Physician Assistants: From High School To The Real Life

Jake Merkel

English III Honors Pd. 1

Mr. Piatak

February 23, 2017

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A family enjoys an annual picnic on a beautiful sunny afternoon playing games and races

like kickball and the egg on the spoon race. During the kickball game, little Karen ran to first

base after kicking the ball and tripped over a rock. While catching herself, an excruciating pain

in her hand made her jump up and begin to cry. Her finger had dislocated and at that point she

needed to go to the doctor. Karen and her family rushed to an emergency room and she saw a

physician assistant (PA) to put the finger back into place. After waiting for five minutes, the

nurse called her in to see the PA. The PA looked at x-rays from the finger and numbed it to make

it less painful. With a count of three, the finger had snapped back into place. After that, they took

another x-ray, checking for any major bone fractures and ligament or tendon damage. After the

x-ray, numbing and putting the finger back into place, and another x-ray checking for any further

damages, the doctor put a splint on her finger to stop it from moving around, making sure she

would let it heal. After the entire process, Karen made out ok and nothing major happened. If this

took place in the 1960s, Karen would have had to wait longer than she did in this situation.

Physician assistants have played a major role in the medical world, increasing in numbers, and

having the same amount of knowledge as physicians and medical doctors do; PAs make the

medical field an opportunity for students wanting to become doctors as well as offering

affordable care for patients.

Like every medical profession, career path, etc. it all comes from medical history dating

back centuries. More and more learning and advances in technology and knowledge allows for

branching off in the medical world. The history of medicine really took off in the 19th century,

making incredible advances and learning new things. Before the 19th century, the public and
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doctors believed that the main causes of illnesses and epidemics came from the odor from

sewage and feces not properly disposed; whereas the cause really came from bacteria from all

the undisposed sewage and feces (Lyons). In the early 19th century, France lead every other

country in medical advancements. Francois Magendie, a French physiologist, liked to keep his

findings short and simple, straight to the point. He was remembered for his experimental proofs

that the posterior roots of the spinal canal carry sensory nerve fibers (receiving impulses to the

cord) and the anterior roots are motor nerves... (Lyons). Magendie discovered the spinal canal,

something on the physical and logical scale; however, Claude Bernard made discoveries on the

chemical scale. Bernard questioned Magendies discoveries, looking at them at a chemical level

and at the same time perfecting the chemical experiment processes (Lyons). Since early history,

more medical discoveries have created different fields of medicine without realizing it.

Compared to other professions such as doctors and specialists, the PA career path has not

existed in the medical world as long as others have. The need for physicians and primary care

doctors increased in the mid-1960s. The first class of physician assistants graduated a few years

after the creation of the first PA program in 1965 at Duke University by medical doctor Eugene

A. Stead Jr. He chose four Navy Hospital Corpsmen with great medical experience from the

military to participate in this new program. The fairly new profession of becoming a PA began to

rise. The idea of becoming a physicians assistant became popular and was backed by the

government as early as the 1970s as a creative solution to the physician shortage issue. The new

profession encouraged the establishment of the national certification process and standardized

exams, and as well as new medical education requirements (The PA Role). New tests and

advancements in the PA career path became more popular in the years to come.
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It took little time for academies and schools to start teaching and branching off into the

PA profession. The American Academy of Physician Assistants or more formally known as the

American Association of Physician Assistants (AAPA), created in North Carolina in 1968.

Rapidly increasing in members in a few short years; it grew by over 300 members in the year

1973 and created a national headquarters for PAs in Washington, DC (History). When the PA

association grew in numbers by 1973, the association had renamed itself to the Physician

Assistant Education Program (History). The renaming of PA programs and rapid increase in

PA students proves the increasing popularity in this career path.

Becoming a PA involves many different requirements, including hours of volunteering or

working, both of which show a great deal of effort and dedication into the PA career. Experience

and volunteering in the medical field increase the amount of hours students earn during and after

college (Health Diagnosing and Treating...). Another requirement includes all states requiring

PAs to pass the Physician Assistant National Certifying Examination administered by the

National Commission on Certification of Physician Assistants (NCCPA) (Health Diagnosing

and Treating). PAs use a large quantity of information and skill in their line of work and

actually have the same amount of knowledge as a regular physicians or medical doctors (MD)

might have (Vught et al). Physicians and MDs typically specialize in a certain part or subject in

the medical field. Depending on the career path of a PA, one might see many different things

during a normal day. PAs provide diagnostic, therapeutic, and preventive healthcare services

such as: taking x-rays and make diagnoses in regards to an injury, treating minor injuries by

suturing, splinting, or casting, and can prescribe medicine for a patient (Health Diagnosing and
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Treating) Lots of different aspects of the job require a variety of knowledge and skill during

the course of an average work day.

