Physician associates (PAs) can perform a wide range of medical procedures, from stitching wounds and setting fractures to intubating patients in the emergency room and assisting in complex surgeries. The specific procedures a PA performs depend on their specialty, their training, and the laws of the state where they practice. In practical terms, PAs in many settings handle much of the same procedural work as physicians.
Primary Care and General Procedures
In a primary care or urgent care setting, PAs routinely perform the bread-and-butter procedures that keep a clinic running. These include suturing lacerations, draining abscesses, removing foreign bodies, performing skin biopsies, and applying cryotherapy to warts or precancerous lesions. PAs also conduct physical exams, Pap smears, and other screening procedures.
Interpreting diagnostic tests is a core part of the job. PAs read EKGs, evaluate X-rays, and order and interpret lab work. With additional training, PAs can also perform and interpret diagnostic ultrasound exams. The American Institute of Ultrasound in Medicine outlines specific training pathways for PAs to gain competency in ultrasound, including supervised case volume requirements and demonstrated knowledge of anatomy, physiology, and image interpretation. Point-of-care ultrasound has become increasingly common for PAs working in emergency medicine and primary care alike.
Surgical First Assisting
One of the most hands-on roles for a PA is serving as a surgical first assistant. In the operating room, PAs work directly alongside the surgeon and perform tasks that go well beyond holding a retractor. According to Mayo Clinic’s career overview, surgical first assistants handle visualization of the operative field, trocar insertion for laparoscopic cases, injection of local anesthetics, and hemostasis (controlling bleeding). They clamp, cauterize, suture, cut, and ligate tissue throughout the procedure.
At the end of a case, the PA typically closes the incision using suturing techniques matched to the surgeon’s preference and the tissue layers involved. They also place and secure wound drains when needed. For PAs who specialize in surgery, first assisting is often their primary daily responsibility, and experienced surgical PAs may manage pre-operative workups and post-operative care as well.
Orthopedic Procedures
Orthopedic PAs perform a particularly wide variety of procedures across both clinic and OR settings. In the office, they interpret X-rays, reduce fractures, apply splints and casts, and perform joint injections and aspirations. Joint injections are a staple of orthopedic PA practice. These include corticosteroid injections for inflammation and viscosupplementation (hyaluronic acid injections into the knee to improve joint lubrication in osteoarthritis patients). PAs in orthopedics often build long-term relationships with patients who return regularly for these injections.
In the operating room, orthopedic PAs assist with procedures like open reduction and internal fixation of fractures, positioning hardware such as metal plates and screws under X-ray guidance, and fabricating post-surgical splints. A single day for an orthopedic PA might include assisting in ankle surgery in the morning, performing knee injections over lunch, and evaluating new patients with musculoskeletal complaints in the afternoon.
Emergency and Critical Care Procedures
Emergency medicine is one of the most procedure-heavy specialties for PAs. In the ER, PAs perform endotracheal intubation (placing a breathing tube), insert chest tubes for collapsed lungs, establish intraosseous access (drilling into bone to deliver fluids when veins aren’t accessible), and perform needle decompression for tension pneumothorax. These are high-stakes, time-sensitive skills that PA programs train students on using cadavers and simulation models before clinical rotations.
Beyond those critical interventions, ER PAs also handle laceration repair, wound irrigation, fracture splinting, lumbar punctures, abscess drainage, and procedural sedation for painful procedures like dislocated joint reductions. The volume and complexity of procedures depends on the facility. PAs at busy trauma centers may encounter a broader range of critical procedures than those working at smaller community emergency departments.
Dermatology Procedures
PAs working in dermatology perform several types of skin biopsies, including shave biopsies, punch biopsies, and excisional biopsies. They also remove benign and suspicious lesions, perform cryotherapy on skin growths, and suture surgical sites. Many primary care PAs add these dermatologic procedures to their skill set as well, since skin concerns are among the most common reasons patients visit a clinic. Training programs specifically designed for primary care providers cover surgical technique, cryotherapy, and biopsy skills to help PAs handle these cases without referring patients to a specialist.
Prescribing Medications
Prescribing is one of the most common “procedures” PAs perform daily, though it’s governed by its own set of rules. PAs can prescribe medications, including controlled substances, in all 50 states. The details vary by state, particularly for Schedule II drugs (the most tightly controlled category, which includes medications like oxycodone and amphetamine-based stimulants).
Georgia and Texas prohibit PAs from prescribing Schedule II medications entirely, though PAs in those states can prescribe Schedule III through V drugs. Arkansas and Missouri only allow PAs to prescribe hydrocodone combination products within the Schedule II category. Several states, including Arizona, Illinois, Montana, North Carolina, Pennsylvania, and South Dakota, cap Schedule II prescriptions at a 30-day supply. Florida allows PAs to prescribe Schedule II drugs but limits them to a 7-day supply. Some states also require supervising physician approval before a PA can authorize refills on Schedule II medications.
How Scope of Practice Works
There is no single national list of procedures every PA can or cannot do. What a PA is authorized to perform depends on three layers: state law, the practice agreement with their collaborating physician, and the PA’s own training and competency. A PA trained in cardiac surgery will have a very different procedural skill set than one working in psychiatry, even if they’re licensed in the same state.
The legal framework has shifted significantly over the past decade. Historically, state laws defined the PA-physician relationship as strict supervision, with the physician directly overseeing the PA’s work. Many states have since moved toward a collaborative practice model, recognizing that PAs deliver high-quality care and that rigid supervision requirements limit patient access. The PA profession’s updated model legislation uses “collaboration” rather than “supervision” to describe how PAs and physicians work together, and many states have adopted this language into law. In practice, this means experienced PAs in many states have substantial autonomy in deciding which procedures to perform and how to manage patients, while still functioning as part of a physician-led team.
The trend over time has been toward broader procedural authority for PAs. As individual PAs gain experience in a specialty and demonstrate competency, their collaborating physicians typically expand the scope of procedures they’re entrusted to perform independently.