Physician Assistant

Gabrielle R. Kolesar

English III Honors Pd. 5

Mr. Alburger

February 23, 2017

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Gabrielle R. Kolesar

Mr. Alburger

English ​III Honors

February 23, 2017

Physician Assistant

After a loved one suggests a visit to the doctor for a yearly appointment, Amy could not

create an appointment with a primary care physician until the end of next month due to the

physician’s demanding schedule between patients. A week later, Amy has an appointment with a

physician assistant who listens to Amy’s worries about her increasing weight even with a new

lifestyle of exercise and healthy eating. The physician assistant orders a blood test to rule out a

thyroid issue even though her family history did not reveal any diseases or possible contributing

factors from any family members. The blood test concludes she possesses minuscule thyroid

hormones, explaining her fatigue, weight-gain, and mood-swings. Therefore, the physician

assistant prescribed Amy a medication aimed to balance the irregularity of her thyroid hormones.

The physician assistant informs Amy she must schedule an appointment for her children because

of the hereditary disease. Three weeks later, Amy’s children receive their results from the blood

test concluding they have the same disease as their mother. Physician assistants, a

recently-created job title after World War II, use general knowledge learned from rigorous

schooling and additional certification for specialties to perform tasks like ordering medical tests,

asking questions to understand the patient's family medical history, and prescribing medication.

Physicians and physician assistants interact similarly with their patients, allowing the

physician to see more patients, while increasing patient care and decreasing the stress of a
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workplace. Due to the scarcity of physicians in the 1960’s, a plan of development for physician

assistants in the healthcare system, based on doctors in the Vietnam War, restored the use of

primary care in the healthcare system (Legler, Cawley, and Finn 22). Ever since World War II,

the career has become increasingly popular and a crucial part of the healthcare system because

they perform similar tasks as a physician. For example, Jennifer Roach, a cardiovascular

physician assistant, primarily works independently but can always rely on a physician for any

questions or concerns about patients medical care (Roach).​ ​In 1965, Dr. Eugene A. Stead at

Duke University created the first physician assistant program in order to fulfill the position of

nurses through education of former doctors and other healthcare careers from the Navy (Martin)​.

Through the creation of a physician assistant program, other countries have recognized physician

assistants as a professional career. The first physician assistant program led to the creation of

hundreds of other programs around the country and the world. In the late 1960’s, the

breakthrough of Prentiss Harrison, an African American, and Joyce Nichols, a woman,

graduating from the physician program at Duke University showed the diverse environment at

the time (Martin). The addition of women demonstrated the importance of change for women as

Joyce Nichols graduated from an originally male-only physician assistant program at Duke

University. The addition of African Americans in the late 1960’s demonstrates a shift in society,

indicating the desire for diversity.

Though not technically doctors, physician assistants aid in patient care along with other

doctors and staff by covering a wide range of patients. Physician assistants learn about primary

care at a generalized level, then apply it to everyday life in order to ease capacity for a physician

and provide care to patients (Legler, Cawley, and Finn 22)​.​ The generalized knowledge allows
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for an increase in patient diversity between every age, gender, and race, allowing the physician

assistant a wide range of patients to treat. By learning primary care, physician assistants help

provide patient care to both individuals and families. Many important skills of a physician

assistant include customer satisfaction, confidence and support when treating patients, and

establishing a relationship between the themselves and the patient (Roach). Since patients visit

yearly, they build a relationship with their physician assistant, establishing a familiarity in

previous treatments and tests performed on the patient. “More often than not, the physician

assistant takes the patient’s history, examines and diagnoses the patient, interprets diagnostic

tests and studies, and prescribes medications and other courses of treatment” (“As Healthcare” ).

By ordering medical tests and asking questions to understand the patient’s history, they can

prepare a plan of treatment specialized to the specific patient. Since physician assistants know

personal information about the patient, a level of trust and comfort forms in the relationship. ​ ​In

2011​,​ states including North Dakota, amended a law so physician assistants do not need to

communicate with a physician in order to prescribe medications (Robeznieks). Beneficial to both

patients and physician assistants, the right for physician assistants to prescribe medication allows

more patients to receive medication without the need of a physician. Adding the right to

prescribe medication shows the recent change in position of physician assistants which gives

them more independence as a professional. “The Association of American Medical Colleges

(AAMG) projects there will be a shortage of approximately 125,000 doctors by the year 2025”

(Stuemky 38). The prediction of a shortage of doctors from the AAMG will likely increase the

number of physician assistants because of their general knowledge of healthcare, while also

requiring further advanced education. Although fairly new, the role of physician assistants will
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likely adapt to differences in the healthcare system because of changes to the Affordable Care

Act and patient health insurance (Stuemky 38). With changes in patient health care insurance,

physician assistants will have to adapt to either the increasing or decreasing number of patients

to treat.

