The Vital Role of the Physician Assistant

A team approach is necessary to provide comprehensive care in today’s complex healthcare settings. And nowhere is the need for a cadre of medical professionals more evident than within the practice of rheumatology, where complicated diagnoses and tailored treatments are the rule rather than the exception. Among the highly trained members of these healthcare teams are physician associates/physician assistants (PAs), who not only supplement busy practices, but also heighten the level of care patients receive.

Background

Originally created in 1965 to address an overall shortage of physicians, the PA profession continues to grow. In the past decade, the National Commission on Certification of Physician Assistants (NCCPA) has reported a steady rise in the number of practicing PAs in the U.S., increasing from 95,583 certified PAs in 2013 to 168,318 in 2022. Of that 2022 total, about 400 specialize in rheumatology.¹

Educational requirements have evolved over the years. Currently, those pursuing a PA already hold a bachelor’s degree and have about three years of healthcare experience, according to the American Academy of Physician Associates.² In addition to graduating from a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), students must obtain a passing score on the Physician Assistant National Certifying Examination (PANCE), as well as a license from the state in which they practice.

Ms. Hughell

Many universities have now begun offering PA graduate degrees. “Twenty years ago, I was in the first master’s level class for PAs at our university, and now there are some PA programs that offer a Doctor of Science (DSC),” says Laurie Hughell, PA-C, MPH. Her path to becoming a PA included earning an undergraduate degree in psychology and chemistry, working during college as a certified nursing assistant (CNA) for three years and spending two summers interning at an inpatient psychiatric hospital—all before she was admitted to the graduate PA program at Des Moines University, Iowa.

“Many hours of healthcare experience are required to apply to PA school, and admission has always been highly competitive,” Ms. Hughell says. Her alma mater, for example, reported that students admitted to its 2025 PA class had an average cumulative GPA of 3.66 and an average science GPA of 3.62; most of the entering students had already accrued more than 750 hours of hands-on, direct-patient experience prior to applying to the program.³ Overall, the PA Education Association reports that about 20% of applicants are typically accepted into PA programs each year.⁴

A PA’s Role

Ms. Hughell says her PA program provided instruction on everything from patient education and preventive care to diagnosis and treatment of a range of medical conditions. Once she earned her degree and became certified, she was ready to find a position in the healthcare field.

“I was recruited into a rheumatology practice because my background included working with geriatric patients, who often require rheumatic care,” she says. The field was a good fit for her personality, too. “I’m a social gal, and I appreciate forming connections with others, so I wanted to join a field where I could follow patients over time and develop relationships,” she says.

It has worked out so well that she has continued as a PA in the same practice—the Iowa Arthritis and Osteoporosis Center in Urbandale—for 17 years.

One of the many things she enjoys about her profession is the variety. “My practice has 14 rheumatologists, who have been amazing mentors, and I work with all of their patients. On a single day, I’ll typically meet with upwards of 15 patients, who may include patients who come on a scheduled basis—perhaps every three or six months—or those who present for acute care,” Ms. Hughell says. “I may be diagnosing conditions, prescribing medications, performing joint injections, and making treatment decisions.”

Having a PA as part of the medical team serves multiple purposes, she says. For one thing, if a physician’s schedule is full, patients can receive care from a PA. This is helpful for acute patients who need to be seen quickly, and also for those patients who need to schedule regular visits. “Basically, it gives the patient one additional clinician that they can rely on for their rheumatology care [and] gives patients increased access to rheumatology care in a specialty where access can be limited.”

PAs also offer a layer of connection between clinician and patient. “I’ve had the opportunity to develop relationships with patients over the years, which includes getting to know their families and personal interests. It is personally rewarding to form those connections, and I enjoy the camaraderie with patients,” she says. “That is also particularly helpful in dealing with chronic and complex rheumatic conditions, where in-depth conversations can reveal nuances useful in making diagnoses or fine-tuning treatment regimens.”

Raising Awareness

Although PAs have been around for more than 50 years now, and the American Academy of Physician Assistants reports that they currently engage in more than half a billion patient interactions each year, some patients and some members of the medical profession still are unaware of how PAs fit into the healthcare team, says Ms. Hughell. That is where efforts like National PA Week can be helpful.

National PA Week is an expansion of the original National PA Day, which the American Academy of Physician Assistants planned in 1987 to note the 20th anniversary of the first graduating class of PAs (Oct. 6, 1967, from Duke University, Durham, N.C.). Since then, the anniversary has become an annual affair and grown into a week-long celebration. The 2023 National PA Week will be held Oct. 6–12 to recognize the contributions of PAs and publicize the profession and its vital role in healthcare.

Raising awareness is important. “PAs are skilled, qualified medical professionals who are an important part of the healthcare team,” Ms. Hughell says. “I have talked with multiple rheumatologists at ACR meetings who have been curious about incorporating a PA into their practice. I advocate for them to consider this option to extend the care they can provide to their patients. Many times they are stretched thin and have long wait times for consults and return appointments, [so] adding a PA can remedy those challenges.”

Leslie Mertz, PhD, is a freelance science journalist based in northern Michigan.

References

1. Gooch K. PAs are growing in number: Here’s how many are in each state. Becker’s Hospital Review. 2023 May 1.
2. Become a PA. American Academy of Physician Associates. (n.d.) https://www.aapa.org/careercentral/become-a-pa.
3. PA class profile. Class of 2025. Des Moines University.
4. Sample J. Understanding PA school acceptance rates & admissions in 2023. Rosh Review. 2023 Jan 2.