So You Want to Be a Physician Assistant (PA)

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Welcome to our next installment in So You Want to Be. In this series, we highlight a specific specialty or profession within medicine, such as physician assistant, and help you decide if it’s a good fit for you. 

So you want to become a physician assistant. You want to work in healthcare, but being a doctor seems like overkill. Why not get most of the benefit without all the crazy competition, super long training, and unnecessary stress?

Here’s how you can decide if becoming a PA is a good career for you.

 

What is Being a Physician Assistant (PA)?

As my PA colleague says, being a physician assistant is like being a “Doctor Lite”. PAs do many of the same things as doctors including history and physicals, diagnosis, interpreting labs, and even some basic procedures. But they’re a clearly distinct and separate entity from being a doctor.

To better understand the practice of physician assistants, it helps to review the history of the profession. In the mid-1960s, Dr. Eugene Stead from Duke put together the first class of PAs to help address the shortage of primary care physicians. The curriculum was based on the fast-track training of doctors during World War II.

Two years later, in 1967, the first PA class graduated, and the concept quickly gained federal backing in the early 1970s as a novel approach in addressing the physician shortage. But since then, the role of the PA has expanded. PAs don’t just work in primary care but can work in any department where physicians work, such as cardiology, plastic surgery, neurosurgery, psychiatry, emergency medicine, and many other specialties.

One of the big perks of being a PA is the variety and flexibility in your type of practice. As a physician, you’ll complete medical school, then a residency in your desired specialty, and then be board certified in only that specific specialty. But as a PA, you can more easily move to another specialty without going through several years of formal training.

While certainly a perk, this benefit shouldn’t be overstated. The reason PAs can flexibly move from specialty to specialty is because the depth of their work is more superficial in nature. Sure, a PA can move from neurosurgery to plastic surgery to orthopedic surgery, but they’ll forever be first assist, meaning they help retract, suture, and assist the surgeon. These are supporting roles that don’t vary as widely between specialties. The PA, however, is never doing any part of the actual surgery.

PAs can be trained to independently perform certain procedures though, such as central lines, intubations, dialysis line insertions, and arterial lines to name a few. While they can do bedside ultrasound, they aren’t able to do comprehensive echocardiograms.

PAs don’t replace doctors or take away their work — rather, they work in tandem, with physician supervision, and help to decrease routine work for doctors and ease their load.

 

Physician Assistant Myths

There’s a broad range of myths that confuse pre-health students considering a career in healthcare. Let’s set the record straight.

First, the title “Physician Assistant” can be misleading. They do much more than a scribe or a medical assistant, and they have a far broader scope in what they can do. PAs can see their own patients, do their own workups, do their own simple procedures, and interpret their own labs. However, if their supervising physician disagrees on any step in the diagnosis or management, it’s the physician making the final decision, not you, and as a PA you’ll have to be ok with that.

Second, the inter-specialty flexibility benefit is often overstated, particularly for those interested in surgical fields. PAs working in the operating room do not have autonomy. In terms of operating room responsibility, think of them as forever being a fourth-year medical student or first-year resident. There are a few exceptions, but this is the general rule.

Third, the training between PA and physician is not the same. PAs can easily handle the simple bread and butter like straightforward diabetes management. But when it comes to more obscure conditions or complex and nuanced management, PAs are not trained to that level. If you’re ever unsure about something, you’ll always be able to reach out to your supervising physician for help. Which brings us to the PA training system.

 

How to Become a PA

In college, the PA prerequisites are less standardized than they are for premedical students, but there’s a good amount of overlap. Most programs require 1 year of chemistry with lab, human anatomy & physiology, microbiology, statistics, and psychology. Other frequently recommended courses include general biology, genetics, organic chemistry, biochemistry, social/behavioral sciences, and medical terminology.

Don’t think that it’ll be a walk in the park to get into PA school, as it’s still a competitive process! PA school matriculants have an average GPA of 3.5. Most schools require the GRE, with the average PA matriculant having GRE performance in the 40th to 50th percentile, but more are moving to a new standardized test, the PA-CAT, specifically designed for PA school admissions.

Your time in school is much shorter, usually 2 to 2.5 years in length. The first year is primarily didactics, with lectures for 6-8 hours per day, and you may even be attending the same classes as medical students in some instances.

