A physician assistant or physician associate (PA) is a type of
mid-level health care provider.
In North America PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and may serve as a principal
healthcare provider
A health care provider is an individual health professional or a health facility organization licensed to provide health care medical diagnosis, diagnosis and therapy, treatment services including medication, surgery and medical devices. Health ca ...
. PAs are required in many states to have a direct agreement with a
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
.
In the United States and Canada, PAs are certified by their respective certifying bodies. The educational model was initially based upon the accelerated training of physicians during the shortage of qualified medical providers during
World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
. In the UK, PAs were introduced in 2003. They support GPs, but require oversight from a physician.
Nomenclature
The occupational title of physician assistant and physician associate originated in the United States in 1967 at
Duke University
Duke University is a private research university in Durham, North Carolina. Founded by Methodists and Quakers in the present-day city of Trinity in 1838, the school moved to Durham in 1892. In 1924, tobacco and electric power industrialist James ...
. The role has been adopted in the US, Canada, UK and Ireland, each with their own nomenclature.
Services
Physician assistants or associates may:
*conduct patient interviews and take medical histories
*conduct physical examinations
*order and interpret diagnostic tests and exams
*diagnose illnesses
*formulate treatment plans
*coordinate and manage care
*perform medical procedures
*prescribe medications
*conduct clinical research
*provide patient counselling
*offer advice on preventative health care
*first assist in surgery
Workplaces
Physician assistants or associates train to work in settings such as
hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
s,
clinic
A clinic (or outpatient clinic or ambulatory care clinic) is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care needs ...
s and other types of health facilities, or virtually via
telemedicine. PAs are commonly found working in teaching and research as well as hospital administration and other clinical environments. PAs may practice in
primary care
Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care t ...
or medical specialties, including emergency medicine, surgery and cardiology.
Training
Physician assistant or associate education is shorter than a medical degree. It also typically does not involve
residency training
Residency or postgraduate training is specifically a stage of graduate medical education. It refers to a qualified physician (one who holds the degree of MD, DO, MBBS, MBChB), veterinarian ( DVM or VMD) , dentist ( DDS or DMD) or podiatrist ...
, although this is increasingly offered in a variety of specialties. Renewal of certification is usually required every few years, varying by jurisdiction.
History
In 1961 Charles Hudson recommended that the
American Medical Association
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.
The AMA's state ...
create new medical provider certifications.
Eugene A. Stead
Eugene Anson Stead Jr. (October 6, 1908 in Atlanta, Georgia – June 12, 2005) is best known as a physician, medical educator, and researcher. He served on the faculties at Harvard, Emory (where he received a Bachelor of Science and MD degree), ...
of the
Duke University
Duke University is a private research university in Durham, North Carolina. Founded by Methodists and Quakers in the present-day city of Trinity in 1838, the school moved to Durham in 1892. In 1924, tobacco and electric power industrialist James ...
Medical Center assembled the first class of physician assistants in 1965, composed of four former
US Navy
The United States Navy (USN) is the maritime service branch of the United States Armed Forces and one of the eight uniformed services of the United States. It is the largest and most powerful navy in the world, with the estimated tonnage of ...
Hospital Corpsmen
A hospital corpsman (HM r corpsman is an enlisted medical specialist of the United States Navy, who may also serve in a U.S. Marine Corps unit. The corresponding rating within the United States Coast Guard is health services technician (HS) ...
. He based the curriculum of the PA program on his first-hand knowledge of the fast-track training of medical doctors during
World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
.
Two other physicians, Richard Smith at the
University of Washington
The University of Washington (UW, simply Washington, or informally U-Dub) is a public research university in Seattle, Washington.
Founded in 1861, Washington is one of the oldest universities on the West Coast; it was established in Seattle a ...
, and Hu Myers at
Alderson-Broaddus College launched their own programs in the mid-late 1960s. Dr. J. Willis Hurst started the
Emory University
Emory University is a private research university in Atlanta, Georgia. Founded in 1836 as "Emory College" by the Methodist Episcopal Church and named in honor of Methodist bishop John Emory, Emory is the second-oldest private institution of ...
Physician Assistant Program in 1967.
Beginning in January 1971, the US Army produced eight classes of physician assistants, at 30 students per class, through the
Academy of Health Sciences
The U.S. Army Medical Center of Excellence (MEDCoE) is located at Fort Sam Houston, Joint Base San Antonio, Texas. MEDCoE comprises the 32d Medical Brigade, the U.S. Army Medical Professional Training Brigade (MPTB), and the AMEDD Noncommissi ...
,
Brooke Medical Center (academically accredited by
Baylor University
Baylor University is a private Baptist Christian research university in Waco, Texas. Baylor was chartered in 1845 by the last Congress of the Republic of Texas. Baylor is the oldest continuously operating university in Texas and one of the fir ...
).
In 2017, approximately 68% of physician assistants in the United States identified as women and approximately 32% identified as men.
