Scope of PA Practice

What areas of medicine can physician assistants work in?

Physician assistants (PAs) practice in all areas of medicine. They are well represented in primary care medicine, which includes the areas of family medicine, internal medicine, and pediatrics. PAs also practice in medical subspecialties, general and specialty surgery and psychiatry.

Can PAs prescribe medications?

Laws to allow PA prescribing exist in all 50 states, the District of Columbia, the Commonwealth of the Northern Mariana Island, American Samoa, and Guam. Regulations vary by state.

Where do PAs ‘draw the line’ between what they can treat and what a physician will treat?

What a physician assistant does varies with training, experience, and state law. The scope of the PA’s practice is related to the supervising physician’s practice. In general, a physician assistant will see many of the same types of patients as the physician. The cases handled by physicians are generally more complicated medical cases or those cases that require care beyond the range of the PA’s usual work. Referral to the physician, or close consultation among the patient-PA-physician team, is common for unusual or hard to manage cases. Physician assistants are taught to ‘know our limits’ and refer to physicians appropriately. It is an important part of PA training.

Physicians and PAs

How are PAs authorized to work?

PAs must graduate from an accredited education program in the US and pass the national certification, or board, exam to be eligible for state licensure. This test is administered by the independent National Commission on Certification of Physician Assistants (NCCPA). Passing the certifying exam allows the new PA to add the ‘-C’ and become a PA-C. State licensure laws vary; check with your local state board for further information.

What is the difference between a PA and a physician?

Physician assistants are educated in the ‘medical model;’ in some schools they attend many of the same classes as medical students.

One of the main differences between PA education and physician education is not the core content of the curriculum, but the amount of time spent in formal education. In addition to time in school, physicians are required to do an internship, and the majority also complete a residency in a specialty following that. PAs do not have to undertake an internship or residency.

A physician has complete responsibility for the care of the patient. PAs share that responsibility with the supervising physicians.

What is the working relationship between a physician and a physician assistant?

The relationship between a PA and the supervising physician is one of mutual trust and respect. The physician assistant is a representative of the physician, treating the patient in the style and manner developed and directed by the supervising physician. The physician and PA practice as members of a medical team.

In 1995, the American Medical Association (AMA) developed Guidelines for Physician–Physician Assistant Practice. These are based on the unique relationship of physician assistants who recognize themselves as agents of physicians with respect to delegated medical acts and legal responsibilities. In all settings, physician assistants recognize physician supervision in the delivery of patient care. The suggested guidelines are as follows:

  1. The physician is responsible for managing the health care of patients in all practice settings.
  2. Health care services delivered by physicians and physician assistants must be within the scope of each practitioner’s authorized practice as defined by state law.
  3. The physician is ultimately responsible for coordinating and managing the care of patients and, with the appropriate input of the physician assistant, ensuring the quality of health care provided to patients.
  4. The physician is responsible for the supervision of the physician assistant in all settings.
  5. The role of the physician assistant(s) in the delivery of care should be defined through mutually agreed upon guidelines that are developed by the physician and the physician assistant and based on the physician’s delegatory style.
  6. The physician must be available for consultation with the physician assistant at all times either in person or through telecommunication systems or other means.
  7. The extent of the involvement by the physician assistant in the assessment and implementation of treatment will depend on the complexity and acuity of the patient’s condition and the training and experience and preparation of the physician assistant as adjudged by the physician.
  8. Patients should be made clearly aware at all times whether they are being cared for by a physician or a physician assistant.
  9. The physician and physician assistant together should review all delegated patient services on a regular basis, as well as the mutually agreed upon guidelines for practice.
  10. The physician is responsible for clarifying and familiarizing the physician assistant with his/her supervising methods and style of delegating patient care.

What do physicians think about physician assistants?

Most physicians who have worked with physician assistants like having PAs on staff. The American Medical Association, the American College of Surgeons, the American Academy of Family Physicians, the American College of Physicians, and other national medical organizations support the physician assistant profession by actively supporting the PA certifying commission and the PA program accrediting agency. Studies of PA practice have demonstrated that PAs, working with the supervision of physicians, provide care that is comparable to that provided by physicians.


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