A PA is a licensed medical professional who can diagnose illnesses, develop treatment plans, and prescribe medications. PAs practice in virtually every area of medicine, from family clinics to operating rooms, and they earn a median salary of $133,260 per year. The profession is one of the fastest-growing in healthcare, with a projected 28% increase in jobs over the next decade.
What PAs Actually Do
PAs perform many of the same clinical tasks as physicians. They take medical histories, conduct physical exams, order and interpret lab work, diagnose conditions, and create treatment plans. In 44 states, PAs can prescribe controlled medications including opioids, stimulants, and other regulated drugs. In most states, the specific tasks a PA handles are determined at the practice level, meaning a PA working in orthopedics will focus on musculoskeletal problems while one in cardiology manages heart conditions.
The profession was built around flexibility. Unlike nurse practitioners, who often specialize during their training, PAs receive broad-based medical education that lets them switch between specialties throughout their careers. A PA who spends five years in emergency medicine can transition to dermatology or surgery without going back to school, though they’ll typically need on-the-job training in the new field.
Where PAs Work
PAs practice across a wide range of specialties, and the distribution has shifted significantly over the past two decades. In 1997, about 46% of PAs worked in primary care. By 2013, that number had dropped to roughly 25%. The shift reflects growing demand for PAs in surgical subspecialties, emergency medicine, urgent care, dermatology, and gastroenterology. About 10% of PAs now work in urgent care alone.
This spread across specialties is one of the key differences between PAs and nurse practitioners. NPs are far more concentrated in primary care, with about 43% practicing in family medicine, internal medicine, or geriatrics. PAs are more evenly distributed and are more likely to work in procedural and surgical settings.
How PAs Are Trained
PA programs typically take about two and a half to three years to complete and award a master’s degree. The first year covers classroom-based medical sciences: anatomy, pharmacology, pathophysiology, and clinical medicine. The second year is almost entirely clinical, with students rotating through multiple medical specialties. At Duke University, where the profession was founded, PA students complete 10 clinical rotations covering required areas like surgery, internal medicine, pediatrics, and emergency medicine, plus elective rotations in areas of personal interest.
The training model mirrors medical school but in a compressed format. PAs learn to approach patients using the same diagnostic framework physicians use: identify the problem, consider possible causes, run tests, and treat. This is sometimes called the “medical model,” and it distinguishes PA education from nurse practitioner programs, which build on nursing theory and place greater emphasis on preventive care, patient counseling, and holistic treatment.
Getting into PA school is competitive. Most programs require a bachelor’s degree, prerequisite coursework in sciences like biology, chemistry, and anatomy, and direct patient care experience. The typical applicant has about three years of hands-on healthcare work before starting a program, often as an EMT, medical assistant, or paramedic.
Certification and Licensing
Every PA in the United States must pass the Physician Assistant National Certifying Examination (PANCE) to become licensed. The exam is administered by the National Commission on the Certification of Physician Assistants. Once certified, PAs enter a 10-year recertification cycle that requires ongoing medical education and periodic testing to maintain their credentials.
How PAs Relate to Physicians
The relationship between PAs and physicians has been evolving. Traditionally, PAs practiced under a physician’s direct supervision, and in most states the supervising physician determined what tasks the PA could perform. That model is changing. A growing number of states have adopted what the profession calls “optimal team practice,” which eliminates the legal requirement for a specific supervisory relationship with a physician. Under this framework, PAs collaborate with physicians and other providers as part of a healthcare team, but proximity requirements, chart co-signatures, and scope of practice are all determined at the practice level rather than by rigid state mandates.
In practical terms, this means a PA in an optimal-practice state might run a rural clinic with a physician available by phone, while a PA in a more restrictive state might need a physician physically present or reviewing a set percentage of charts. The day-to-day work, however, looks similar regardless of the legal framework: PAs see patients, make clinical decisions, and manage care with varying degrees of physician involvement depending on the complexity of the case and the setting.
The Name Is Changing
The profession is in the middle of a title change. The American Academy of Physician Associates (formerly the American Academy of Physician Assistants) has been pushing to replace “physician assistant” with “physician associate.” The reason is straightforward: the word “assistant” suggests PAs simply help physicians, which doesn’t reflect the independent clinical decision-making the role actually involves.
Oregon, Maine, New Hampshire, and Iowa have officially adopted “physician associate” as the legal title through state legislation. In states that haven’t passed title-change laws yet, individual PAs can use “physician associate” at their own discretion, though they need to check with their state licensing board, employer, and malpractice insurer first. The title change doesn’t affect what PAs are allowed to do clinically. It’s a rebranding, not a scope expansion.
How PAs Compare to Nurse Practitioners
PAs and nurse practitioners fill similar roles in the healthcare system, and patients often see them interchangeably. Both can diagnose, treat, and prescribe. The core differences are in training philosophy and career flexibility.
NP education is rooted in nursing. NPs start as registered nurses, gain clinical experience, then complete a graduate program that trains them in advanced practice within a chosen specialty. Their training emphasizes preventive care, patient education, and addressing social factors that affect health. PAs, by contrast, enter a medical-model program that covers a broad range of specialties from the start, with a stronger focus on diagnosis and treatment of acute and chronic conditions. This generalist training is why PAs can switch specialties more easily than NPs, who would typically need additional certification to practice in a new area.
Origins of the Profession
The PA profession was created in 1965 at Duke University by Dr. Eugene Stead, who chaired the Department of Medicine. The idea grew out of a national shortage of medical personnel that the U.S. Surgeon General had formally declared years earlier. Stead recognized that former military medics, who had extensive hands-on medical training from their service, could be taught to extend the reach of physicians in civilian healthcare. He designed a two-year curriculum to formalize their skills, and that first class became the foundation for a profession that now includes more than 168,000 practicing clinicians nationwide.