02 January 2012

Getting with the PA program

How comfortable would you feel if your clinician had never examined the inside of a human body?

I chatted for several hours with a physician assistant student who is six months away from receiving his license. "Bob" struck me as a genuinely good guy, and he intends to help people where they need it most--in war zones for the military and in underserved rural areas. It usually takes two years to become a physician assistant (PA), and in most states they are licensed to prescribe certain drugs. They technically have to practice under physician supervision, but "supervision" here is defined loosely. Some supervising physicians simultaneously supervise several PAs spread over several cities. In many rural towns, the PA is the sole provider of clinical care.

Bob mentioned that he wished he had a deeper understanding of the human body. His program does not teach gross anatomy but instead requires it as a prerequisite. Yet very few universities and colleges are able to teach undergraduates anatomy using human cadavers. Bob's anatomy class had only used prosections of cats (a prosection is an anatomical specimen that an expert has previously dissected, for the sake of instruction). Some students become PAs without ever seeing a human cadaver.

Bob's understanding of physiology was quite basic. For example, his program gave only a cursory overview of what causes diabetes, and he did not understand why diabetes causes symptoms such as polyuria (excessive urinary output). Bob confessed that he has such a hard time with math that he stopped at introductory algebra. His classroom education prior to PA school was a two-year stint in community college, where he earned an associates' degree.

I had a great impression of Bob, and we really hit it off. But the medical background his program provides strikes me as flimsy. He would need to know statistics to interpret published medical studies. He likely lacks some of the vocabulary one would encounter in a medical chart. And his limited background in physiology would give him a hard time understanding the mechanisms of the drugs he prescribes, let alone predicting whether they might interact with other medications.

PAs like Bob are increasingly becoming America's first-line primary-care providers, taking the place of physicians. The Bureau of Labor Statistics (BLS) forecasts a boom in new physician assistant jobs over the next decade. The pay is good, too: BLS estimates the median salary nationwide is at $81,230. By my back-of-the-envelope calculations, some older students would have a higher lifetime earning potential if they entered PA school instead of medical school. They would earn money more quickly and dodge the hundreds of thousands of dollars in high-interest student loans.

Medicine is a big tent, and PAs are occupying an increasing section of it. It was eye-opening for me to talk to Bob and understand more about his training.