A physician assistant in Canada, the United States, and other select countries or physician associates in the United Kingdom (PA) can also be called an Advanced Practice Provider (APP).
Physician assistants are healthcare professionals who diagnose ailments, create and manage treatment plans, prescribe medications, and frequently function as a patient’s primary healthcare provider.
Having gone through tons of hours of medical training, physician assistants are versatile and collaborative. They practice in every state and many medical settings. In the United States and Canada, physician assistants are nationally certified by their respective certifying bodies.
Physician assistants fully attain their qualifications for certification in a shorter period. It is shorter than a conventional medical degree due to the adherence to an educational outline hinged on physicians’ fast-tracked training during the scarcity of providers during World War II.
History of physician assistants
In 1961, Charles Hudson recommended to the American Medical Association the emergence of new medical providers. Eugene A. Stead of the Duke University Medical Center in North Carolina gathered the first class of physician assistants in 1965, comprised of four former US Navy Hospital Corpsmen.
He established the physician assistant program’s curriculum on his first-hand knowledge of the fast-track education of medical doctors during World War II. Two other physicians, Hu Myers at Alderson-Broaddus College in Philippi, West Virginia, and Richard Smith at the University of Washington in Seattle, also introduced their programs in the mid and late 1960s. Dr. J. Willis Hurst also began the Emory University Physician Assistant Program in 1967.
Starting in January 1971, the US Army churned out eight classes of physician assistants, at the rate of 30 students per class, via the Academy of Health Sciences, Brooke Medical Center, Fort Sam Houston, Texas (academically accredited by Baylor University, Texas). Fast forward to 2017, roughly 68% of physician assistants in the United States identified as female and about 32% identified as male.
As a profession, physician assistants have primarily impacted the theory and conceptualization of socially accountable health professional education.
The profession has grown worldwide. It can now be seen in Afghanistan, Australia, Canada, Germany, Ghana, India, Israel, Liberia, the Netherlands, New Zealand, Saudi Arabia, and the United Kingdom. Several countries do not use the term but have human resources recruited to do similar kinds of work.
In Africa, they are known as clinical officers. They are referred to as clinical associates in South Africa, assistant medical officers in Malaysia, assistant doctors in China, health extension officers in Papua New Guinea, and feldshers in countries previously making up the Soviet Union.
Overview of physician assistants
Physician assistants or physician associates are capable of:
- Handling patient interviews and compiling medical histories
- Organizing physical examinations
- Ordering and interpreting diagnostic tests and exams
- Diagnosing ailments
- Developing treatment plans
- Coordinating and managing care
- Performing medical procedures
- Prescribing medications
- Conducting clinical research
- Patient counseling
- Advising on preventative health care
- First assist in surgery.
Physician assistants train to operate in clinical environments such as hospitals, clinics, and other health facilities or even remotely via telemedicine services. They are typically found working in academics, teaching, and research. They are also found in hospital administration and other clinical environments.
Physician assistants may operate in general care or medical specialties, including emergency medicine, surgery, cardiology, etc. Comprehensive clinical training is required before obtaining certification to serve as a physician assistant.
Physician assistant training is similar to physician training but takes less time. Renewing one’s certification is usually required every few years, depending on the jurisdiction.
Physician assistants may also conclude residency training, just like physicians’ residencies, but again, most typically take a shorter period. This occurs in specialized areas such as OB/GYN, emergency medicine, critical care, orthopedics, neurology, surgery, and other medical disciplines.
A convincing 2015 Netherland study conducted on physician assistants in four different care models studied tasks, performed, and revealed that direct and indirect patient care on a hospital ward varies.
The researchers concluded that physician assistants in PA-only models expended a more extended period on direct patient care and attained the highest provider continuity. A Dutch cross-sectional study on general skill levels revealed that PA students and physicians score roughly equal on taking histories, physical examinations, and interaction.
Overview of the profession in selected countries
Physician assistants in the United Kingdom
The position of physician associate was founded in the United Kingdom in 2005. It evolved from that of a physician assistant, established in the US in the 1960s. In 2012, the profession elected to restructure the name to physician associate to separate it from another with identical nomenclature within the NHS.
Hillingdon Hospitals NHS Foundation Trust was requested to coordinate 200 physician associates expected to come from the US for 40 NHS trusts in September 2015. The Faculty of Physician Associates is the professional body for Physician Associates operating in the United Kingdom.
The faculty was formally introduced in July 2015, assuming control over every professional body’s rights from that moment onwards. The faculty coordinated the managed voluntary register, to which all practicing associates are advised to become members. This includes structuring and running the National Assessment Examination and National Recertification Examination.
Physician Associates/Assistants are educated under the medical model, their training in close semblance to physicians, to provide medical care in primary and auxiliary care settings. Upon graduation, they can attain specialty in various medical fields, including acute medicine, primary care, emergency medicine, surgery, and psychiatry.
The role has evolved to offer medical services similar to house officers or senior house officers. They are trained to carry out different tasks, including diagnosis, treatment, complex medical procedures, and taking medical histories.
Training for this profession in the UK is via a two-year fast-tracked medical training (MSc or Postgraduate Diploma) in Physician Associate Studies.
