More people are coming into contact with physician assistants as they access the healthcare system and with good reason. With a continued shortage of physicians to deliver primary care, clinics, hospitals and employers are looking for ways to fill the gap. The Bureau of Labor statistics expects a 30% growth in career opportunities for physician assistants by 2020. Many of these jobs will be found in less traditional settings like prisons, universities, rural clinics and even telemedicine.
Len Bergstein, who represents ZoomCare, a network of neighborhood clinics touted as “(t)he modern alternative to urgent care and old fashioned doctors' offices...”, thinks he knows why. Physician assistants are, “qualified, licensed and at the top of their career,” he says. “People come to our neighborhood clinics and want to be taken care of by their physician assistant. They think of them as their doctor, and they deliver excellent care.”
Despite the name, a physician assistant's role goes far beyond merely helping doctors manage their practice. In fact, they're care providers in their own right with distinct licensing requirements and a formalized scope of practice.
Physician assistants began to emerge in the mid-1960s in response to the need for more primary care providers. The availability of health benefits was expanding through new federal programs such as Medicare and Medicaid, and there was an urgent need to meet the demand, especially for those in rural areas or without access to care. Training was initially based on the methods used to prepare doctors for service in World War II, allowing for completion in a fraction of the time usually needed.
Even today, physicians assistants are more apt to focus on caring for the under-served. Pacific University, which began a physician assistant program in 1999, has graduated nearly 500 since then – twice the national average. Its College of Health Professions designed an innovative curriculum, according to the college's mission statement, “to provide quality care for a diverse global community focusing on primary care for under-served and rural populations.”
Many physician assistants came to their careers through non-traditional channels. Lydia Jackson recalls, “I have always been interested in medicine, and thought I would go to medical school, but started to adjust my outlook on my medical career options in college.”
Jackson's route to her career as a physician assistant wasn't without interest. “After college, I moved to Hawaii where I worked as an ER tech and a youth counselor at an at-risk youth program. I obtained very important patient contact experience at these jobs. I then moved to Peru for five months to volunteer at a rural medical clinic. I had traveled to South America before, but it was this experience that helped me solidify my desire to work with the under-served community and gave me a special interest in and the ability to speak to the Latino community.”
In fact, many physician assistant programs require this kind of medical experience. The college's director, Judy Ortiz, explained that those applying at Pacific needed to have completed 1,000 hours of work in a medical setting. Often this experience is gained in areas such as nursing and through work as an EMT.
The question is often asked, why don't physician assistants go on to become doctors? While the answers vary, there are several factors that are frequently cited – flexibility, shorter training periods and the opportunity to more easily enjoy a varied lifestyle both before and after training.
Additionally, the cost of becoming a physician assistant is a fraction of that for medical school. For those who have a desire to work as a medical provider, while also pursuing other interests, being a physician assistant seems ideal.
Lydia Jackson certainly doesn't regret her decision to forgo medical school. “I was able to finish school in a shorter amount of time, allowing me to have amazing experiences prior to physician assistant school that have allowed me to grow as a person and provider. I work in a job where I have a lot of autonomy in the care that I provide. I enjoy this about my job and have honestly never regretted my decision to become a physician assistant rather than going to medical school. I also appreciate that I have the ability to easily change my career to another specialty if life leads me that way.”
Pacific University's Ortiz added that the collaborative nature of a physician assistant's work, where being part of a healthcare team is an important component, also proves attractive to many graduates.
Zoomcare's Bergstein also recognizes the focus on teamwork. “Physician assistants are uniquely qualified and willing to work in teams. The whole concept of team-based care is their model... (It's a) convergence of skill level and temperament.”
In fact, that team approach is highlighted in the way physician assistant's interact with doctors. While they are fully-fledged members of the medical profession, they work in concert with doctors through a process called delegated autonomy. Working independently, they partner with physicians to discuss and evaluate a patient's care. The roles of the doctor and physician assistant have evolved over the years as well. Now, because of legislation widening their scope of practice, physician assistants are able to provide more services than ever.
To highlight that, Lydia Jackson described her regular and extremely varied duties. “I carry my own panel of patients who I have face-to-face office visits with on a daily basis. I make medical decisions based on their histories and physical exams. I order labs and diagnostics and follow up with the patients depending on the results. I place referrals when that is necessary and coordinate care with the patient's specialists. I have a DEA license and can write prescriptions. I am also a member for a medical home team, to which I act as a facilitator, helping everyone play a role in the patient's care so we can best treat them. As a physician assistant, I have served the clinic as a lead clinician. There is not one aspect of my job that I can say is lacking in responsibility, and I can not think of any examples where I may want more responsibility. Physician assistants work in all different types of specialties from family practice, like myself, to emergency and surgery. There are physician assistants working on specialty teams in the hospital and in outpatient clinics. There are amazing opportunities in all aspects of medicine for physician assistants right now.”
Patients appear to be happy, too.“I've never had better care,”says Judy Campbell. “My physician assistant spends time getting to know me and makes sure that all of my questions are answered. We've developed a real relationship.”
It's clear that as the availability of healthcare expands, once again in large part due to federal programs, the role and prominence of the physician assistant will grow as well.
