The Answers to All Your Questions

     I'll admit right away that this post will not answer every question you've ever had. In fact, it might just answer a bunch of questions you've never had, but hopefully it should at least clear up some of the confusion about what PAs are and what I'll be doing very soon. I've actually had quite a bit of experience answering such questions already. Almost every school I applied to asked me, either in an essay or in an interview, to explain what a Physician Assistant is, and most asked me to explain the profession as if I was talking to a friend or family member who had never even heard of a PA before. That was decently easy for me since that I have had to do just that over and over since I decided to pursue a career as a PA. There's still a lot of confusion though, amongst friends and the world in general, so I thought I'd take a moment to explain a bit about what Physician Assistants are and what they do. I'm also going to explain a bit of what's in store for me as I begin PA school this fall. First though, a little history.

History of the PA Profession

Dr. Charles L. Hudson

     Many people don't realize that Physician Assistants have been around for almost half a century already. The idea for the PA profession is credited to a physician, Dr. Charles L. Hudson, who in 1961 proposed “an advanced medical assistant with special training, intermediate between that of the technician and that of the doctor, who could not only handle many technical procedures, but could also take some degree of medical responsibility.” Dr. Hudson recognized, as did many at the time, that there would soon be a shortage of general practitioners in the US and he thought that the sort of medical assistant he described could help solve this problem. Another physician, Dr. Eugene A. Stead Jr., realized that the US already had men with intermediate medical training thanks to Korean War and the necessity of training soldiers to act as medics on the battlefield. He thus assembled a few former Navy medical corpsmen to create his first class for a new "physician assistant" program.  This first PA program began at Duke University in 1965, the same year that the first Nurse Practitioner program began at the University of Colorado, and the first PAs graduated in 1967. In 1971 the American Medical Association officially recognized the profession and created guidelines for practice and program accreditation. 

Dr. Eugene A. Stead Jr.

     The program has grown and expanded since its early days. Today there are at least 150 PA programs in the US and approximately 100,000 practicing PAs. PAs have prescriptive authority in all 50 states, which means that they can prescribe medications to their patients. The scope of practice for PAs, as I will describe in a moment, has also expanded. This has led some people to suggest a change of name for the profession. Many people mistakenly refer to PAs as "Physician's Assistants" which gives the impression that the PAs belong to, or merely assist, physicians who control their actions. As this is simply not the case some people have suggested that the title be changed to "Physician Associate." This is actually the title that Yale University already uses for their PA program. Whether or not this will change someday in the future is yet to be seen, but for now the standard title is Physician Assistant. Also, while the program began in the US, it is spreading to other countries, particularly ones that are experiencing a similar shortage of primary care providers.

So What Exactly Does a PA Do?

     One of my regular customers at the coffee shop recently told me that I'd picked an excellent career choice. I heartily agreed until he finished his thought by cheerily saying, "after all, physicians will always need assistants. So will you be taking blood pressures and things like that?" This just demonstrates the confusion prevalent amongst Americans about what a PA does. Hopefully I can clear some of this confusion up. The shortest, and probably least helpful description is that a PA is like a doctor, but not. Let me expand that. 
      PAs are healthcare providers who work in a team with doctors to provide care for their patients. They must have a doctor on their license to practice, and thus they are under the doctor's supervision. However, this does not mean that the doctor is standing over the PA's shoulder and observing everything they do or telling them how to treat the patients; i.e. "supervision" does not necessarily require the doctor's presence. In fact, the doctor may not even be in same office as the PA, let alone the same city. This means that PAs exercise a great deal of autonomy within the doctor/PA team. PAs have their own patients whom they interview, diagnose, counsel and treat. PAs can order and interpret diagnostic tests, as well as prescribe medications. A PA is truly centered on patient care, so they tend to spend a bit more time with their patients than a doctor would, and they also place emphasis on patient education and preventative care. PAs can be found not only in primary care positions, but also specialty care, like surgery. PAs can also be found in any healthcare setting, whether it be a multi-specialty practice group, hospital, large institution or rural clinic.
     PAs are required, like most medical professionals, to maintain a certain number of Continuing Medical Education (CME) hours (100 hours per 2 years for PAs). This is can be fulfilled by reading medical journals or attending lectures, but there are many options. Furthermore, PAs and NPs must both take a recertification exam every 5-6 years to maintain their certification. Some people think this is unfair because many physicians are not required to maintain their board certification, but there are many PAs who like it because they think it forces them to keep on top of medical news and continually hone their skills. Besides, so long as you are still practicing and using your skills, the recertification exam should not be ridiculously difficult.

     If it helps, here's a rather cheesy little video of the frustration most PAs, or even future PAs, go through trying to explain what a Physician Assistant does: Physician Assistant -A Conversation We've All Had.

