What Is a PA?

 A PA in light pink scrubs administers a vaccination to a patient.

PA consistently ranks among the best jobs in the United States, yet many people are still unfamiliar with this health care career path. PAs—also known as physician assistants or physician associates—are patient care providers licensed to practice medicine in all 50 states, in every medical setting and all medical specialties. They work directly with patients, diagnosing injuries and illnesses, creating treatment plans and prescribing medications. In some environments, they act as principal care providers, and the scope of PA practice is growing in many parts of the U.S.

Even those somewhat familiar with this role may not be aware that PAs have one of the highest-paying and most in-demand jobs in the U.S. Many people are attracted to this health care pathway, not for the money, but because they can start making a profound impact in the lives of patients more quickly and for a smaller financial investment. Aspiring PAs in the University of Pittsburgh's 82-credit hybrid MS in Physician Assistant Studies program, for example, spend just under $115,000 for their degrees and can work as soon as they pass the National Commission on Certification of Physician Assistants (NCCPA) licensure exam—no extra training required.

If that sounds like your ideal pathway into a medical career, keep reading. This guide explores what PAs do, how to become a physician assistant, Pitt's Physician Assistant Studies Hybrid Program, the skills PAs need and even more reasons people choose this career.

What is a Physician Assistant?

The answer to the question 'What is a physician assistant?' is defined by what they do. PAs diagnose, monitor and treat patients, and their status as "advanced practice providers" affords them relative autonomy in most medical settings. They see patients and make decisions about patient care in collaboration with a physician or surgeon, but that doesn't mean they do exactly what physicians (or advanced practice registered nurses) do. PAs train as generalists and the traditional physician assistant education emphasizes preventative care, patient education and broad didactic and clinical training.

According to the American Academy of PAs (AAPA), this lets physician associates "provide a wide spectrum of patient care and treat the whole patient. For example, during an appointment with a PA working in cardiology, in addition to discussing the patient’s heart issues, a PA might notice a skin condition and either treat it or refer that patient to a dermatology practice." PAs can also move between specialties more easily than other providers.

The scope of physician assistant responsibilities typically includes examining and counseling patients, diagnosing illnesses and injuries, requesting diagnostic tests and interpreting results, creating treatment plans, prescribing medications, performing medical procedures and assisting in surgery. However, a PA's specific responsibilities will vary based on their professional experience, any additional training they complete, their specialty, where they work and applicable state laws.

The Difference Between PAs and MDs or DOs

Doctors and PAs both study for years and complete many clinical rotations to qualify for licensure, but MDs/DOs spend more time in school and longer in their clinical rotations before they can work independently. Despite this difference, they study many of the same subjects and hone many of the same competencies. The curriculum of MS in Physician Assistant Studies programs is similar to the traditional medical school curriculum, and the classroom experience of aspiring PAs and MDs/DOs is very similar. PAs also complete more than 2,000 hours of clinical rotations in internal medicine, family medicine, surgery, obstetrics and gynecology, emergency medicine, psychiatry and pediatrics.

What's important to understand is that most people don't decide to become a PA after deciding not to become an MD or DO. They choose this career path because they want to work directly with patients and see how physician assistants can positively impact the health care field. MDs, DOs and PAs work collaboratively in most settings, and studies show that PAs increase access to care, make care more cost-effective and make practices more efficient.

The most significant difference between PAs and MDs or DOs may be that PAs work under the oversight of physicians or surgeons even though all three types of providers provide direct patient care. The level of management PAs receive from supervising physicians varies by state and by facility. In some settings, a physician assistant's responsibilities may be identical to that of MDs or DOs on staff.

