There’s a wide gamut of professionals that provide healthcare to people every day besides doctors and nurses. A physician assistant, for example, typically has more time than a rushed doctor to actually spend time with patients and provide care. At a glance it’s an easily misunderstood role—becoming a physician assistant requires more education than a nurse, and you’ve likely seen or been treated by a PA and probably just assumed they were the physician. To learn what it means to be a physician assistant, we spoke with a PA of three years, Jordan Hall. First of all, tell us a little about your current position and how long you’ve been at it. My name is Jordan Hall. I am a physician assistant (PA) in Atlanta, Georgia. A PA is a medical professional who is licensed both federally and locally to practice medicine. My scope of practice includes examining patients, ordering and interpreting tests, preforming procedures, and diagnosing and treating pathology under the supervision of an employing or sponsoring physician. I have been working a little over three years now. Prior to that, I was in school for about seven years preparing for this career. What drove you to choose your career path? Like many of my colleagues, I was drawn to medicine through an affinity for science. I was always interested in biology, chemistry, and physics, so it was natural that I gravitated towards a profession built upon those subjects. I was ignorant of this profession until I attended a career fair through the college of physiology late in my undergraduate education. Prior to the career fair, I was set on attending medical school, but what I discovered at the fair piqued my interest. I contacted a few of the doctors I was shadowing, each of whom employed physician assistants, to see if I could come observe them in clinic. After my observations, I researched the career extensively. The broad range of options following graduation as well as the ability to take more time with each patient and not have a rushed schedule were appealing to me. Additionally, I learned I could do everything I wanted in medicine as a PA: I could see and treat patients with autonomy, prescribe medicines within my scope of practice, and participate in surgery with my attending physician. After I considered the costs and benefits, I decided it was the right choice for me and felt it suited the quality of life I wanted. How did you go about getting your job? What kind of education and experience did you need? Nearly all the PA programs are 2-3 year Masters programs which require a bachelor’s degree for admission. Typical acceptance is based on overall undergraduate GPA, core science GPA, and GRE/MCAT scores. There are prerequisite classes that are deemed mandatory by each institution. These classes typically include organic chemistry, microbiology, genetics, and anatomy/physiology. Most applicants have a degree in a life science, which fulfills the aforementioned requirements. Admission to a PA program is competitive, and admission boards often require candidates to have a certain number of “clinical experience hours.” Clinical experience hours are earned by observing or working alongside medical providers in a professional setting. Candidates with clinical experience have a clearer idea of what the profession entails. Clinical experience requirements can vary among programs from 200 to 5000 hours. Did you need any licenses or certifications? Upon completion of your professional degree from an accredited university, you must take a national licensing exam: the Physician Assistant National Certification Exam (colloquially known as the PANCE). Passing this exam is required to practice medicine as a PA. Additionally you are required to be certified in the state that you practice through the local medical board. Until recently, PAs were required to “re-certify” at the national level every six years; however, that has recently been extended to every 10 years, so it is consistent with the requirements of physicians. We also have to complete 200 hours of continuing medical education every two years. What differentiates a physician assistant from a nurse or doctor? (I probably would have mistakenly assumed you were a nurse.) Nurses are more limited in the decisions they can make without a physician. Nurses are not allowed to diagnosis and treat patients, order studies, or write medications. In short a nurse is not allowed to make any decisions regarding a patient without a physician permission. A more correct comparison would be to a nurse practitioner who can also do the above. We have more training than a nurse and less than a physician. What kinds of things do you do beyond what most people see? What do you actually spend the majority of your time doing? Documentation is becoming a major focus in medicine right now. There has been a large push by federal review boards and private insurance to increase not only the thoroughness of documentation, but also the quality. Documentation and dictation take up about thirty percent of my time. I spend about forty-five percent of my time in person with patients in a clinical or surgical setting, and the remaining twenty-five percent is spent reviewing medical studies such as x-rays and lab test results. PAs are able to spend more time with the patient in clinic than a physician, which is something I am always happy to do, and frankly, it is the aspect of the job that appeals to me the most. I enjoy educating my patients by discussing the finer points of pathologic findings. I feel this gives the patient a deeper understanding of their healthcare. Physicians often do not have time for such personal attention and patient education due to overbooked schedules, so PAs take pride in this aspect of the job. What misconceptions do people often have about your job? The profession is still relatively young and people both outside and inside medicine have misunderstandings. One misunderstanding is that a PA is still in school or training to be a doctor. If faced with this misconception, I do not take offense. I respond by explaining that I already spent a lot of time in school in order to become a PA and that I am a fully licensed medical professional who has completed all requisite training. I want my patients to feel comfortable knowing they are being cared for by a well trained, proficient professional. The second, more troubling misconception is that one becomes a PA due to an inability to get into medical school. This misconception usually appears as an overheard derisive remark. The remark is undeserved and unsupported. PA school is incredibly competitive with a difficult academic and clinical course load. Admission rates are around three percent at most institutions (according to Yale, Duke, and GRU) due to small class sizes. Many of my classmates and I were accepted into medical school, but chose to pursue PA school instead. The misconception seems to be more prevalent in older patients. My younger patients tend to have a better