What is a Physician Assistant?

• By School of Health Professions
• April 9, 2020

Today, many people are familiar with physician assistants (PAs) and the excellent care they provide. For those who are less familiar, PAs are medical professionals who are licensed to diagnose and treat illnesses, prescribe medications, and perform medical procedures. The training programs can be completed in 27 months, after which students must pass the Physician Assistant National Certifying Exam (PANCE).

Today, this health profession is a popular choice for students who have an interest in a medical role and a passion for serving patients day to day. But while many patients receive care from a PA at some point in their health care journey,  fewer of them know the history behind this popular health profession and how the career has adapted to our changing health care system.

The First Physician Assistants

The practice of medicine changed dramatically in the 1900s. World War II and new technological advances led to more physicians seeking to become specialists and fewer of them looking to become primary care doctors. At the same time, insurance benefits started expanding and Medicare and Medicaid were implemented, increasing patient access to care and driving up the demand for general providers.

By the mid-1960s, America was facing a shortage of primary care providers. Recognizing this need, Dr. Eugene Stead of Duke University set out to create a program for generalized specialists who could help fill this gap and assist physicians in providing care to patients. Stead created a curriculum based on his knowledge of the military’s physician medical training in WWII. The first physician assistant program had a ready set of students in veterans who had received on-the-job medical training but had not obtained any medical degrees or certifications. The first class of PAs graduated in 1967.

The concept of a physician assistant program became so popular it gained federal attention and backing in the 1970s to help the physician shortage. This quickly led to the creation of accreditation standards, national certification programs, and standardizing exam requirements. In 1971, the American Medical Association (AMA) recommended PAs as medical providers.

Since then, the profession has grown to over 100,000 jobs, with more than 30,000 predicted to be added in the next 10 years. There are now 141 accredited physician assistant programs in the U.S.

Physician Assistants in Today’s Health Care World

While physician assistant programs still focus on general medicine, PAs have the opportunity to specialize in just about any medical area and help provide access to care for many underserved patients.

In the clinic, PAs can take medical histories, conduct physical exams, interpret tests, counsel on preventive care, assist in surgery, and make rounds in hospitals and nursing homes.

Since the founding of the first PA program, the main goal of PAs has remained the same: to provide quality treatment to patients and increase access to care. Over the years, though, the profession has seen an evolution of the PA role.

From its initial roots as a true assistant to physicians, the PA’s role as a fairly independent medical professional has significantly strengthened over the past 53 years. Stead did not originally intend PAs to work independently, but in the quickly changing field of health care, PAs have continued to gain increasing autonomy and responsibility. PAs are now allowed to prescribe medication in all 50 states, and the profession has expanded to multiple other countries.

Changes in regulations give PAs the option to work collaboratively with a specific physician or group of physicians, allowing them much more autonomy. PAs are also directly reimbursed by all private and public insurance, a recognition of both their prevalence and permanence as medical professionals.

The involvement of PAs in patient care has reduced the length of stay and transfer times for patients in trauma settings and has helped to increase workplace morale while lowering stress levels.

Today’s health care system is once again facing a physician shortage. It was previously believed that this shortage could only be filled by increasing the number of practicing physicians, but PAs have shown that they have the skills and training to address the need for primary care providers.

With this change in the understanding of the profession, the demand for PAs to fill the physician shortage is once again increasing, just as when the profession was founded. “Everybody's starting to realize what we are and what it is that we do and that we can really mold into any specialty. And I think that more physicians are finding that out and want to hire PAs,” states Dayna LaVallee, Assistant Professor of the Physician Assistant Program at Texas Tech University Health Sciences Center (TTUHSC).

Growing health care costs are also responsible for the rapid growth of the profession. An appointment with a PA typically saves patients money, while still providing excellent and professional care.

Misconceptions About Physician Assistants

Even though the profession has been around for over 50 years, many people still wonder, “What is a physician assistant?” and many misconceptions persist about their role.

• Patients won’t be happy unless they see a “real” doctor.
  PAs are trained under the medical model, which is the same as physicians train under. An American Academy of Physician Assistants (AAPA) poll showed that 93% of patients view their PA as a trusted medical provider and think they provide excellent patient care.
  
  
• A physician has to be on-site for a PA to treat patients.
  No state requires MDs to be on-site 100% of the time.
  
  
• PAs cannot see new patients.
  PAs can see patients in all health care settings without an MD present. This is especially critical to a PA’s role in providing care to rural communities. LaValle states that when patients come in she is able to diagnose, treat, and order any imaging or lab work that may be required.
  