PAs preform many different jobs, however certain things may prohibit PAs from

continuing their job. The qualifications needed to obtain the PA degrees and qualification papers

continues to grow. PAs need a college health degree, some health-related work experience, and

must pass the national exam to obtain a licence to become a PA (Health Diagnosing and

Treating). PAs also perform different types of procedures that might seem normal to some. If

someone gets a physical or goes for normal check-up, a PA takes all of that information down.

PAs train to master the paperwork aspect of the job, which makes up the majority of the time.

They can also diagnose an illness a patient could have; for example, they could give strep throat

cultures. In the strep throat cultures, PAs give the culture and then look and examine the culture

to find signs of the strep throat virus to determine if the patient has or does not have the virus.

However, PAs work underneath physicians and MDs, therefore, they cannot do certain things

(Vught et al). PAs also have the option of choosing a specialty in their career paths. Some

different pathways PAs can branch off include: audiology, occupational therapist, physical

therapist, registering as a nurse, and speech-language pathologist (Health Diagnosing and

Treating...). In order to get involved in a specialty, a PA would need to have experience in the

specialty and obtain the specialty continuing medical education certificate (CME) (PA Specialty

Certification). The different pathways that students take out of college create an excellent

option for obtaining a job that he or she loves, either based on favoritism of a certain subject or

environment they would feel most comfortable in.

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The types of environments PAs work in can vary from controlled and calm to crazy and

chaotic. Different types of offices do different things: general internal medicine, pediatrics,

family medicine, orthopedics, etc. list general places a PA may work. An orthopedic office

provides services for a patient if he or she has a broken, fractured, or bone chip, to get it x-rayed,

and put into a cast; as well as things involving muscles, ligaments, and tendons give reason for

going to an orthopedic. Patients who go to a regular family medicine office typically see a PA,

where the PA would take the measurements and record the data of a patient. The types of

environments vary within the different types of offices. Normally, the environment of an office

or workplace generally remains calm and steady paced, however, it can get out of hand and

become busy at times. Stress also contributes a big part in the career of PAs. Certain

environments can take a major toll on some people depending on the situation. It is also

extremely important to have excellent people skills. Being able to listen and communicate with a

parent and patient is imperative (Mayhew). The listening part of the job can hurt a patient's

health, meaning if a patient is not heard, the correct treatment could possibly not be treated.

Working in a normal office will generally stay calmer than if a PA works beside a surgeon,

where in that case, PAs and the surgeon stand for hours at a time (Health Diagnosing and

Treating...). An outpatient pediatric PA would work anywhere from 35-40 hours a week on

average (Mayhew). Depending on what career path a student would choose, the workload and

difficulty would change in both the real world and in school, high school and college.

For any career, from becoming a doctor or becoming an engineer, it all starts with

education and for anyone, it starts in high school. For becoming a PA, students should have a

rigorous course schedule showing colleges students have the ability to challenge themselves and
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work toward great things; the schedule should involve more math and science leaning more

towards the PA career path. Core classes required by most medical/dental schools are: biology,

general chemistry, organic chemistry, and physics with laboratory experience (Elam et al). The

classes students take in high school should also consist of higher level math and science classes.

Standardized tests should go well for students to should show colleges that students can

understand and can read and comprehend text, read charts, etc (Elam et al). Teachers and college

counselors provide a great source of information and help to get into college, giving great advice

and helping with resums. Teachers who develop personal relationships with a student can result

in great teacher recommendation letters for college. High school teachers and counselors can

create pre-health clubs, which would get students sort of into the career by helping them learn

about what the profession has to offer and students can do this with actual medical doctors and

PAs. This would allow students to get their feet wet about the PA day to day job and what goes

on (Elam et al). Counselors and other academic partners like teachers can provide exceptional

help getting into college, from applications to recommendation letters, leading to the next step

from high school.

From high school, the step up consists of going to college. If students want to continue

their medical studies, they would send their transcripts to a medical school in between June and

November and in December would begin medical school in July and August. The American

Medical College Application Service (AMCAS) serves as a centralized location students can

enter their medical transcripts for medical school, which will allow participating schools to see

what a certain student offers and what they did in their college careers; grades, volunteering, and

amount of laboratory hours completed, to name a few, shows what the transcript would include.
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Some people decide that they would like to continue their careers and specialize in a certain field

or subject while still staying a PA; however, they still need certain things to do so. A letter of

evaluation contributes to a big part of getting into medical school. Students would want a

professor they worked the closest with because the professor should know his or her students

work ethic and the attitude toward the subject they pursue in college. Interviews show off

character and can weigh heavier than what a student would send in a transcript, allowing the

college to see how students handle themselves in person. It also verifies what a student sent in on

the application letter (Elam et al). A helpful and smart thing to do in college would involve

establishing a great relationship with a professor to create an outstanding recommendation letter.

