Physician Assistants Impact on the Medical Field

Eva Farrell

English III Honors Pd. 6

Mr. Alburger

February 23, 2017

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Eva Farrell

Mr. Alburger

English III Honors

23 February 2017

Physician Assistants Impact on the Medical Field

Throughout the years, patients have waited hours in order to receive healthcare from a

physician, but the emergence of the physician assistant (PA) profession has decreased the wait

time. Rather than a patient going to a physician, physician assistants provide the same health care

at a more efficient rate and less cost. Physician assistants play a major role in the medical field

by increasing the amount of patients seen on a daily basis, while still providing great medical

care. They work with their leading physician to provide the best medical care for their patients.

The training PAs receive certifies them to work in medicine since they obtain a wide range of

medical knowledge and skills; these skills increase access care for patients and decrease the

workload of doctors (Stuemky). Due to the intensive schooling physician assistants receive, and

the amount of medical knowledge they must obtain, it takes PAs out of the nurse category. The

physician assistant profession holds a positive job outlook, and earns a salary enough to provide

for a family. Depending on the facility and specialty a physician assistant works in, the work

hours differ. The career of physician assistants has changed over the years from working in the

military to assisting in hospitals, resulting in intensive education requirements to provide similar

medical care to that of a physician, which increases the productivity of the healthcare facility in

which they work.

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In the 1960s, the physician assistant profession first emerged in the military due to a

shortage in doctors (Hariharan). After years of deciding how to solve this shortage in medical

care, creating a new profession in the medical field provided the best results. Eugene A. Stead

Jr., a doctor at Duke University Medical Center, helped aid the shortage of health care providers

by organizing the first class of physician assistants in 1965 (History). After thinking about the

types of people to become the first physician assistants, Stead recruited men used as medical aids

in the army. Stead chose four men who received a substantial amount of medical training from

the Navy Hospital Corpsmen (History). Consequently, war acted as a great hands-on training

experience for the PA career. Men returning from Vietnam did not find a place to apply their

medical training and experience from the war, but became perfect candidates for the physician

assistant profession (Stuemky). The men who underwent medical training during the Vietnam

War highly benefited from the new career, since it helped ease them back into normal living

conditions by providing them with jobs. Due to prior medical experience, these men knew how

to handle most medical situations and easily qualified for the physician's assistant profession.

The first class of physician assistants graduated from Duke University on October 6, 1967

(History). The beginning of this new medical profession changed the way healthcare works

today.

Originally, the concept of the PA profession started off as a suggestion to the National

League of Nursing in order to expand the responsibilities and roles of specific nurses, but the

leaders of this nursing program did not support this concept, and declined to the idea of nurses

expanding their capabilities (White). The expense of sending nurses back into schooling to learn

advanced medical techniques did not seem practical for the medical field. Once discovered,
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physician assistants held important roles in hospitals, and first worked in the hospital at Duke

University Medical Center, the place where the profession came about (Cawley). By working in

hospitals, physician assistants increased the efficiency of patient care. Introducing the physician's

assistant profession in the 1970s as the solution to physician shortages immediately gained

acceptance from the government (History). The increase in patient care provided many

benefits to the medical field, including a growth in income towards the working PAs facility.

Other medical professions endorsed the new profession by establishing standard examinations,

certification standards and processes, and the continuation of medical education requirements in

order for physician's assistants to become officially certified (History). Physician assistants

became official and respected members of the medical field.

Physician assistants established a designated academy for the PA profession since it

became a certified career in the medical field. The establishment of the American Academy of

Physician Assistants (AAPA) took place in North Carolina in the year 1968 (History). This

academy serves to unite all physician assistants. Graduates of the Duke University PA program

became the first members of the American Academy of Physician Assistants (History). Once

the AAPA entered the medical field, physician assistants took part in their role of the medial

field and began partnering with physicians. The founders of the PA profession believed the key

to success lays in the strong practice relationship between the PA and physician (Cawley). In

order to provide the best medical care for patients, the PA and physician must obtain a strong

practice relationship.

Aspiring physician assistants must attend a two year graduate-level PA program in order

to become a licensed and certified physician's assistant (Stuemky). This program provides all of
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the knowledge a PA will need in order to succeed in the medical field. The top PA programs in

the country consist of Duke University in North Carolina, Emory University in Georgia, and

Yale University in Connecticut (Best). The article ranked Duke University as the top PA

program in the nation. Once completing graduate school, physician assistants obtain a masters

degree (Smith). Physician assistant programs involve rigorous courses in order to train and teach

students basic medical skills and knowledge. Before PAs enter a graduate level program, they

usually work in the medical field for a few years as a nurse or paramedic with an undergraduate

degree (Stuemky). Prior knowledge in the medical field will make learning new skills for

becoming a physician assistant less challenging. The first year of Physician Assistant School

involves basic PA curriculum, which includes fundamental sciences, such as anatomy,

physiology, diagnosis, organ systems, and treatment algorithms (Hlavin). It also involves more

of a class setting, while the second year becomes more hands-on and involved with medical

techniques and patients. The second year of schooling becomes more intense, involving clinical

clerkships and rotations. In clerkships, students apply their first year knowledge, and work hands

on with practice models (Hlavin). Rotations expose the PA to a variety of medical field

specialties, such as pediatrics and dermatology. Once students become more comfortable

performing basic PA procedures, they start branching out into specialties they possibly want to

pursue. Students also experience working with a practicing physician and other physician

assistants in specific medical branches including: obstetrics, surgical medicine, family practice,

and orthopedics (Kelly). After completing the physician assistant program, students take a

required board test for certification. The National Commission on Certification of Physician
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Assistants provide the exam for physician assistants (Hariharan). After a student passes the board

exam, he or she become a licensed physician assistant in the medical field.