The profession expanded globally. It can now be found in Afghanistan, Australia, Canada, Germany, Ghana, India, Israel, Liberia, the Netherlands, New Zealand, Saudi Arabia, and the United Kingdom. As a profession physician assistants have greatly influenced the theory and conceptualization of socially accountable health professional education.
Jurisdictions
Australia
In 2011, Health Workforce Australia began developing the role of physician assistant throughout the country culminating with registration and a PA Program based out of James Cook University. Despite all initial indicators showing that the new profession would be successfully integrated into the health care system, the progress has floundered resulting in the majority of PAs in Australia being unemployed.
Canada
Overview
, there are approximately 800 physician assistants working in healthcare settings in Canada. The first formally trained physician assistants graduated in 1984 from the
Canadian Forces Medical Services School at Borden, Ontario.
The
Canadian Medical Association
The Canadian Medical Association (CMA; french: Association médicale canadienne, AMC) is a national, voluntary association of physicians and medical learners that advocates on national health matters. Its primary mandate is to drive positive ch ...
(CMA) recognized physician assistants as a health professional in 2003.
Physician assistants are able to perform medical functions such as ordering tests, diagnosing diseases, prescribing medications, treating patients, educating patients and performing various medical and surgical procedures. Physician assistants are labeled under the federal government national occupational classification code 3124: allied primary health practitioners.
Education and certification
The first civilian physician assistant education programs were launched in 2008 at the
University of Manitoba
The University of Manitoba (U of M, UManitoba, or UM) is a Canadian public research university in the province of Manitoba.[McMaster University
McMaster University (McMaster or Mac) is a public research university in Hamilton, Ontario, Canada. The main McMaster campus is on of land near the residential neighbourhoods of Ainslie Wood and Westdale, adjacent to the Royal Botanical Ga ...](_blank)
.
In 2010, a third civilian program was launched by the consortium of physician assistant education (
University of Toronto
The University of Toronto (UToronto or U of T) is a public research university in Toronto, Ontario, Canada, located on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution ...
,
Northern Ontario School of Medicine
Northern Ontario School of Medicine University (NOSM University; french: Université de l'École de médecine du Nord de l'Ontario) is a public medical university in the Canadian province of Ontario. It is mandated both to educate doctors and t ...
, and
The Michener Institute
The Michener Institute of Education at UHN, or simply Michener, is a specialist post-secondary institution in Toronto, Ontario, Canada. Based in Downtown Toronto and governed by the University Health Network (UHN), Canada's largest funded health c ...
). Admission to the physician assistant program in all three of the university programs across Canada are highly competitive with grades, education, interviews, professional experience, credentials, personal statements and testing considered in the candidate selection process. Approximately 15 seats at the University of Manitoba are available yearly while the two other programs in Ontario respectively have approximately 30 seats at the University of Toronto and approximately 24 seats at McMaster University. In Canada, the education of a physician assistant generally consists of three years of professional post-graduate university education. The education is delivered over a two calendar year time-frame by completing fall, winter and summer semesters for both years of the program in either a master level university physician assistant program or post-graduate professional university bachelor level physician assistant program. Physician assistant graduates become eligible for the certification exam by being a graduate of a Canadian physician assistant program that is recognized by the Physician Assistant Certification Council of Canada (Canadian Armed Forces physician assistant program, University of Manitoba, McMaster University and the consortium of physician assistant education all of which are accredited by the Canadian Medical Association).
Scope of practice
Physician assistants resemble and provide many of the functions of
physicians in Canada
Physicians and surgeons play an important role in the provision of health care in Canada. They are responsible for the promotion, maintenance, and restoration of health through the study, diagnosis, prognosis, and treatment of disease, injury, a ...
and act as advanced-level medical provider. Physician assistants may be compared to the role of nurse practitioner by the general public and may be confused as the same profession. Nurse practitioners in Canada practice under an advanced nursing model. Physician assistants practice under a medical model, similarly modeled after medical school (physician) education. Nurse practitioners practice within their defined specific scope of practice autonomously and sometimes collaboratively. The defined scopes of a nurse practitioner include the areas of (family care, adults and paediatrics). Physician assistants are permitted to practice in all medical specialties by mirroring the practice of a physician with a full range of skills and scope by practicing both autonomously as a clinician and collaboratively with physicians when required. Some examples of practice areas for physician assistants include (emergency medicine, critical care medicine, cardiology, psychiatry, community and family medicine, neurology, surgery, orthopaedics, internal medicine, oncology, gastroenterology, military medicine, respirology, dermatology, women's health and many more specialities). Physician assistants may perform certain roles which have been traditionally only provided by physicians in clinical practice, making the PA's medical training over other providers unique in this regard.
