonal skills, and the capacity to react to emergencies in a calm and reasoned manner. An attitude of respect for self and others, adherence to the concepts of privilege and confidentiality in communicating with patients, and a commitment to the patient’s welfare are essential attributes of the graduate PA.

Employment characteristics
The 2005 Physician Assistant Census, published by the American Academy of Physician Assistants, indicates that of the more than 58,600 practicing physician assistants, about 41% are practicing in primary care. Family practice is the most common specialty for physician assistants (28.4%), followed by surgery and surgical subspecialties, emergency medicine, subspecialties of internal medicine, general internal medicine, and dermatology.

The majority of physician assistants practice in ambulatory care settings. Solo and group practices employ 56.4% of all physician assistants. The number of physician assistants employed by hospitals is 22.4%, owing in part to the number of physician assistants working as house staff. The government employs almost 10% of the physician assistant workforce, primarily in the military and the Department of Veterans Affairs. The remaining members of the profession are practicing in community health centers, managed care organizations, freestanding urgent care centers, correctional facilities, and other settings.

Physician assistants work an average of 44.3 hours per week. The number of patient visits for physician assistants in outpatient settings averages 96.5 per week; in inpatient settings the average is 67.3 patient visits per week. Forty percent of physician assistants have on-call responsibilities that average 96 hours per month.

Salary
Salaries vary depending on the experience of the individual, the practice specialty, job responsibilities, and the regional cost of living. Refer to Section IV, Table 5 of this Directory for more information, or see www.ama-assn.org/go/hpsalary.

Educational programs
Length. Although 25 to 27 months is most common, the length of programs varies, largely owing to a difference in student selection criteria and in the educational objectives of the individual program.
Prerequisites. Although requirements differ widely, a majority of programs require 2 years of undergraduate study and some work experience in health care. A balance of study in the applied behavioral sciences and the biological sciences is advised for students who wish to qualify for admission to a physician assistant program.
Curriculum. Accreditation standards require competency-based curricula. The professional curriculum for PA education includes basic medical, behavioral, and social sciences; clinical preparatory sciences, patient assessment, and supervised clinical practice; health policy; and professional practice issues. Four-year programs are designed to provide the student with a balance of traditional liberal arts courses and biological and applied behavioral science courses. These courses are prerequisites to clinical didactic and supervised clinical practice instruction common to both 2-year and 4-year programs. Supervised clinical practice rotations in pediatrics, family medicine, internal medicine, prenatal care and gynecology, geriatrics, emergency medicine, psychiatry/behavioral medicine, and surgery offer advanced applied content and supervised clinical work experience in dealing with commonly encountered demands for the primary health care of individuals from infancy through childhood, adolescence, and the various phases of adulthood.

Licensure
All 50 states, the District of Columbia, and the majority of US territories have enacted laws regulating the practice of physician assistants. In order to practice as a physician assistant, an individual must meet the state’s licensing criteria and have a supervising physician. Forty-nine states and the District of Columbia allow physicians to delegate prescriptive authority to the PAs they supervise.

Inquiries

Careers
American Academy of Physician Assistants
950 N Washington St
Alexandria, VA 22314
(703) 836-2272
(703) 684-1924 Fax
E-mail: aapa@aapa.org

Physician Assistant Education Association
300 North Washington Street, Suite 505
Alexandria, VA 22314-2544
703 548-5538
703 548-5539 Fax
E-mail: info@PAEAonline.org

National certification
National Commission on Certification of Physician Assistant   
12000 Findley Road, Suite 200
Duluth, GA 30097
(678) 417-8100

Program accreditation
Accreditation Review Commission on Education for the Physician Assistant 
John McCarty, Executive Director
12000 Findley Road, Suite 240
Duluth, GA 30097
(770) 476-1224
(770) 476-1738 Fax
Email: arc-pa@arc-pa.org