The Difference Between PAs and Nurse Practitioners

There are probably more similarities than differences between PAs and nurse practitioners (NPs)—at least in terms of scope of practice in specific settings. For instance, nurse practitioners and physician assistants work in the same settings and both can examine patients, take medical histories, diagnose illnesses and injuries and write prescriptions. PA training, however, is based on traditional medical education and includes a much broader range of clinical health care experience. PAs must also complete at least 2,000 hours of rotations versus a minimum of 500 for NPs. Additionally, nurse practitioners typically train in a specialty area based on population (e.g., pediatrics or women's health) while PAs study general medicine and get hands-on experience in a wider variety of medical specialties.

PAs Work in Many Different Settings

There are approximately 150,000 licensed PAs practicing in different medical settings across the United States. They work in all settings where physicians and surgeons work, but not all PAs work in patient care roles. Sometimes a physician assistant's responsibilities are non-clinical, and there are PAs in administrative, educational and research settings as well as in private practices, hospitals, outpatient clinics, surgical centers, community health centers, nursing homes and mental health facilities. Additionally, some PAs work as patient care providers in the armed forces.

Because Physician Assistant Studies programs cover an array of specialized subject matter, PAs can build unique career trajectories around their interests and professional preferences. Some work in family medicine or acute care. Others work in oncology, pediatrics, radiology or even surgery, where they assist during surgical procedures and provide post-surgery follow-up care. PAs can transition between specialty areas of medicine, and many do. One survey found that 57% reported changing specialties at least once and 49% did so during their first two years of practice.

Becoming a Physician Assistant

Aspiring PAs must graduate from ARC-PA-accredited, master's-level PA programs and pass the 300-question, five-hour, multiple-choice Physician Assistant National Certifying Exam (PANCE) to be eligible for licensure. Degree programs for physician assistants go by various names, including the Master of Physician Assistant Studies, the MS in Physician Assistant Studies, the Master of Health Sciences (MHS) in Physician Assistant Studies and the Master of Clinical Health Services (MCHS). The University of Pittsburgh's program is the PAS-Hybrid because it pairs interactive virtual lectures with hands-on immersion opportunities and clinical placements.

Physician assistant programs attract students with prior experience in patient care who want to make a more profound impact in medicine. Many students in the University of Pittsburgh Physician Assistant Studies Hybrid Program, for example, are RNs, EMTs or paramedics, nurse's aides or nursing assistants, respiratory therapists, medical assistants or otherwise professionally involved in patient care. This hands-on patient care experience is extremely useful in the PA Studies program, though students also have to meet specific academic prerequisites to be eligible to apply.

Most PA students have taken specific mathematics and science courses, and they usually have bachelor's degrees in one of the sciences or a discipline related to health care. In some cases, however, prospective PAS-Hybrid candidates must complete additional bachelor's-level coursework or experiential prerequisites to submit the most competitive application possible and prepare for what they'll encounter in the typical PA studies program. This includes a didactic curriculum covering clinical medicine, pharmacology, working with patients, diagnostic and therapeutic procedures, health policy and surgery, as well as intensive clinical rotations designed to give aspiring PAs experience in a wide variety of health care settings.

Upon passing the PANCE, newly-minted PAs may use the PA-Certified (PA-C) credential. Every state has distinct licensing processes, however. In Pennsylvania, for instance, PAs with a PA-C apply for licensure by filling out Pennsylvania State Board licensure applications and paying the necessary application fees. They also submit a criminal background check, a report from the National Practitioner Data Bank, letters of good standing, proof of education and a resume or CV. Finally, they complete approved training on child abuse recognition and reporting and the practices of prescribing opioids in the context of addiction.

What Skills and Knowledge Do PAs Need?

Physician assistants need highly developed hands-on clinical skills, which they learn in their clinical rotations, as well as a solid understanding of medical ethics and health care administration. They also need effective communication, decision-making, critical thinking and research skills because caring for patients involves more than just identifying and treating illnesses. Patients are people, and the U.S. health care system is large and complex, which is why Pitt PAS-Hybrid candidates study not only clinical medicine but also health care finance and systems, interprofessional collaborative practice, leadership, legal aspects of health care and population health.

