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Physician assistants or associates (PAs) are highly trained healthcare professionals licensed to practice medicine under the supervision of a physician. Most PAs are trained in a generalist model, which provides them with comprehensive knowledge across all areas of medicine and allows them to treat various medical issues. Their duties can include conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests, counseling on preventive health care, assisting in surgery, and, in most states, prescribing medication.
However, PAs can also specialize in various fields of medicine. Specialization allows PAs to focus on a specific demographic, condition, or type of care, allowing them to develop a refined skill set and extensive knowledge. For example, a PA specializing in pediatrics can develop an understanding and expertise in treating illnesses common among children, while a PA in psychiatry will develop a keen eye for diagnosing and treating mental health conditions.
Specialization can also enhance a PA’s career trajectory and earning potential. By developing focused expertise, PAs can position themselves as specialists in high-demand areas, making them more appealing to potential employers. Certain specialties inherently demand knowledge and skill that justifies a higher pay scale than the average salary in general practice. Also, PAs who specialize may have the opportunity to pursue leadership roles within their workplaces, such as leading a team of healthcare professionals or managing a specific department, which can also contribute to a higher income.
The choice of specialty significantly influences a PA’s daily routine, the complexity of cases they handle, and their interaction with patients. Each specialty not only brings its unique set of challenges but also may require additional education, residencies, fellowships, or certification. Listed below are the specialties recognized by the American Academy of Physician Associates (AAPA), along with the unique requirements for each.
The largest internal medicine specialty for PAs is cardiology, with more than 4,000 PAs specializing in this field. An AAPA survey conducted in 2016 among PAs in cardiology found that 50 percent were based in group practices, while 42 percent were affiliated with hospitals. Additionally, 67 percent of these PAs provide both inpatient and outpatient care, indicating a comprehensive approach to patient treatment.
Responsibilities for cardiology PAs encompass an extensive range of tasks, including performing physical examinations, diagnosing cardiac conditions, interpreting cardiac tests such as EKGs, managing patient treatment plans, and counseling patients about heart health. They may also assist cardiac physicians during procedures like angioplasty or stent placement. In hospitals, they often serve as the first responders for cardiac emergencies, providing immediate and essential care.
Formally, there are no additional education requirements to work in cardiology as a PA. However, completing a program such as a fellowship in cardiac critical care medicine at Emory University can provide students with the additional training and education to jump-start their careers. This is a one-year-long program that includes didactic classes as well as clinical experiences.
There are no certifications for cardiac PAs. However, PAs who work in this field can demonstrate their knowledge and competence by taking the Certified Cardiovascular Knowledge Examination (CCKE) through the American College of Cardiology (ACC).
This exam validates a candidate’s clinical knowledge, shows they uphold the highest standards in patient care, and demonstrates their commitment to optimizing cardiovascular outcomes. Passing the CCKE earns recognition among peers and patients, as well as credits towards becoming a Fellow of the ACC (FACC) and a member of the American Association of Cardiovascular Care (AACC).
If a cardiac PA performs surgery, they can earn a Certificate of Added Qualifications (CAQ) in Cardiovascular and Thoracic Surgery (CVTS) from the National Commission on Certification of Physician Assistants (NCCPA). More details are under the surgery specialization below.
At least 10 percent of the PA workforce works in emergency medicine (AAPA 2016). Their primary responsibility involves evaluating, diagnosing, and treating patients in emergencies. Conditions for patients can range from minor injuries to critical, life-threatening illnesses. Tasks include conducting physical examinations, interpreting diagnostic tests, performing procedures like suturing wounds or setting fractures, administering medications, and providing lifesaving interventions in critical situations. They collaborate closely with physicians, nurses, and other healthcare professionals to ensure the delivery of timely and appropriate acute care.
There are no additional education requirements to work as an emergency medicine PA. Due to the high-paced nature of this field, completing an emergency medicine training program for PAs is highly recommended. The Society of Emergency Medicine PAs (SEMPA) has identified more than 40 postgraduate programs, such as St Luke’s Post Graduate Fellowship Critical Care/Emergency Medicine. This 11-month-long program rotates fellows through emergency medicine and critical care to provide well-rounded, holistic training.
While not mandatory, the primary certification is the Certificate of Added Qualifications (CAQ) in Emergency Medicine from the National Commission on Certification of Physician Assistants (NCCPA). To pass this exam, candidates must demonstrate they have advanced knowledge and experience in emergency medicine, above and beyond that expected of entry-level PAs. To be eligible for this certification, candidates must have a valid PA-C certification, have a valid state license to practice, and have at least 3,000 hours of work experience as a PA in an emergency setting.
