Physicians have traditionally made up a majority of the clinicians who diagnose, treat, and prescribe medications to patients. As the population ages, however, the market demand for medical services has outpaced the number of physicians who can supply care, particularly in rural or remote areas.
A growing share of services is now being provided by physician assistants (PA). Their number is increasing rapidly, and they offer much-needed relief to the physician shortage without sacrificing care quality and efficiency.
In this post, we focus on the role of physician assistants in hospital-based medicine. We will discuss how PAs fill gaps in care, outline reasons to consider the profession, briefly note the benefits of advanced certification, and examine the outlook for the discipline in the coming years.
Physician Assistants in Emergency Medicine
According to the National Commission on Certification for Physician Assistants (NCCPA), the percentage of physician assistants working in all practice specialties has grown 13 percent over the last three years. Emergency medicine is one of the top areas of growth in utilizing physician assistants, the third-highest behind family medicine and surgical subspecialties.
While hospital medicine is the area most commonly associated with PA practice in hospital settings, physician assistants in emergency medicine not only help to address critical workforce shortages and improve care quality but also assist in other equally vital ways: PAs are taking on leadership roles, creating process improvements, heading up observation units, and setting up and staffing telemedicine programs.
Emergency Medicine physician assistants practice as members of a team with their supervising physicians. To qualify to work in the emergency department, a physician assistant must have:
- Graduated from an accredited physician assistant training program and be certified or eligible to be certified by NCCPA;
- Comply with licensure and other regulations of the PA practice act in the state in which he or she practices;
- Develop or maintain qualifications through:
- Ongoing emergency medicine training and CME;
- Clinical experience in emergency medicine as a physician assistant;
- Graduate from an emergency medicine physician assistant residency.
PAs in Hospital Medicine
It's worth noting that more than 3,200 PAs now work in hospital medicine, according to NCCPA’s most recent Statistical Report of Certified PAs by Specialty, a 21 percent increase over three years. PAs are often in charge of patients throughout their hospital stay, with a physician available to see the patient on an as-needed basis.
CAQs for Working in Hospitals
PAs are educated and certified as generalists, ensuring that they possess a broad fund of core medical knowledge, which gives them the flexibility to practice in a range of areas from primary care to surgical specialties.
"There is greater opportunity for PAs to move into different specialties," said Joseph Giannini, NPPA National Director for Hospital Medicine, SCP. "In medicine, you train into a specialty and it takes extensive training to change. The skills of the PA are very portable due to their generalist training and supervisory relationships, enabling them to explore other areas of specialty with on-the-job training and continuing education."
To qualify to work in specialty areas, such as Emergency or Hospital Medicine, it’s helpful for PAs to obtain additional certification in the form of a Certificate of Added Qualifications (CAQ), offered by NCCPA.
Giannini stated that obtaining CAQs makes PAs more "marketable" and more "enticing" to the hospitals looking to integrate PAs into the clinical mix.
"The extra certification is an opportunity for professional growth and an advantage that makes them more marketable," he said. “It's a way to quantify or show expertise in a certain area. To us, it is enticing to get candidates with extra certifications; they can integrate into the practice more quickly and already have the training, skills, and knowledge to work in the specialty."
Reasons to Become a Physician Assistant
There are several reasons to become a physician assistant: education takes less time than training to practice as an MD; PAs are paid reasonably well (the median pay for a PA in 2017 was $104,860 per year, according to the Bureau of Labor Statistics); they also have greater flexibility in career options, work fewer hours than doctors, keep more regular schedules, and have excellent job prospects.
"It’s a wonderful field for anyone in healthcare to get into," Giannini said. "There continues to be expansive growth for the profession in a wide variety of specialties. Nationally, PAs are used in primary care, outpatient subspecialties, inpatient medicine, inpatient specialty, and emergency medicine."
When asked why PAs should consider hospital-based medicine as opposed to primary care or another specialty, he remarked, "PAs working in hospitals see a variety of patient presentations and illnesses. You get to use the breadth of your education working with patients who are at their worst. Also, you get to see the changes you make in their health and feel the reward of that and then help them integrate back into their life and community."
Filling the Gap in Care
Giannini said hospital medical directors have as many reasons to hire PAs as there are to enter the profession. He listed three to consider:
Provider shortage. "SCP Health staffs hospitals in many rural areas and the physician shortage makes it difficult to provide quality care. PAs are a great option to help staff those contracts."
Ease of recruiting. "When talking with physicians and Medical Directors about incorporating PAs into their practice, I always discuss the benefit of increasing the recruiting pool. It allows you to increase your candidate base and bring on the best providers (physician and PA) into your program."
Healthcare industry finances. "Diversifying the provider mix within our hospital medicine programs can help combat the increasing cost of healthcare and decreasing reimbursement from payers."
Giannini warns PAs to be cognizant of the need to outline expectations for their role and for doctors to know their scope of practice.
"Physicians don't always know how to work with PAs, and that can affect relationships," he said. "There is a need to educate physicians on the scope of practice and role of PAs to build a better collaborative and supervisory relationship. The quality they provide is extraordinary; you just need to know how to implement them in practices."
Projections and Outlook for Physician Assistant Industry Growth
The future looks bright for physician assistants.
The occupation is projected to grow 37 percent by 2026, much faster than the average for all occupations, according to the Bureau of Labor Statistics. As the demand for health care services increases, physician assistants will be needed to provide care to patients to fill the gap left by the physician shortage.
In an industry struggling to improve access to care and optimal outcomes for all patients, PAs will continue to be in demand in all specialties, including Emergency and Hospital Medicine.
SCP Health places a high value on the role of physician assistants by making them a vital part of the patient care team. Learn more about working with SCP and see available PA job openings.