Even though the majority of physician assistants train to become generalists in primary

care, a portion of physician assistants can enter into specialties such as surgery or emergency

medicine. “Patients encounter physician assistants in emergency rooms, critical care units,

surgical wards and other departments in hospitals, in private practices and large public health

centers, and in nursing homes and long-term care facilities” (Stuemky 39-40). While other

physician assistants work in nursing homes or long term facilities, specifically to care for the

elderly or the disabled, others can help in large hospitals or family practices. Seen in almost any

setting, some physician assistants choose to work in a practice along with other physician

assistants and physicians or with surgeons in a hospital. Examples of surgical specialties for

physician assistants include cardiothoracic, cardiovascular, and orthopaedic (“As Healthcare” 5).

Only one of many specialties, surgical specialties offers hands on experience and interaction with

patients; many different surgical specialties offer a wide range of options for a physician

assistant. Although different in salary and experience, surgical specialties prove physician

assistants can learn general knowledge and apply it to a specific specialty. Physician assistants in

surgical specialties can perform small tasks before a surgery for a patient, help in a life-changing

surgery or perform a small surgery independently (Stuemky 40). Through preoperative and

postoperative care, physician assistants can educate patients before their surgery or advise the
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patient on particular treatments most beneficial to the patient (Stuemky 40). Though demanding,

surgical physician assistants can earn rewarding experiences from the challenging role.

Due to the growing use and success of general physician assistants, other countries such

as the United Kingdom have a need for physician assistants in their healthcare system. The

European Working Time Directive, a directive restricting the number of hours a healthcare

professional can work in a week, caused the introduction of professional positions like physician

assistants and nurse practitioners (Ross and Parle 29). Limiting the number of hours healthcare

professionals can work creates an effective workplace and improves the quality of healthcare

given to their patients. The United Kingdom’s need for the general public to have a new

profession due more medical professionals retiring, led to the creation of physician assistants (

Ross and Parle 29). ​Furthermore, older physicians retiring will increase the need for new

occupations such as primary care physicians, especially in the United Kingdom. ​Compared to the

United States, physician assistants in the United Kingdom do not have the right to prescribe

medication or ask for radiation tests such as x-rays and gamma waves; the National Health

Service (NHS) will address this issue in order to increase the value and rights of a physician

assistant (Watkins). The inability to prescribe medication or order radiation tests for patients

limits the responsibilities of a physician assistant, lowering the amount of patients a physician

assistant can see. Overall, physician assistants in both the United States and the United Kingdom

work similarly in that they have the same job description and role in the healthcare system.

Due to their general knowledge, many physician assistants have the option to work

outside of the healthcare system through the military. Due to their extensive knowledge, around

41% work in primary care, while 12% work for the Department of Veterans Affairs, the military,
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or state governments (Legler, Cawley, and Finn 23). ​Seen in almost any setting, physician

assistants do not have to directly work with any hospital or practice in the healthcare system

because many can work for the military in different countries or in the United States. This proves

physician assistants general knowledge gives them many options for job opportunities. ​The army

places the majority of physician assistant in the O-3 or O-4 rank as either a captain or a major,

respectively (Soliz 27). However, many physician assistants do not receive any promotions or

increase in rank (Soliz 27). The inability to not receive promotions means many physician

assistants could not receive an award for their hard work and experience over the years. Without

an increase in rank, many army physician assistants would stay stagnant in their occupation,

leaving little room for any advancements in the future. ​The very few number of physician

assistants above the O-4 rank include two O-6 physician assistants who control a clinic and

military hospital, and two physician assistants who control their own surgical team in the

military (Soliz 29). The physician assistants above the O-6 rank proves that physician assistants

have demanding roles in the military because they control a surgical team or military hospital.

Overall, physician assistants have very different roles while working for the army or state

government compared to those working in a hospital or private practice because of the different

workplace environment.

In order to become a physician assistant, one has to have bachelor’s degree and enter a

two year physician assistant program with a rigorous class schedule and a year of different

medical rotations. ​Examples of courses required before entering a physician assistant program

include anatomy, microbiology, physiology, and chemistry; however, students can have a major

in any field (Legler, Cawley, and Finn 23). Through ​taking anatomy, chemistry and other general
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subjects courses during their four years at a university, these classes further prepare the students

for the challenges yet to come. By learning science-related classes before entering into a

physician assistant program, students have a basic foundation that can help them excel and

succeed in their medical career and further education. As an example of an undergraduate major,

Jennifer Roach majored in biology while studying genetics at North Carolina State University

because the major covered a majority of the required courses of a physician assistant program

(Roach).​ ​As part of her schooling, Jennifer Roach had a mentorship with two physician assistants

ensuring she could continue to become a physician assistant because she received insight into

their daily lives and relationships with other doctors (Roach). This shows the importance of

understanding the profession before committing to further education. ​The second year of the

physician assistant program includes medical rotations in surgery, emergency medicine, internal

medicine, family medicine, pediatrics, and other specialties (Legler, Cawley, and Fenn 23). The

second year of rotations provides insight into the daily life of a specialty offering the students

real world experience in a short amount of time without a commitment. With colleges offering a

wide range of specialties, students have the option of choosing specialties they enjoy before

committing, therefore saving time and money. After finishing the program, around 80% of

physician assistant programs reward the student with a master's degree or a graduate degree,

some contingent on a paper or a research project (Legler, Cawley, and Finn 23). Earning a

master's degree in the span of two years proves the high level of education and rigorous

schooling required for physician assistants. The short amount of time it takes to earn a master's

degree allows physician assistants to enter into the healthcare system faster.
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Many colleges have outstanding physician assistant programs but remain selective with

high test scores and GPA requirements that will eventually lead students to succeed when

entering the healthcare system. Based on previous years, Duke University accepted around 88

applicants after interviewing 2,562 applicants, many average around 3.5 to 3.8 for a GPA and a

verbal score of 156-162, a quantitative score of 153-159, and an analytical score of 4-4.5 on the