Controversial aspects revolve around the profession due to recent changes in the

recertification process changing significantly. After becoming a licensed PA, the National

Commission on Certification of Physician Assistants require a proctored, closed-book exam

based on the physician assistants specialty. This exam determines whether or not a PA can

continue working in their profession. These recertification requirements include two or three

take- home tests along with the closed-book exam (Pagel). Physician assistants argue against the

new method of recertification due to the injustice of retesting. Physician assistants must retest

every six years, while the physicians retest every ten years (Pagel). Physician assistants feel that

the doctors should retest sooner since they hold more authority in the medical field. The

intensive medical training physician assistants undergo already takes licensing requirements

similar to that of a physician, nurse practitioner, and pharmacist (Pagel). The importance of

passing a test in the medical field proves whether or not a physician can provide proper medical

care to patients. Rather than focusing on taking a retest years after becoming licensed, physician

assistants must focus on the health care they provide their patients. The American Medical

Association argues against the exams due to the high stakes that can lead to privilege loss and

unemployment for a PA (Pagel). By ridding the recertification exam, physician assistants could

focus more on their patients and provide better quality health care.

Physician assistants provide medical care and complete tasks similar to that of a

physician, but must run their procedures and plans by the leading physician first. Physician

assistants accommodate the busy work schedules physicians handle daily. These
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accommodations include caring for certain patients and handling medical procedures, such as

ordering an x-ray or ultrasound. Since physician assistants alleviate the schedule of a physician,

PAs might need to finish work at home which could include reviewing prescription requests,

reading notes from specialists, or looking at lab images (Smith). The physician assistant finishing

the work of the doctor acts as an example of how the PA and physician work together. Physician

assistants can handle many tasks including taking patient histories, conducting physical

examinations, treating illnesses, assisting or performing in surgery, and ordering tests (Stuemky).

They perform procedures similar to ones performed by M.D.s, meaning Doctor of Medicine,

and the corresponding M.D. skills to medical care, such as patient education, health promotion,

and disease prevention (Cawley). Physician assistants can perform diagnostic and therapeutic

procedures and prescribe medications after consulting their leading physician. They also have the

ability to diagnose a patient by reading the history of the individual and performing a physical

examination (Watkins). Physician assistants allow for the physicians to broaden their schedules,

maintain good quality medical care, and reduce medical cost by improved practice performance

and physician productivity (Hlavin). PAs provide a variety of benefits for their patients and

leading physician. These benefits include a more flexible schedule for physicians, an increase in

patient satisfaction, increased revenue, and an increase in efficiency (Stuemky). Physician

assistant acquire the ability to choose a medical specialty to focus on, including pediatrics,

obstetrics, and dermatology.

Physician assistants who tend to work in hospitals obtain a broader range of medical

knowledge since they work with multiple surgical units. Hospital physician assistants work in

almost all surgical departments and work with the physician in those surgical specialties
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(Hospital). Since hospital physician assistants acquire a wider range of medical knowledge,

they tend to perform more complex procedures within their specialty. While working in a

hospital setting, physician assistants take part in cardiac transplant teams, burn units, and

neurology (Cawley). Once a physician assistant earns their license, he or she will look for a

higher position in the medical field, such as working under a neurologist or cardiologist.

Physician assistants most commonly work in pediatric, surgical, and inpatient medical wards

(Cawley). Choosing a specialty to focus on allows a PA to utilize their medical knowledge and

training in that area, making the job somewhat easier. Training in certain specialties increases the

income for physician assistants (Hlavin). From nursing homes to large public health care

centers, physician assistants work in any aspect of the medical field.

Physician assistants and physicians must build a strong relationship while working

together in order to provide the best health care for their patients. Physicians hold responsibility

for the actions performed by a PA, therefore a physician and physician assistant must maintain a

relationship built on trust and communication (Hlavin). A PA must consult with the physician

before prescribing a medication or performing a medical procedure in order to maintain a

trustworthy partnership. Due to physicians working a limited amount of hours, PAs must fill in

and work the remaining hours (Hlavin). Physician assistants filling in the rest of a physicians

work hours results in the decrease of mistakes a physician could make due to a lengthy and

exhausting work day. Since physician assistants do not hold the same authority or power as a

physician, certain specialties lack full trust from the physician. Specifically, urologists, remain

hesitant about putting their physician assistants to work. Urologists do not understand their PAs

full range of capabilities in medicine, and remain skeptical about allowing their PAs to perform
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procedures (Hilton). This skepticism comes from physician assistants not obtaining a medical

degree, and not acquiring the same level of education as their physician. Physicians can resist the

care provided by a PA, but physician assistants can carry out any clerical medical order a

physician can (Hilton). Other specialties, such as cardiothoracic surgery, dermatology, primary

care, and orthopedics allow their PAs to assist more in their practices (Hilton). Most specialists

use their physician assistants to their full capacity, and trust their PAs performing certain

procedures and treatments.