During your second year of PA school, you’ll be clinical, on service with medical students, residents, and the rest of the healthcare team. While medical students have more academic knowledge – after all, they’re spending several more years studying the human body in greater depth – PA students tend to have more clinical experience by the time they start rotating. This is because, in order to apply to PA school, many programs require anywhere from 1,000 to 4,000 hours of direct patient healthcare experience.

In terms of cost, the entirety of PA school tuition comes out to around $80,000 – $90,000 in most instances. Once you’re done with PA school, you can start practicing immediately. You’ll pick up your role and responsibilities with on the job training, with oversight either from your supervising physician or by other mid-levels, meaning nurse practitioners and physician assistants. My PA colleague describes it as throwing you into the fire in a rapid crash course, whereas a residency for newly minted doctors is more structured, rigorous, and longer in duration.

Median compensation is around $95,000 – $100,000 per year, depending on the specialty. In terms of specialties, PAs are trained as generalists first and foremost, meaning primary care. However, some PA programs have a greater focus on surgical specialties if you want to assist in the operating room. If there’s a specialty that has physicians, then it’s likely that specialty has room for a PA as well — from orthopedics to neurosurgery, interventional radiology to emergency medicine, and many more. The specialties where you won’t find PAs tend to be highly specialized and advanced like cardiac electrophysiology or pediatric oncology.

 

What You’ll Love About Being a PA

There’s a lot to love about being a physician assistant. The human aspect can be tremendously rewarding, and you’ll have direct patient contact and make a difference in people’s lives.

Training is much shorter than becoming a physician, lasting only 2 to 2 and a half years compared to 4 years of medical school plus 3 to 7 years of residency. The cost is much lower too, so you’ll likely graduate with less debt than if you went the MD or DO route.

As a PA, you also won’t have to take work home with you, keep track of patients longitudinally, or deal with things like overnight call — these are all factors that come with the added responsibility of being a physician. And because you’re not the person on the line, there’s less stress about malpractice or things going sideways.

For physician assistants, hours are much more regular and predictable. While it depends on the specialty, you can expect to work around 40 hours per week.

And lastly, you can change specialties if you get burned out or want to switch things up. Some PAs even work in multiple different specialties concurrently.

 

What You Won’t Love About Being a PA

But while you can change specialties, that comes with a cost. As a PA you don’t have the same level of autonomy in patient management and decisions. You’re working underneath a supervising physician, not as a physician. Right out of school, your autonomy is quite limited, but as you develop working relationships with your supervising physicians, your scope of practice and autonomy for clinical decision making expands and is dependent on two main factors: first, state and hospital regulations, and second, the trust and relationship with your supervising MD.

And while you can change specialties, your roles and responsibilities will always be limited. For example, surgery has a strong appeal, but you won’t be a surgeon — you’ll be first assist, helping to retract, suction, and close at the end. Some PA’s in surgical specialties don’t even go in the operating room, and instead, help the team by rounding on patients and handling the floor work pertaining to the preoperative and postoperative patients. Consider it being a lifelong resident, but with better hours and better pay. But keep in mind the pay is substantially less than what attending physicians make — around 1/2 to 1/3 in comparison.

There’s also less prestige and respect than what you would receive as an MD or DO. My PA colleague says this can present as a barrier to trust in dealing with certain patients. On the other hand, if you’re able to put your ego aside and understand your role on the team, including your responsibilities and scope of practice, you may not mind at all.

While the training is only a couple of years long, the intensity is quite high. You’ll be learning a large amount of information incredibly quickly, so don’t think it’ll be a walk in the park. During your training, you’ll be missing weddings and other personal events to prioritize your future career.

 

Should You Become a PA?

If you want to be on a medical team and see your own patients, but ultimately answer to a physician for guidance, then consider being a PA. There’s shorter training to get out into the real world and a more relaxed lifestyle with shift work rather than being always on.

If you are currently on the nursing track and want to go to the next level, consider becoming an NP, which we’ll cover in a future post.

If you want more control, autonomy, and depth, knowing the ins and outs of various diseases, including the obscure ones, be at the pinnacle of patient care and research, or be a high-level educator, go to medical school and become a physician.

These are all tradeoffs and there’s no right or wrong here. You have to figure out what type of life you want. Look at the future paths of each, and see which is better suited to your personality, values, and long-term desires.

If you enjoyed this post, check out my post comparing the competitiveness of PA school to NP school to medical school, or my So You Want to Be post on being a doctor.

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