Physician assistants (PA's) practice medicine under the supervision of physicians and surgeons. They should not be confused with medical assistants, who perform routine clinical and clerical tasks (medical assistants are discussed elsewhere in the Handbook). PA's are formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. Working as members of the health care team, they take medical histories, examine and treat patients, order and interpret laboratory tests and x-rays, and make diagnoses. They also treat minor injuries, by suturing, splinting, and casting. PA's record progress notes, instruct and counsel patients, and order or carry out therapy. In 48 States and the District of Columbia, physician assistants may prescribe medications. PA's also may have managerial duties. Some order medical supplies or equipment and supervise technicians and assistants.

Physician assistants work under the supervision of a physician. However, PA's may be the principal care providers in rural or inner city clinics, where a physician is present for only 1 or 2 days each week. In such cases, the PA confers with the supervising physician and other medical professionals as needed and as required by law. PA's also may make house calls or go to hospitals and nursing care facilities to check on patients, after which they report back to the physician.

The duties of physician assistants are determined by the supervising physician and by State law. Aspiring PA's should investigate the laws and regulations in the States in which they wish to practice.

Many PA's work in primary care specialties, such as general internal medicine, pediatrics and family medicine. Other specialty areas include general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PA's specializing in surgery provide preoperative and postoperative care and may work as first or second assistants during major surgery.

Although PA's usually work in a comfortable, well-lighted environment, those in surgery often stand for long periods, and others do considerable walking. Schedules vary according to the practice setting, and often depend on the hours of the supervising physician. The workweek of hospital-based PA's may include weekends, nights, or early morning hospital rounds to visit patients. These workers also may be on call. PA's in clinics usually work a 40-hour week.

All States require that PA's complete an accredited, formal education program and pass a National exam to obtain a license. PA programs usually last at least 2 years and are full time. Most programs are in schools of allied health, academic health centers, medical schools, or 4-year colleges; a few are in community colleges, the military, or hospitals. Many accredited PA programs have clinical teaching affiliations with medical schools.

In 2005, more than 135 education programs for physician assistants were accredited or provisionally accredited by the American Academy of Physician Assistants. More than 90 of these programs offered the option of a master's degree, and the rest offered either a bachelor's degree or an associate degree. Most applicants to PA educational programs already have a bachelor's degree.

Admission requirements vary, but many programs require 2 years of college and some work experience in the health care field. Students should take courses in biology, English, chemistry, mathematics, psychology, and the social sciences. Many PA's have prior experience as registered nurses, while others come from varied backgrounds, including military corpsman/medics and allied health occupations such as respiratory therapists, physical therapists, and emergency medical technicians and paramedics.

PA education includes classroom instruction in biochemistry, pathology, human anatomy, physiology, microbiology, clinical pharmacology, clinical medicine, geriatric and home health care, disease prevention, and medical ethics. Students obtain supervised clinical training in several areas, including family medicine, internal medicine, surgery, prenatal care and gynecology, geriatrics, emergency medicine, psychiatry, and pediatrics. Sometimes, PA students serve one or more of these "rotations" under the supervision of a physician who is seeking to hire a PA. The rotations often lead to permanent employment.

All States and the District of Columbia have legislation governing the qualifications or practice of physician assistants. All jurisdictions require physician assistants to pass the Physician Assistant National Certifying Examination, administered by the National Commission on Certification of Physician Assistants (NCCPA) and open only to graduates of accredited PA education programs. Only those successfully completing the examination may use the credential "Physician Assistant-Certified." In order to remain certified, PA's must complete 100 hours of continuing medical education every 2 years. Every 6 years, they must pass a recertification examination or complete an alternative program combining learning experiences and a take-home examination.

Some PA's pursue additional education in a specialty such as surgery, neonatology, or emergency medicine. PA postgraduate educational programs are available in areas such as internal medicine, rural primary care, emergency medicine, surgery, pediatrics, neonatology, and occupational medicine. Candidates must be graduates of an accredited program and be certified by the NCCPA.

Physician assistants need leadership skills, self-confidence, and emotional stability. They must be willing to continue studying throughout their career to keep up with medical advances.

As they attain greater clinical knowledge and experience, PA's can advance to added responsibilities and higher earnings. However, by the very nature of the profession, clinically practicing PA's always are supervised by physicians.

Physician assistants held about 62,000 jobs in 2004. The number of jobs is greater than the number of practicing PA's because some hold two or more jobs. For example, some PA's work with a supervising physician, but also work in another practice, clinic, or hospital. According to the American Academy of Physician Assistants, about 15 percent of actively practicing PA's worked in more than one clinical job concurrently in 2004.

More than half of jobs for PA's were in the offices of physicians. About a quarter were in hospitals, public or private. The rest were mostly in outpatient care centers, including health maintenance organizations; the Federal Government; and public or private colleges, universities, and professional schools. A few were self-employed.

Employment of PA's is expected to grow much faster than average for all occupations through the year 2014, ranking among the fastest growing occupations, due to anticipated expansion of the health care industry and an emphasis on cost containment, resulting in increasing utilization of PA's by physicians and health care institutions.

Physicians and institutions are expected to employ more PA's to provide primary care and to assist with medical and surgical procedures because PA's are cost-effective and productive members of the health care team. Physician assistants can relieve physicians of routine duties and procedures. Telemedicine-using technology to facilitate interactive consultations between physicians and physician assistants-also will expand the use of physician assistants. Job opportunities for PA's should be good, particularly in rural and inner city clinics, because those settings have difficulty attracting physicians.

Besides the traditional office-based setting, PA's should find a growing number of jobs in institutional settings such as hospitals, academic medical centers, public clinics, and prisons. Additional PA's may be needed to augment medical staffing in inpatient teaching hospital settings as the number of hours physician residents are permitted to work is reduced, encouraging hospitals to use PA's to supply some physician resident services. Opportunities will be best in States that allow PA's a wider scope of practice.

General medical and surgical hospitals:	$70,310
Offices of physicians:	$69,210

According to the American Academy of Physician Assistants, median income for physician assistants in full-time clinical practice in 2004 was $74,264; median income for first-year graduates was $64,536. Income varies by specialty, practice setting, geographical location, and years of experience. Employers often pay for their employees' liability insurance, registration fees with the Drug Enforcement Administration, State licensing fees, and credentialing fees.