Graduate Record Examinations (GRE) (“Duke Physician”).​ ​These astonishing numbers prove the

competitive nature of applicants to get into the best physician assistant program in the nation.

Many have to excel from their four year university with a high GPA, a certain score on their

GRE, or any other achievements before facing consideration into the program. Based on the

years of 2011 to 2015, physician assistants at Duke University have passed the Physician

Assistant National Certifying Examination (PANCE) with a higher score than the nation’s

average and around 95% will find employment six months after finishing the physician assistant

program (“Duke Physician”). After the completion of the program, physician assistants have all

the necessary education to pass the PANCE exam and succeed in the healthcare system. At Elon

University, a 27 month program allows students to learn in different ways from labs that includes

hands-on experience, to lectures from professors and group discussions (“Physician Assistant”).

Due to students learning in different ways, universities and colleges have provided many options

for students to reach their full potential. Group discussions and labs provide students with an

in-depth understanding of the material enabling them to realize their mistakes and to learn from

it. Group discussions allows the students to understand different perspectives while labs provide

students with an in-depth understanding of the material.

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In order to become a physician assistant, one must pass an exam for certification and

occasionally even additional certification for specialties. ​After graduating from a physician

assistant program, students must pass an exam called the PANCE that includes extensive

knowledge like organ systems, while performing common day-to-day tasks of a physician

assistant (Stuemky 40)​.​ ​The PANCE ensures future physician assistants have significant

knowledge before they enter a practice in the healthcare system. ​Due to students learning the

day-to-day tasks of a physician assistant, they understand the expectations starting in this

position after they pass the PANCE exam. For some specialties, like emergency medicine,

thoracic surgery, psychiatry, and cardiovascular surgery, provides another certification called the

Certificate of Added Qualifications (CAQ) (Stuemky 40). Due to the challenging specialties, an

additional certification could provide a physician assistant with more job opportunities because it

shows a higher level of education compared to those who do not have a CAQ. Employers likely

hire, promote, or offer more money to a physician assistant with a CAQ because of their higher

credentials. In the United Kingdom, physician assistants must recertify every six years and have

fifty hours of Continuing Professional Development (CPD) every year to record experience and

training (Watkins 3). Recertification every six years assures employers that physician assistants

maintain the required education in order to practice. Beneficial to physician assistants, the CPD

allows them to continue education through classes to keep up with the changing healthcare

system.

Not only can specialties vary, but the salaries based on the specialties fluctuate because

physician assistants with some specialties earn more than others. On average, physician

assistants make around $84,000 per year, while their practice or hospital earns around $231,000
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a year from the physician assistant (Stuemky 41). ​Many employers will likely hire physician

assistants because of their general knowledge that makes the hospital, practice, or any workplace

profitable. Not to mention, physicians would more likely want to work with physician assistants

because they can cover some of their own patients while also increasing the efficiency and

profits of the workplace. They can cover a wide range of patients from every age, gender, and

race because of their general knowledge that creates profits for their workplace. Due to the many

specialties, an emergency medicine physician assistant earns around $118,380 per year, while a

primary care physician assistants earns around $85,461 a year (Robeznieks). Additionally,

surgical specialties earn around $99,968 a year, while a physician assistant working at a inpatient

hospital averages around $103,589 a year (Robeznieks). This proves that the specialty affects the

average salary of the physician assistant. The average salary of the physician assistant can also

differ based on the region of the state and desire for a physician assistant (Turner). Based on

Occupational Employment statistics, the salary of a physician assistant will rise by around

20-25% because of the increasing demand for physician assistants (Turner). The dramatic

increase in salary demonstrates the changing role and effectiveness of physician assistants in the

healthcare system.

After the creation of physician assistants in World War ​II, the first program created at

Duke University allowed them to enter into the healthcare system as generalists; however,

physician assistants created more specialties including pediatrics, emergency medicine, and

surgery. After an acceptance into a two year physician assistant program, the student must pass a

certification exam prior to entering into the healthcare system. The PANCE exam ensures

physician assistants still obtain the required knowledge in order to practice while the CAQ
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ensures certification. While many work as primary care physician assistants, other specialties

offer different skill sets based on the individual. Many can work as a surgical physician assistant,

a primary care physician assistant, or even for the military or state governments. Overall, the

salaries for the specialties fluctuates due to the different workplace, education, and the region of

the state.
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