Compensation
Physician assistant salaries in civilian practice in Canada are relatively new and can range from approximately $80,000 CAD for entry level positions to $142,000 CAD a year for experienced providers which are not on call and up to $178,000 CAD for experienced providers which are on call. The physician assistant profession is newer to civilian practice in Canada. The compensation report published in 2019 by the Canadian Association of Physician Assistants outlines the typical salaries across Canada being an entry median salary of approximately $80,000 CAD and an experienced median salary of approximately $105,000 CAD.
Regulation
Physician assistants are currently practicing across Canada in the Canadian Armed Forces as commissioned officers in domestic and international environments and have been in practice since the 1960s. Physician assistants outside of the Canadian Armed Forces practice usually in the public health care system in the provinces of Manitoba, Ontario, New Brunswick, Nova Scotia, and Alberta. Physician assistants have been regulated in Manitoba since 1999 and in New Brunswick since 2009 and are registrants of their respective provincial college of physicians and surgeons. In Ontario, Alberta and Nova Scotia the profession is not regulated at this time. Physician assistants in Ontario were introduced in 2007 to the public health system as a joint venture between the Ontario Ministry of Health and the Ontario Medical Association. In Alberta, a registry has been established for physician assistants under the
College of Physicians and Surgeons of Alberta
The College of Physicians & Surgeons of Alberta (CPSA) is a regulatory college in the Canadian province of Alberta. Its stated purpose is to "register physicians and issue medical practice permits, develop and administer standards of practice a ...
with future regulation underway. In Ontario, future regulation has been discussed by the Ontario Ministry of Health in which physician assistants would be members of the
College of Physicians and Surgeons of Ontario
The College of Physicians and Surgeons of Ontario (CPSO) is the regulatory college for medical doctors in Ontario, Canada.
The college issues certificates of registration for all doctors to allow them to practise medicine as well as:
monitors an ...
. Physician assistants are represented by the Canadian Association of Physician Assistants, which originally was formed in October 1999 as the "Canadian Academy of Physician Assistants".
Germany
In Germany the ''Physician Assistant'' is called ''
:de:Arztassistent''. It was introduced in 2007.
India
The first PA program in India was established in 1992 with a focus on expanding cardiovascular surgery. Since then, eight additional programs have developed (in total seven baccalaureate and two master's level programs).
Ireland
Physician Associates were introduced by the
Health Service Executive
The Health Service Executive (HSE) ( ga, Feidhmeannacht na Seirbhíse Sláinte) is the publicly funded healthcare system in Ireland, responsible for the provision of health and personal social services. It came into operation on 1 January 2005 ...
in the mid-2010's. The
Royal College of Surgeons has offered a PA
postgraduate degree
Postgraduate or graduate education refers to academic or professional degrees, certificates, diplomas, or other qualifications pursued by post-secondary students who have earned an undergraduate ( bachelor's) degree.
The organization and stru ...
since 2016, with 28 graduating by .
PAs may not write
prescriptions.
Israel
Physician Assistants were introduced in Israel in May 2016 to help augment a shrinking physician workforce. The initial training programs have been overseen by the ministry of health directly, but transition to academic training is planned. Israeli PA education is modeled after United States' and Netherlands' approaches, and has focused on former paramedics with bachelor's degrees. As of 2022, the 100 or so PAs in Israel work exclusively within Emergency Departments. While PA scope of practice includes many emergency procedures, Israeli PAs are not currently allowed to prescribe or administer medicine in non-emergency settings.
New Zealand
In February 2015, Health Workforce New Zealand completed a Phase-2 trial of PAs who worked for a period of two years (2013–2015) in four clinical settings.
Specifically, the sites included one rural emergency department and three primary care settings (two rural and one urban) located on the North and South Islands of New Zealand.
At conclusion of the trial, several clinics continued to employ PAs while the process of health regulation makes its way through the government bureaucracy.
United Kingdom
The position of physician associate was established in the United Kingdom in 2005. It evolved from that of physician assistant, developed in the US in the 1960s. In 2012, the profession voted to change the name to ''physician associate'' to distinguish it from another with the same name within the NHS.
Hillingdon Hospitals NHS Foundation Trust
The Hillingdon Hospitals NHS Foundation Trust is the NHS trust responsible for the healthcare services provided at Hillingdon Hospital and Mount Vernon Hospital in the London Borough of Hillingdon.
The trust is part of Imperial College Healt ...
was asked to manage the recruitment of 200 physician associates who are expected to come from the US for 40
NHS trust
An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several ...
s in September 2015.
In 2022 it was reported that private company Operose Health, owned by US company
Centene Corporation, which had acquired many UK
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
(NHS) GP practices, was using many PAs—at less than half the cost of a GP
[—and allowing them essentially to act as GPs, without required supervision. A ]BBC #REDIRECT BBC #REDIRECT BBC
Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board exam. ...
...
reporter worked undercover at an Operose practice for six weeks, reporting on many problems.
A senior GP said that the company was prioritising profit, putting patients at risk.