  
• PAs are educated like nurse practitioners.
  PAs are educated in the medical model, which is substantially different from the nursing model.
  
  
• PAs are held to lower standards than MDs.
  PAs are certified to provide medical care similar to physicians and must pass a rigorous licensing exam. They are the only providers licensed by state medical boards other than MDs.

When asked about misconceptions, LaVallee states, “I think the biggest misconception about PAs is that people think we're assistants to the providers. Yes, we're very helpful and we assist in a lot of ways, but so does everyone in the office because we work as a team. But we have a lot of autonomy as well. In fact, when I work in urgent care, I'm the only provider there in the building. My supervising physician is always available if I need to call him or I have any questions.”

How Much Autonomy Does a PA Have?

With increasing health care needs, comes necessary evolution in the medical professions. Many states are recognizing that PAs are educated and highly-skilled and have begun to expand their professional autonomy accordingly. In 2019, PAs were granted autonomous care for American Indians and Alaskan Natives. They can now provide medical care and assume the full responsibility of that care without the supervision of a physician, “commensurate with their education, experiences, competencies, and operational needs for the service to which they are assigned.”

In Texas, MDs do not have to be in the same building where PAs are practicing. North Dakota passed a law in April 2019 allowing PAs to practice without a specific relationship to an MD, opening up the opportunity for PAs to run their own practices. In July, Missouri became the 11th state to pass a law changing the PA-MD relationship from “supervision” to “collaboration.” Collaboration terms can now be met through telemedicine, instead of requiring an MD to be on site for a certain number of hours every month, and PAs can practice at another location other than where the MD sees patients. Many other states are moving to copy these models as well.

The American Academy of Physician Assistants (AAPA) is actively working with the Department of Veterans Affairs to increase the roles and responsibilities of PAs as well.

These changes in the regulations around the supervision of PAs mean that PAs can more easily practice in a variety of settings. As long as a physician is accessible, even if they are half-way across the world, PAs can treat patients. This has major implications for patients in rural settings where access to specialists and primary care may be very limited.

AAPA is also promoting the use of telecommunication to enhance PA-MD collaboration and increase PAs’ autonomy in every state.

Texas Tech University Health Sciences Center (TTUHSC) fully embraces the use of telecommunication, and its physician assistant program has begun to educate some students on providing care through telemedicine. In addition, TTUHSC also trains PAs on how to efficiently conference with other specialists to help with patients when needed.

The growing use of electronic health records has also improved administrative duties and access. Physicians can log in from anywhere to access patients’ health records, allowing for greater levels of coordinated care across the health care team.

In Texas, Many PAs do work with a supervising physician, though, and physician-PA teams work to support efficient and patient-centered health care. “From my experience working as a PA around physicians who don't have a PA, many of them seem very interested because we're so helpful in relieving their patient load in the clinic, performing procedures, and assisting in surgeries,” explains LaValle.

The PA-MD relationship, like any, requires mutual trust and respect. Together, PAs and MDs improve continuity of care and provide access to high-quality care to a greater number of patients.

Adapting to Fit the Changing Nature of Health Care Today

As mentioned, PAs have a tremendous amount of options when it comes to delivering health care. Over the years, this has grown to include work outside of the clinical environment as well. Today, PAs work in clinical teaching, administrative and supervisory roles, patient education, as well as in research. “With the growth of our profession, we're seeing more and more PAs get involved in leadership roles and health care administration. There are also PAs that work with pharmaceutical or drug companies to facilitate education about certain medications,” explains LaVallee.

She goes on to state, “I would say the biggest change is the increase in awareness of the profession in the last two decades. It has really allowed a substantial amount of growth in the number of practicing PAs, as well as the number of new PA programs that have become established. It's really exciting that we're growing so quickly and becoming so much more helpful to our communities.”

The number of women entering the PA profession has also greatly increased. The age of the average practicing PA has likewise changed, with younger applicants entering programs.

PAs are able to spend more time face-to-face with patients than a physician provider, and physicians are increasingly relying on PAs to help provide comprehensive care to patients. With their growing responsibilities, PAs help to balance the increasing demands on providers. The addition of a PA to a medical practice can help prevent physician burnout, which is important as industry estimates show that as many as 43% of doctors are considering cutting back or retiring.

Just as Stead intended with his first class of students, PAs are still helping to fill in the gaps in health care delivery. As the health professions continue to grow, access to medical care becomes even more readily available to patients.

If you would like to learn more about what it takes to become a physician assistant, or how to apply for TTUHSC’s program, please visit the program page. You can also email the SHP Office of Admissions and Student Affairs at health.professions@ttuhsc.edu or call 806-743-3220 to learn more.