grasp on my profession, which I suspect is due to an increase in the number of practicing PA’s over the last decade. What are your average work hours? A PA’s schedule is dependent on their individual situation and the needs of the practice and the attending physician. The schedule can be extremely flexible if necessary. My typical workweek is between forty and forty-five hours. What personal tips and shortcuts have made your job easier? When I was a student rotating in pediatric cardiology, I had an attending tell me to “study as if you are a first year student for the rest of your life.” What appeals to me the most about medicine and science in general is that it is a constantly evolving medium. I continue to delve into research and lectures out of professional and personal interest. I hope that this profession attracts curious and driven individuals because that is what modern medicine needs. We live in an age of increasing information availability, and providers have to sprint to keep up. But for me, that’s what makes it so fun! Forging the frontiers of health sciences is how we as a species combat disease and bestow benefits on mankind. What do you do differently from your coworkers or peers in the same profession? What do they do instead? I am more technologically versed than some of my peers. I am constantly utilizing technology for educational and professional purposes. There are excellent apps for everything from drug interactions to illustrations that I show patients to explain pathology in detail. I am very interested in computer science and feel there will be amazing healthcare impacts when the merger of modern technology and medicine reaches fruition. We have already had striking advancements with laboratory methods and I am excited to see the results when the clinical side experiences a similar revolution. What’s the worst part of the job and how do you deal with it? I work in orthopedics, so I have the misfortune of seeing some insidious metastatic diseases and subsequently have the duty to disclose the diagnosis. This quickly puts my own personal problems into perspective and reminds me how fragile our health can be. I am not sure if that part of the job is for everyone. It is extremely difficult when I have to inform a patient she has cancerous lesions when she came to see me for back pain. I do my best to approach all patients like they are my friends. I do this because I hope if anyone I love were in that situation, they would be treated with compassion and consideration for their illness. I try to follow the proverbial golden rule: treat others as you would want to be treated. What’s the most enjoyable part of the job? Having a positive impact on someone’s life is the most rewarding part of the job. I hope that even the most cynical and jaded person in healthcare initially came to the profession to help others. It is certainly not all happy times. I have stressful days, but the patient who sincerely appreciates your care quickly buffers any acidic memories. Do you have any advice for people who need to enlist your services? I am genuinely pleased when a patient asks me a question about their health because it shows they are interested in being involved. I would encourage all patients to ask a few questions ranging from clarification of a diagnosis or prognosis to preventative strategies. Do not feel intimidated. Medicine is very complex and it can be helpful to break it down to more understandable parlance. However; please also understand that while we are happy to answer a few questions, we are also expected to see patients according to a very tight schedule. I would recommend asking no more than two questions per issue. If you need additional information, simply inquire about obtaining another appointment for further discussion. Also, avoid the following phrase at all costs: “I saw this on Dr. Oz and wanted your opinion...” What kind of money can one expect to make at your job? The salary range most commonly referenced for a PA through public sources is $95,000.00 - $150,000.00 annually. This number represents an average across the country. Salaries will generally be higher in large cities however, I suspect it is because I work in a subspecialty in a large city, and there is a known discrepancy between subspecialties and more broad careers. In less populated areas and in family medicine, salaries will be lower. Experience and productivity play a large role in salaries as well, with salaries increasing as experience and productivity rise. How do you “move up” in your field? Experience and clinical skill set are the two ways I see PAs move up. It’s clear that as your skill set grows and you are able to take on more complicated cases, you tend to be valued more and will be compensated appropriately. By clinical skill set I am referring to the procedures you are competent at preforming in addition to the ability to handle complex medical situations. Also, as your caseload increases and you see more patients, you are relieving a burden off your employing physician, which will likely be rewarded. Additionally taking on administrative roles is an avenue one could take if they were no long interested in formally practicing. What do your patients under/over value? I think patients overvalue the idea of a quick fix. There are so many people who want immediate and permanent relief from pathologies that took years to develop and that is simply not going to happen. We live in a society where deferred gratification has become antiquated and unfortunately in medicine you need to cast away that myopic mindset. If I had a magic wand to make every one of my patients instantly better, I would use it without hesitation, but we have to do the best with what medical science has given us. If there were a scientist or doctor who found a “cure” for arthritis she or he would win the Nobel Prize in Physiology. It would be an astonishing discovery, one that would change the course of medicine. It would not be something you would read about in a magazine advertisement or someone’s blog. As my hero Neil deGrasse Tyson says, “there is no such thing as alternative physics” and medicine is no different. A treatment is either found to be efficacious through a stringent scientific process or it is hokum. Despite what you may think, there is a not a lot of gray area. What advice would you give to those aspiring to join your profession? I would say go for it! There are still a lot of barriers set up in medicine and it still has a “members only” façade to those not yet indoctrinated. Do not let the heavy set of pre-requisite science courses or a daunting MCAT examination hamper your desire. We need passionate curious people to help care for an increasing and aging population. Whether your desire is to be a RN, a PA, a NP or a MD, at the end of the day letters after your name are only letters. Strive to become a competent, intelligent, compassionate provider and always remember those that help you along the way. Source