During college, time contributes to one of the major factors in graduating. A normal PA

course would take about two years to complete within a four year degree, then a standard PA

would graduate with a bachelor's degree. In those four years, students would learn how to treat

patients in their fields. A shortlist that includes using a stethoscope or writing paper work for

example, show a few things students will learn how to perfect in their college careers. Roughly

142 education programs for the PA career and 80%, or 113, of those schools offered the option

to continue a student's medical studies and allow them to earn a medical degree (Elam et al). In

those courses, students can branch off into other specialties within the PA field.

The demand for PAs continues to increase and with the many different branches involved

in the PA world, many available jobs exist to college students after college compared to the PAs

in 1996, increasing competition in the PA profession (Askildsen and Holms). There was 74,800

jobs in 2008, 15% of them moonlighted which created more job opportunities for people, 53%

worked in an office of a physician, 24% work in general medicine and surgical hospitals, and
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finally the last few become unemployed. Moonlighting occurs when someone works during the

day and the night. For example, a college student works at a library during the day, and another

job at night. People moonlight for different reasons including earning extra spending money or

for help making ends meet. Although competition for becoming a PA remains strong, a PA can

obtain a job and continue his or her career. With the busy schedule some PAs have, they can still

have flexible hours if they work in a calmer environment. Sickness and other reasons like

vacations and other family related issues allow PAs to take time off of work (Mayhew). All in

all, job searches can result in easier findings compared to some jobs and some extra work might

need to get taken care of to fight for a job and make more money.

Other careers might have difficult job opportunities out of college, however, a PA can

find a job relatively quickly out of college. As expected, from 2008-2018 the employment rate

grew 39% because of many people becoming PAs. The rural and inner-city locations bring the

most popular jobs amongst PAs, which in turn increases the employment rate because of the

larger population as well. The rural areas increase the job competition amongst PAs rather than

in areas with less population. Cities and areas around cities would make great places for PA

offices. Areas like farmland and small towns would increase the PA competition because of the

decrease in population numbers. PAs generally make a large amount of money annually.

Depending on where a PA works, both the location of an office or hospital and what field

someone goes into, the pay can start at $85,000-$95,000 (Mayhew). A median wage for a PA

would consist of $81,230 in May of 2008, 50% of PAs would make somewhere in between

$68,210-$97,070, the lowest 10% made less than $51,360, and the highest 10% made more than

$110,240. In May 2008, the average median wages of industries employing the largest numbers
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of PAs include general medical and surgical hospitals making $84,550 and working at colleges,

universities, and professional schools would make $74,200. The gap remains fairly small

between the two (Health Diagnosing and Treating). Depending on where a PA works, both

the location of an office or hospital and what field someone goes into, the pay can start at

$85,000-$95,000 (Mayhew). Even for the lowest 10%, the annual salary pay can result in

excellent pay.

Whether a student does this for school requirements or just to get experience in the field,

volunteering can contribute a substantial amount into becoming successful in the PA career.

Colleges love that students volunteer and how they can get involved with the career they want to

study in high school. Many different reasons students should volunteer include: helping get an

idea of the career, making a difference in his or her community, using medical skills, meet new

people and create new relationships, etc. This allows students to get first hand of what a normal

day at a hospital or office day would consist of. Volunteering also can show a student whether or

not they would want to pursue this career. I started volunteering in a small outpatient facility

while an undergraduate student at UNC Chapel Hill. I was able to work with several PAs who

were passionate about their job in medicine (Mayhew). However, some students may not

volunteer for different reasons. These reasons could involve: not enough time, students worry

they dont have the required skills needed to volunteer with, concern for medical liability, etc.

Legitimate concerns could make someone not want to volunteer and not for reasons like they do

not want to, but they do not want to hurt someone in the process (Metropolitan Washington

Regional Medical Program). An important key factor, not comfortable enough to volunteer,
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shows great knowledge of a student's judgment and can pay off in the long run. If a student gets

uncomfortable and makes a mistake, it could have drastic consequences.

Finally, from a knowledge standpoint, PAs compared to regular physicians do not differ

that much. However, some differences include pay and hours for example. The need and

occupation for PAs continues to grow in offices, hospitals, and in any area in need.
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