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Physician Assistants

THE JOB

PHYSICIAN ASSISTANTS, as their title suggests, support physicians.  They are
formally trained to work under the supervision of a medical doctor,
assisting in the diagnosis and treatment of diseases and injuries.  These
workers should not be confused with medical assistants (see California
Occupational Guide No. 513).

Physician Assistants (PAs) provide primary health care in rural areas where
people have little access to doctors, in inner-city clinics where people
have little money for health care, and in hospitals and private doctors'
offices where physicians caught up in the revolution of managed care have to
see more patients in less time.

Physician Assistants perform many time-consuming tasks normally done by
doctors.  They interview patients, take medical histories, give physical
examinations, order laboratory tests, make diagnoses, and prescribe
appropriate treatment.  They perform routine therapeutic procedures, such as
giving injections and immunizations, cleaning and stitching minor wounds,
applying splints, and removing casts.  Routine laboratory procedures may
include drawing and examining blood, taking cultures, and performing and
reading skin tests.  By doing these tasks for the doctor, PAs allow
physicians more time to treat more seriously ill patients.

Alternative titles sometimes used by these workers are MEDEX, physician
associate and community health medic.  Some PAs help physicians in such
specialty areas as pediatrics or surgery.  They perform routine procedures
such as physical examinations, provide postoperative care and help during
complicated medical procedures such as cardiac catherizations.  These
specialist PAs include child health associates, urologic Physician
Assistants, surgeon assistants, and emergency room Physician Assistants.


WORKING CONDITIONS

Physician Assistants work in the same places as physicians.  Hospitals,
clinics, and physicians' offices usually provide a comfortable, well-lighted
environment, although PAs must often stand for long periods and do
considerable walking.  Workplaces are sometimes stressful environments
filled with sick or dying people who need constant attention.

Physician Assistants belong to the California chapter of the American
Academy of Physician Assistants.


EMPLOYMENT OUTLOOK

The following information is from the California Projections of Employment
published by the Labor Market Information Division.

Estimated number of workers in 1993             5,110
Estimated number of workers in 2005             6,330
Projected Growth 1993-2005                        24%
Estimated openings due to separations by 2005   1,150

(These figures do not include self-employment or openings due to turnover.)

There were 3,132 licensed Physician Assistants in California as of March 1,
1998.

The number of Physician Assistants needed will depend on the increase in the
number of prepaid health plans.  The present needs are in under-served
communities such as rural areas and inner cities. 

Nationally, the Bureau of Labor Statistics predicts a growth rate for PAs of
50 percent above the norm for all occupational growth through 2005.

The increase in the population aged 65 and over should have a favorable
impact on the employment of Physician Assistants.  New nursing homes and
home health care agencies that serve the elderly will require additional
PAs.  

The advent and growing use of communications technology, specifically the
Telemedicine 3/4 device, now makes it easier for consultations between
physicians and PAs and for more accurate diagnoses.  This trend alone is
expected to expand the use of PAs by doctors and health care providers.


WAGES, HOURS, AND FRINGE BENEFITS

The 1996 median hourly wage for Physician Assistants in California was
$24.65.  This number reflects all levels of experience, from new
inexperienced workers to those with many years' experience; however,
earnings will most likely be lower both in rural settings and inner cities.

The work week and schedule vary according to the setting.  Some emergency
room PAs work 24-hour shifts twice weekly and others work three 12-hour
shifts each week.  The work week of PAs in doctors offices may include some
night office hours or early morning hospital rounds visiting patients.
PAs in clinics usually work a five-day, 40-hour week.

Most employers offer the usual fringe benefits, such as paid vacation, sick
leave, and medical and dental coverage.


ENTRANCE REQUIREMENTS AND TRAINING

In California, several educational programs for primary care Physician
Assistants or surgeon assistants are approved by the Committee on Allied
Health Education and Accreditation of the American Medical Association.
They are University of California at Davis, Charles Drew Postgraduate
Medical School, University of Southern California (Primary Care Physician
Assistant Program and Emergency Medicine Residency Program), the Stanford
University/Foothill College, and the College of Osteopathic Medicine in
Pomona.

Admission requirements to these programs vary from a high school diploma to
a bachelor's degree, but 60 credit hours or two years of college in a
science or health professions program is common.  Entry is competitive; many
applicants already hold a bachelor's or master's degree.  Many schools
consider experience in jobs ranging from medical technician to nursing aide
an important requirement for admission.  Still, lack of experience need not
be a barrier to applicants who are otherwise qualified.

Training programs are generally two years in length, although some are
longer and a few that require prior health-related training are shorter.
PA training begins with a classroom or pre-clinical phase that lasts nine
to twelve months.  Students then spend about a year doing clinical work in
areas such as family practice, inpatient medicine, general surgery,
obstetrics and gynecology, emergency medicine, internal medicine,
psychiatry, and pediatrics.  Often, one or more of the rotations are served
under the "preceptorship" or supervision of a physician who is seeking to
hire a PA.

The MEDEX training program is a shorter, slight variation of the PA program.
It is designed specifically for trainees who have had extensive, direct
patient care experience, and allows for a shorter period of classroom
training and increased emphasis on clinical experience.

Certification of Physician Assistants is done by the California State Board
of Medical Quality Assurance.  The certification exam consists of an all-day
written test and a practical part to assess the candidates' skills in
conducting a physical examination.  Applicants must have graduated from a
California approved Physician Assistant Program and pass a written exam.

Individuals planning a career as a Physician Assistant should be
conscientious and willing to study throughout their career in order to keep
up with medical advances.  They should be able to show leadership, self-
confidence and emotional stability.  A pleasant personality, patience and
the ability to deal with all kinds of people are also helpful.


ADVANCEMENT

Formal lines of promotion have not developed within this young profession.
There are no head PAs in hospitals or nursing homes as there are head
nurses; by the very nature of the profession, individual PAs are supervised
by physicians.  Since a supervising physician shares responsibility for the
quality of care rendered by the PA, this relationship must be a close one
and a middle level of supervision would be an interference.

For most PAs, advancement takes the form of the added responsibilities and
higher earnings that come with experience and, sometimes, with completion of
continuing education courses.


FINDING THE JOB

The local county Medical Association has information on jobs available for
Physician Assistants.  Placement offices in schools offering training assist
their graduates to find employment.


ADDITIONAL SOURCES OF INFORMATION

California Academy of Physician Assistants
9778 Katella Street, Suite 115
Anaheim, CA 92804-6446
(714) 539-1430

American Academy of Physician Assistants
950 North Washington Street
Alexandria, VA 22314
(703) 836-2272

Department of Consumer Affairs
Board of Medical Quality Assurance
Physician Assistant Examining Committee
1424 Howe Avenue, Suite 35
Sacramento, CA 95825
(916) 263-2670 or (800) 555-8038


RELATED OCCUPATIONAL GUIDES

Registered Nurses & Nurse Practitioners   No.  29
Physical Therapists                       No. 117
Licensed Vocational Nurses                No. 313
Physicians & Surgeons                     No. 319
Nurse Aides/Nursing Assistants            No. 442
Physical Therapy Aides & Assistants       No. 451


OCCUPATIONAL CODE REFERENCES

DOT (Dictionary of Occupational Titles, 4th Ed., Rev 1)
Physician Assistant (medical serv.)   079.364-018

OES (Occupational Employment Statistics) System
Physician's Assistants                     325110


Source: State of California, Employment Development Department,
        Labor Market Information Division, Information Services Group,
        (916) 262-2162.