They learn to communicate effectively and respectfully with different audiences, coordinate care for optimal outcomes and patient satisfaction, incorporate risk management into their practice, draw upon principles of public health and understand and operate within the financial constraints of patients, organizations and society.

PAs also need confidence—especially in settings where physician or surgeon oversight is indirect—which the PAS-Hybrid emphasizes in its approach to physician assistant education. Many groups also support an expanded scope of practice for PAs, allowing for increased independence or even independent practice in the future. Some states have even adopted expanded scope of practice laws for PAs to ease physician shortages.

How Much Do PAs Earn?

PAs earn more than double the national average across all occupations. The typical PA earns about $115,000 per year, according to the U.S. Bureau of Labor Statistics (BLS), and the highest-paid 10% earn more than $162,000 annually. Ambitious PAs who pursue additional certifications or education in specialty areas can earn more. For example, the average PA working in oncology earns about $149,000. There are also many non-clinical opportunities for PAs in hospitals and health settings, and these administrative and managerial roles can be as lucrative as or even more lucrative than clinical roles.

Average salaries don't tell a complete story, however. PA salaries can vary considerably by location. Top-paying states for physician assistants include Connecticut ($137,060), Washington ($129,520), New Jersey ($129,440), Alaska ($128,530) and California ($127,520). In Pennsylvania, a successful PA can earn $130,000, while a PA in Mississippi with the same physician assistant responsibilities might earn just over $80,000. Salaries also vary by experience level. PAs with 15-19 years of experience may earn up to $30,000 more per year than their less-experienced colleagues.

Reasons to Become a PA

The salary variations described above shouldn't give aspiring PAs pause. Physician associates are relatively high earners, and the fast-growing demand for PAs may drive salaries up further in the future. That said, there are several compelling reasons to become a PA that go beyond compensation.

The first two are job availability and job stability. According to the Association of American Medical Colleges, the U.S. may face a shortage of 120,000 physicians by 2030. It may very well be PAs who step in to bridge the gap, given that they work in the seventh-fastest growing profession in the country. Employers will create more than 40,000 new jobs for PAs in the next 10 years—a growth rate of 31%. Once they do, it's improbable that automation will affect the security or scope of those jobs. Becoming a PA almost certainly means having a job for life.

There is also the versatility of this health care career pathway. PAs work in every medical setting and specialty, and while every specialty has distinct practice guidelines, PAs are qualified to work in all of them once they're licensed. More importantly, they typically don't have to recertify to change specialties or work in new settings. They can launch a career they love, whether they prefer the hustle and bustle of the ER or the routine and relationships of family medicine, and then pivot if they discover a new area of interest.

PAs tend to have a better work/life balance than other practitioners. They don't spend as much time on call as physicians and have lower rates of burnout than either physicians and nurses. According to a Physician Assistant Education Association Student Survey, the number one reason people gravitate toward this career is that they want to work in medicine and have a personal life.

There's the fact that PAs can do much of what physicians do with less schooling. U.S. MDs and DOs complete about 14 years of higher education: four years of college, four years of medical school and three to eight years in a residency or fellowship. PAs can treat patients after completing just six to nine years of higher education and comprehensive clinical rotations. Students graduate from Pitt's PA Studies Hybrid Program in just 24 months and start making a difference in the lives of patients and their communities soon after.

Finally, there's the fact that PAs have a measurable impact on patients and health systems. Physician assistants play a crucial role in providing underserved patient populations (e.g., the uninsured, rural-dwelling individuals) and will likely provide even greater access to care in the future. In some areas of the United States, PAs are the only licensed health care providers for miles around. And they can often spend more time with their patients than other providers because they don't have to worry about budgets and bureaucracy in the same way physicians do.

Whether that leads to better patient outcomes is something researchers don't know yet. What's clear, however, is that PAs do a lot to make medicine better. If you want to become one of them, now is the time to apply to the University of Pittsburgh's PAS-Hybrid program. To learn more, register for an upcoming webinar to connect with the enrollment team and get your questions answered.

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