One in seven PAs work in family medicine, and more than half work in office-based practices (AAPA 2016). Family medicine PAs provide comprehensive and continuous healthcare to patients of all ages and genders. They have many duties, including conducting routine check-ups, diagnosing and treating common illnesses, providing preventive care, and managing chronic diseases such as diabetes or heart disease. PAs in this specialty also perform minor surgical procedures, prescribe medications, and may provide prenatal care and family planning services.
Family medicine PAs are not required to have additional education beyond what is required to enter this field. However, there are many residencies and fellowships across the country that can provide additional training and education to help PAs get started in this field. For example, the University of Iowa offers a one-year family medicine residency to train PAs in all aspects of care. This program boasts a high level of customization to allow PAs to pursue their interests.
Currently, there are no certification or test options for family medicine PAs to demonstrate their competency in this field. All family medicine PAs must hold a physician assistant certified (PA-C) certification and be licensed in their state.
Hospice and Palliative Medicine
While PAs have been practicing since the mid-1960s, they have only been able to practice in hospice and palliative medicine since 2019 when the federal changed and Medicare recognized PAs as hospice providers. This is a very demanding specialty that requires a lot of empathy and patience.
Duties can include conducting comprehensive assessments to understand a patient’s condition, creating personalized care plans, and coordinating with other healthcare professionals to ensure the patient’s comfort. They also play a crucial role in providing end-of-life care, often working in hospices, hospitals, or in patients’ homes. Communication with patients and their families about the progression of illnesses and treatment options is critical, as is helping to navigate complex decisions and providing much-needed emotional support during challenging times.
Hospice and palliative medicine PAs are only required to complete the minimum education necessary to become a PA. Given the delicate nature of this field, additional education and training from a program such as the graduate certificate from the University of Washington’s Cambia Palliative Care Center of Excellence can be an excellent option. This nine-month program is offered entirely online and is designed for all healthcare providers who work in this specialty.
Brand new in 2023, the National Commission on Certification of Physician Assistants (NCCPA) added a Certificate of Added Qualifications (CAQ) in Palliative Medicine and Hospice Care (PMHC). This certification demonstrates a keen understanding of hospice and palliative care beyond the basic PA education. PAs who sit for the PMHC CAQ can be in any number of fields, including emergency medicine, oncology, pediatrics, neurology, and more.
Obstetrics and Gynecology
There are only around 2,100 PAs in the US who practice in obstetrics and gynecology (AAPA 2016). Typical duties for PAs in this field include conducting routine check-ups, providing prenatal and postnatal care, diagnosing and treating reproductive health conditions, assisting in surgical procedures such as cesarean sections or gynecological surgeries, and counseling patients on family planning and reproductive health. They work in various settings, including hospitals, private obstetric and gynecology practices, women’s health clinics, and public health institutions.
Additional education is not required to work as an obstetrics and gynecology PA, although completing a residency or fellowship can benefit employability and advancement opportunities. Programs such as the OB/GYN PA fellowship at Arrowhead Regional Medical Center provide PAs with opportunities to gain hands-on experience in this field. Participants in this program are trained in both inpatient and outpatient care to be outstanding care providers in labor and delivery settings.
There are no certifications for PAs who practice in obstetrics and gynecology. In 2024, the National Commission on Certification of Physician Assistants (NCCPA) will add a Certificate of Added Qualifications (CAQ) in Obstetrics and Gynecology (OBGYN). This certificate will allow PAs to demonstrate their competency in this specialty.
By far, orthopedic surgery is the largest surgical specialty for PAs. Over 16,000 PAs practice in this specialty (AAPA 2016). While assisting with surgeries is an important part of this field, duties for orthopedic PAs also include conducting physical examinations, diagnosing orthopedic conditions, interpreting diagnostic tests such as X-rays or MRIs, and managing patient treatment plans. Typical places of employment include hospitals, orthopedic clinics, private practices, rehabilitation centers, and sports medicine facilities.
As with most specialties, there are no additional education requirements to enter this field. Due to the specialized nature of orthopedic surgery, a post-graduate residency is highly recommended for anyone looking to enter this field. The University of California San Francisco Fresno offers a one-year orthopedic surgery physician assistant residency program. Residents in this program will learn and work alongside physician residents while they learn patient management skills that will help propel them into successful careers in both academic and private practice settings.
Certification for orthopedic PAs is voluntary. The primary certification earned is the Certificate of Added Qualifications (CAQ) in Orthopedic Surgery through the Certification of Physician Assistants (NCCPA). Earning a CAQ in orthopedics represents a significant professional achievement for PAs and showcases their advanced proficiency and dedication to their specialty. To be eligible, PAs must have gained significant experience in the orthopedic surgery field, completed a minimum of 150 credits of Category I Specialty CME, and hold a valid, unrestricted license to practice as a PA. They must also have performed at least 2,000 hours of work in the orthopedic surgery specialty within the last six years.