Physician assistants often get confused with the nursing profession, specifically with a

registered nurse (RN). Although PAs and RNs have similar qualities, the education requirements

and daily tasks greatly differ between the two jobs. Physician assistants must stick to one route

of education which includes graduate PA school, whereas registered nurses can choose between

three different education requirements. Registered nurses can obtain either a diploma, associates

degree, or a bachelors of science in nursing degree (Xu). After earning one of these degrees, a

nurse must take an exam to become a certified registered nurse. Registered nurses must pass the

National Council Licensure Examination for certification (Xu). Physician assistants must pass

the board exam give by the National Commission on Certification of Physician Assistants, and

retest every six years in order to remain certified, unlike a registered nurse. A registered nurse

completes a nursing program, and may or may not have a bachelors degree depending on where

they went to school (Smith). Unlike a physician assistant, registered nurses can become

certified without obtaining a certain degree, but a PA must acquire a degree from physician

assistant school. They require a more rigorous education than that of a registered nurse since PAs

execute medical procedures similar to a doctor (Xu). In perspective, the educational

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requirements and medical procedures a PA handles compares more to a doctor rather than nurse.

Daily tasks these two careers handle differ as well. Registered nurses prep the patients for the

physician assistant or doctor. A registered nurse cannot order or interpret labs, care for a patient

alone, or perform certain procedures without a physician or physician assistant present (Smith).

The physician or physician assistants job involves checking patients one on one, and ordering

labs and treatments if needed. According to the U.S. Department of Labor, registered nurses take

vital signs of patients, monitor symptoms, and prep the patients for exams or treatments (Xu).

The doctor or PA orders these treatments and procedures for an RN to complete. Physician

assistants perform some similar tasks as a registered nurse, however PAs work closer with the

patients, and collaborate with a physician (Xu). Rather than prepping patients and taking their

vitals, physician assistants interact with their patients and discuss a possible diagnosis for these

individuals.

From 2014 to 2024, the employment of physician assistants expects to increase by 30%,

faster than the average of all other occupations (Physician). As the population grows and ages,

the need for PAs will increase due to the high demand for healthcare. More people means an

increase in health care. For example, Baby Boomers, a group of people born between 1946-1964,

will need medical attention as they age (Physician). The Baby Boomer population ages

together, and will most likely encounter medical conditions during the same time. This will lead

physician assistants to provide backup care for the overloaded physicians. Chronic diseases, such

as diabetes, will increase the demand for PAs to provide care for the ill (Physician). As these

diseases spread and affect more people, physician assistants, along with pharmacists and doctors,

could possibly find a cure for diabetes along with other chronic diseases after treating them many
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times. Physician assistants will start obtaining a larger role in routine medicine since they

provide medical care at a more effective cost compared to physicians (Physician). Families not

able to afford medical care from a physician can see a PA in order to save money. Primary care

will become a main focus for physician assistants when physicians start to retire or enter into

different specialties of medicine (Physician). In the future, PAs might dominate the primary

care field. As states allow physician assistants to practice more medical procedures, the

profession will expand (Physician). Due to the PA career expanding throughout the United

States, more students entering physician assistant graduate school will obtain a greater chance at

acceptance since the need for physician assistants will increase.

The physician assistant career provides an income that comfortably supports a family. In

May of 2015, a physician assistant earned a median pay of about $98,180 (Physician). This

median pay differs for every physician assistant. About 10% of physician assistants earned less

than $62,760, and 10% of the highest paid physician assistants earned over $139,540

(Physician). The salary they earn usually depends on the specialty PAs works in or the state in

which they practice. The majority of physician assistants work full time, and only one in five

work part time based on data collected in 2014 (Physician). Physician assistants who work in

hospitals tend to have a more rigorous schedule. Hospital physician assistants have a possibility

of working night shifts, weekends, holidays, and on call (Physician). Working on call means a

physician assistant must respond to a work request with short notice. Depending on the specialty

or work facility a physician assistant works in, the salary and work schedule varies.

The physician assistant profession started off as an extra medical job in the military, but

later evolved into a significant medical career, resulting in rigorous education requirements to
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provide medical care similar to that of a physician. The physician assistant profession benefits

health care productivity by acting as another doctor. This well-rounded profession involves a

two-year graduate program meant to train students in proper medical care, and a board certified

exam students must take before entering the PA field. Physician assistants positively impact the

medical field by providing quality medical care efficiently, cost effectively, and most

importantly, successfully.
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