Scope of Practice

What's the difference between physician assistants and physicians?

Timothy M. Smith , Contributing News Writer

AMA News Wire

What's the difference between physician assistants and physicians?

Dec 4, 2023

Education matters. It undergirds the quality, safety and cost-effectiveness of care patients receive every day. That’s why lawmakers should tread very lightly when considering proposed scope of practice changes that would give physician assistants (PAs) more latitude to practice independently.

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Patients overwhelmingly agree on this point too. More than 90% say that a physician’s years of training are vital to optimal patient care, especially in the event of a complication or medical emergency.

Fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians.

Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety.

Physician assistant programs usually run about two years long, or perhaps two and a half. In addition, physician assistants have no residency-training requirement.

Compare that with physicians’ training, which includes four years at a medical school—none of which are online-only—along with three to seven years of residency and fellowship training, depending on the physician specialty they pursue.

Physician assistants are trained in the medical model, but it is—intentionally—greatly abbreviated. It covers basic sciences, pharmacology, clinical medicine and behavioral sciences, but the number of hours of didactic training is about half of that in medical school.

Beyond that, physician assistants get only about 2,000 hours of supervised clinical practice in their master’s level training. By comparison, between medical school clinical rotations and residency training, physicians amass between 12,000 and 16,000 hours of patient-care experience.

Postgraduate programs do exist for physician assistants, but less than 5% of PAs pursue this additional training, for which they receive certificates of added qualifications. However, physician assistants are not required to practice in the specialty for which they have certificates of added qualifications or postgraduate training, and specialty switching is common. In 2021, for example, less than half of physician assistants with postgraduate training in primary care still practiced in that area.

For several years, physician assistants have been pushing scope expansion at the state level, often based on the model Optimal Team Practice Act. Among other things, the model—set forth by the physician assistants’ national trade organization, the AAPA—seeks to remove language requiring physician supervision of physician assistants, instead allowing collaboration with other health professionals or even employers.

The problem is that physician assistants are not ready to practice independently—something their own educators acknowledge.

According to 89% of physician assistant program medical directors, 86% of PA program directors, and 100% of past presidents of the Physician Assistant Education Association—the only national organization representing physician assistant educational programs in the U.S.—their current curriculum does not prepare graduates to practice without “a supervisory, collaborating or other specific relationship with a physician.”

This position is even held by physician assistant students themselves. More than 90% have said the collaborating physician relationship is either essential or very important.

Find out in detail why education matters to medical scope of practice, with information on:

  • Nurse practitioners compared with physicians.
  • Physician assistants compared with physicians.
  • Nurse anesthetists compared with anesthesiologists.
  • Psychologists compared with psychiatrists.
  • Naturopaths compared with physicians.

Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.

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Expanding physician assistants’ scope of practice results in higher-cost, lower-quality care. Studies have shown or suggested that physician assistants make more referrals, exhibit lower diagnostic skill and order more diagnostic tests, and prescribe more opioids and more antibiotics than physicians do.

Forty-six states require physician supervision or collaboration of physician assistants, and in nearly all states, physician assistants’ scope of practice is determined with a supervising or collaborating physician at the practice site.

The AMA’s position on physician assistants is that they should be regulated by state medical boards to best reflect the supervisory nature of the relationship between physician assistants and physicians. In addition, medical licensing boards should serve a crucial role in facilitating efficient, safe and productive relationships between physicians and physician assistants.

The AMA has adopted policy opposing legislation or regulation that allows physician assistant independent practice and supports the regulation of physician assistants by state medical boards.

Learn more with the AMA about great resources that set the record straight for policymakers on scope of practice. The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to use when fighting scope creep.

And find out more with the AMA about how expanding physician assistant scope of practice (PDF) leads to higher costs, greater opioid and antibiotic prescribing, and increased x-ray ordering than care provided by physicians.