Back in my Senior Tech days

Why PA and Not MD?

     Another question I was asked at every interview is why I decided to pursue a career as a PA and not a doctor. The answer is probably different for each PA, and I personally have multiple reasons. The shortest answer is that I think it's a better fit for my personality. The longer story is that being a PA appeals to me because of the team aspect and greater amounts of patient interaction. During my undergrad, I worked as a Media Technician, which meant that my coworkers and I took care of any and all technical aspects of events at school. This could be as simple as setting up a mic for a lecture, to controlling the lights, music, projection and recording at the annual talent show (If you're interested what this looked like you can check out some Golden Videos: Closing Dance 2011 or Sophomore Stage Act 2012). During my senior year, I was promoted to Senior Tech which meant that, for the completely student-run events, like Gordon Globes and Golden Goose, it was just my fellow Senior Techs and I calling the shots. I was actually the only Senior Tech at Globes, which my parents were able to see. While I enjoying running those shows, and I believe I did a pretty good job, I liked the fact that my bosses were only a phone call away if I ran into serious issues. Most of the time my coworkers and I could figure out the problem on our own, but it was nice to have a lifeline. Similarly, as a PA there will be a doctor on my license who will always be able to help me think through issues and come up with solutions whenever I cannot figure them out on my own. This system encourages a real spirit of teamwork and cooperation, and many PAs often find that doctors ask them questions as well. In the end, the patients benefit the most because they have healthcare providers humble enough to ask for help when they need it, and they get the experience of multiple people working on their case. 
     PAs also tend to spend more time with patients, and less time on paperwork, than doctors do. Since the time with the patients is one of the aspects I value the most, becoming a PA certainly seems like a better option. Another bonus is that, frankly, as a PA, I will be able to do many of the same things that a doctor can, but I will require only 2 1/2 years of schooling, saving me both time and money. In fact, a recent study my undergrad advisor just heard said that female PAs tend to have higher lifetime earnings than their physician counterparts. The reasons aren't completely clear, but the current hypothesis is that female doctors start working later and spend more time paying off school loans so that, even though their salary may be bigger than a PA's, they make less in the long-term. I'm not sure why this is not true for men as well (probably something with women taking time off to have kids), but it's an interesting tidbit. 

So What's Up for Me Next?

A bit of my future home at night

     This August I will be moving to Boston to begin the PA program at MCPHS University. This is a Master's program so I will be graduating with a Masters in Physician Assistant studies. The entire program at MCPHS is 30 months. This is a bit longer than most other PA programs, which are generally 24 months, but MCPHS includes one 4-month break after the first year (which many students use to work and earn money since working while attending PA school is highly discouraged, if not forbidden, by most programs). Aside from this break and some holidays, I will be in school year-round for 2 1/2 years. PA programs are largely set up to be a sort of rapid version of med school, so the first half is always didactic (the classroom, book, and lab learning) and the last half (about 11 months, beginning summer 2015 for me) are the clinical rotations (known at MCPHS as "clerkships"). Each student in a PA program must complete certain rotations (including pediatrics, internal medicine, surgery, emergency medicine, psychiatry, women's health, etc.), but most programs include room for at least one elective rotation. At MCPHS I will be able to do one elective rotation, and there's a possibility that I could do it out of the country in either Brazil or Germany, which is quite exciting. After completing the program I will need to take the Physician Assistant National Certifying Examination (PANCE). Once I pass I will be a Physician Assistant-Certified or PA-C. Then I just need to get a state license to begin practicing.  

     So there's the PA profession, and the next few years of my life, in short. I hope you're all enjoying this journey as much as I am and I look forward to experiencing and writing about the next steps.  

Much of the information I used for this post comes from these sites:

• http://www.aapa.org/uploadedFiles/content/Common/Files/1-Milestones0610Final.pdf 
• http://www.aapa.org/the_pa_profession/history.aspx 
• http://www.aanp.org/all-about-nps/historical-timeline 
• http://medicine.yale.edu/pa/profession/index.aspx
• http://www.paeaonline.org/index.php?ht=d/sp/i/197/pid/197
• http://www.aapa.org/the_pa_profession/what_is_a_pa.aspx
• http://www.pac.ca.gov/forms_pubs/what_is.shtml 
• http://www.aanpcert.org/ptistore/control/recert/index 
• http://www.fiercehealthcare.com/press-releases/certification-matters-most-americans-want-their-doctors-participate-lifelon
• http://www.ucdenver.edu/academics/colleges/medicalschool/education/degree_programs/PAProgram/prospectivestudent/Pages/WhatisaPhysicianAssistant.aspx