In 2017, there was a minimum of 32 universities offering these programs. Some of them include:
- University of Bolton
- University of Hertfordshire
- Queen Mary University of London
- University of Aberdeen
- University of Bradford
- Anglia Ruskin University
- University of Birmingham
- Canterbury Christ Church University
- University of East Anglia
- Hull York Medical School
- University of Leeds Manchester Medical School
- University of Liverpool
- University of Central Lancashire
- Newcastle University
The median entry-level salary of a physician associate (PA-R) in the United Kingdom is Band 7 (£37,000) and can differ depending on locations.
In London, the median remuneration is roughly £43,000 and can go as high as £50,000 with experience, especially with lead PAs.
PAs are also capable of doing locum shifts in addition to their full-time job. Remuneration of physician associates in the United Kingdom remains lesser than in the United States and Canada. However, physician associates’ remuneration in the United Kingdom is in the same pay category as other advanced care providers such as nurse practitioners.
Physician assistant in the United States
In the United States, the profession is embodied by the American Academy of Physician Assistants. Every physician assistant is mandated to graduate from a nationally accredited ARC-PA program and scaling through the national certification exam.
It wasn’t until 1970 that the AMA adopted a resolution to create educational guidelines and certification protocols for physician assistants. The Duke University Medical Center Archives had founded the Physician Assistant History Center, committed to the study, maintenance, and exhibition of the profession’s history.
The PA History Center became an independent institution in 2011. It was renamed the PA History Society and is now situated in Johns Creek, Georgia. In May 2019, there were 243 approved PA programs in the United States, and several more emerging. It is represented by the Physician Assistant Education Association.
The majority of the educational programs are graduate programs, which on completion, one is awarded a master’s degree in either Physician Assistant Studies, Health Science (Master of Health Science), or Medical Science (MMSc). Such programs require a bachelor’s degree and Graduate Record Examination or Medical College Admission Test scores for admission.
Most of the PA programs in the United States employ the CASPA application for choosing students. Professional licensure is managed by the medical boards of the individual states. Physician assistant students attain their training at medical schools and academic medical centers in different locations across the country.
Physician assistant training is founded on medical education. Although, in contrast, medical school, which lasts for four years in addition to a residency in a specific area of specialty, PA training is typically 2 to 3 years of full-time graduate study. Physician assistants’ training comprises of classrooms and laboratory instruction in medical and behavioral sciences, such as anatomy, microbiology, immunology, pharmacology, pathophysiology, hematology, pathology, genetics, clinical medicine, and physical diagnosis.
These are succeeded by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine, as well as elective rotations.
In contrast to physicians who are mandated to conclude a minimum of three years of residency after finishing medical school, physician assistants are not required to conclude such residences after they finish their schooling. There are available residency programs in particular specialties for PAs who want to continue formal education in such a format.
Physician assistants have their independent licenses with a different scope of practice. Each of the 50 states has various laws pertaining to the prescription of medications by physician assistants and the licensing right given to every category in that specific state via the Drug Enforcement Administration (DEA).
Although trained to prescribe medicines in Kentucky, Puerto Rico, and the US Virgin Islands, PAs are not permitted to prescribe any controlled substances.
Many other states place restrictions on the type of controlled substance or the amount that can be prescribed, given, or administered by a PA. Depending on the particular laws of any given state board of medicine, the physician assistant must have a formal relationship on record with a collaborative physician.
The collaborating physician is required to be licensed in the state in which the PA is operating. However, he or she doesn’t necessarily need to be physically present.
Physician participation can be in person, by telecommunication systems, or by other authentic methods (for instance, availability for consultation). The laws regulating physician assistants’ practice vary by state in emergency departments, usually permitting an extensive scope of practice and restricted direct supervision.
The COVID-19 Pandemic compelled local, state & federal governments to loosen regulations pertaining to the scope of practice to make the most of the healthcare workforce and permit PAs & NPs to enhance assistance in the crisis.
The United States Department of Labor Bureau of Labor Statistics reported that the physician assistants’ recruitment is speculated to grow by 37% from 2016 to 2026, much more rapidly than the median for all occupations.
This is because of multiple factors, including a growing health care industry, an aging baby-boomer population, potential cost containment issues, and recently executed restrictions to reduce physician resident work hours.
For physician assistants in general care practice, malpractice insurance policies with $100,000–300,000 in coverage can cost lower than $600 per annum. At the same time, premiums are higher for PAs in higher-risk areas of specialization. In collaboration with Salary.com, Money magazine listed the PA profession as the “fifth best job in America” in May 2006.
This listing was factored on both salary and job prospects and on an expected job growth of 49.65% in this decade. In 2010, CNN Money scored the physician assistant career as the second-best job in America.
In 2012, Forbes classified the physician assistant degree as the number one master’s degree for jobs. In 2015, Glassdoor ranked physician assistant as the number one best job in America.
The Bureau of Labor Statistics stated that the average pay for physician assistants working full-time was $108,610 yearly or $52.22 hourly, and the top 10 % earned above $151,850. PAs in emergency medicine, dermatology, and surgical subspecialties may earn as high as $200,000 per year.