Approximately 5,250 PAs practice in pediatrics (AAPA 2016). PAs who practice in pediatrics differentiate themselves from family practice PAs in that they only care for patients from birth through young adulthood.
Their job duties include conducting regular check-ups, diagnosing and treating common childhood illnesses, administering immunizations, and providing guidance on nutrition and growth development. It is not uncommon for pediatric PAS to provide health education or engage in prevention efforts geared toward children and their families. They work in diverse settings such as pediatric clinics, hospitals, public health institutions, and even school-based health centers.
While pediatric PAs are only required to complete the base level of education for PAs, completing a residency or fellowship in pediatrics can help start their career and set them apart in this field. For example, the University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh Pediatric Advanced Practice Provider (APP) Fellowship Program fosters the development of a high level of expertise in foundational pediatric skills, encompassing acute care, ambulatory care, performing procedures, and the principles of subspecialty medicine in pediatrics.
Although certification is not required for pediatric PAs, many earn the Certificate of Added Qualifications (CAQ) in pediatrics from the Certification of Physician Assistants (NCCPA). Eligible candidates must have substantial experience in the pediatric field with a minimum of 2,000 hours of work in the pediatric specialty within the last six years. They must also complete at least 150 credits of Category I Specialty Continuing Medical Education (CME) and hold a valid and unrestricted license to practice as a PA.
Each year, one in five Americans experiences a mental health disorder. Unfortunately, there are not enough healthcare providers to care for everyone who has a mental health issue. Psychiatric PAs can help address the growing gap in mental health care. They offer comprehensive care to patients struggling with various mental health disorders, including depression, anxiety, bipolar disorder, substance abuse, and more. Responsibilities often include conducting psychiatric evaluations, diagnosing mental health conditions, managing treatment plans, and providing psychotherapy. Typical work settings include psychiatric facilities, hospitals, outpatient clinics, and correctional facilities.
PAs who want to specialize in psychiatry are not required to attend a postgraduate residency. Currently, there are at least seven postgraduate programs in psychiatry or behavioral health available to PAs who want additional structured education. The Department of Veterans Affairs offers a Physician Assistant Post-graduate Residency in Mental Health. During their residency, PA residents will be exposed to basic and advanced psychiatric concepts and techniques through various environments, including outpatient clinics, hospital inpatient units, and psychiatric specialty clinics.
The primary voluntary certification earned in this field is the Certificate of Added Qualifications (CAQ) in Psychiatry from the National Commission on Certification of Physician Assistants (NCCPA). To be eligible to earn this certification, PAs must have completed at least 2,000 hours of work in the specialty within the last six years, have a minimum of 150 credits of Category I Specialty Continuing Medical Education (CME), and hold a valid, unrestricted license to practice as a PA.
Surgical PAs are equipped to handle various surgical situations, from routine procedures to emergent cases. They work alongside physicians in all aspects of patient care, including conducting pre-operative assessments, assisting surgeons in the operating room, and monitoring post-operative progress. They may also perform some procedures, such as closing incisions and providing wound care.
PAs in this field also have the opportunity to further specialize in orthopedic, cardiac, or neurosurgery. They may work in various settings, such as general surgery departments, specialized surgical clinics, hospitals, and outpatient care centers.
Although it’s optional for PAs to complete postgraduate residencies to begin their practice, there are over twenty postgraduate programs in various surgical specialties. The American Association of Surgical Physician Assistants lists current residency opportunities, including the Johns Hopkins Hospital physician assistant surgical residency program. This 12-month program provides hands-on general surgery experience and didactic coursework to ensure PAs are well-equipped to succeed in this specialty.
There is no general certification requirement for surgical PAs. However, the National Commission on Certification of Physician Assistants (NCCPA) offers a Certificate of Added Qualifications (CAQ) in Cardiovascular and Thoracic Surgery (CVTS) or Orthopedics (covered above). Eligibility requirements for the CVTS certification include a minimum of 2,000 hours of work in the CVTS specialty within the last six years, at least 150 credits of Category I Specialty Continuing Medical Education (CME), and a valid, unrestricted license to practice as a PA.
At HealthcareDegree.com, Kimmy Gustafson has delivered in-depth and insightful articles since 2019, aiding prospective students to navigate the complexities of choosing the right healthcare degree. Her recent work includes topics such as the ethics of gene editing and physician assistant’s fight for autonomy.
Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working, she can be found outdoors, parenting, kiteboarding, or cooking.