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First Year PA

The Secret Ingredient

Published August 8, 2013 4:22 PM by Harrison Reed
People always want to know the secret ingredient. And, frankly, I can't blame them. In a lot of ways the physician assistant profession seems too good to be true.

We study medicine for two to three years after obtaining a bachelor's degree. We practice medicine without post-graduate training or residency. We can switch specialties without recertification and our scope of practice can change from one day to the next. 

Naturally, people wonder how, in a complex and high-stakes field like medicine, this amount of career flexibility is even possible.

Sure, we have great training programs. Plus, many PAs come into their careers with years of related experience. And our skills are honed as we gain experience on our jobs. But here's the real reason our profession works: the supervising physician.

A faction of PAs reading this just cringed, though I'm not sure why. There seems to be a perception that our required agreement to collaborate with a physician somehow holds us back as providers. Calls for increased PA autonomy inevitably lead to suggestions that we abolish the supervisory agreement. While there are some instances where the MD-PA partnership is a liability (and a largely logistical one at that), these views are misguided.

The truth is, the PA-MD partnership is the single strongest aspect of our profession. It is the reason I could apply for a job in any specialty right out of school (and land one in a field like critical care). It's the reason I didn't toil through a residency program with outrageous hours and minimal pay. It's the reason I can place central lines and perform lumbar punctures. It's the reason I can spend my evenings in the Emergency Room or the Operating Room or any other room that chooses to hire me.

Our chameleon-like ability to adapt the scope of practice of our supervising physicians is what attracted me to the physician assistant profession. My supervising physicians aren't shackles around my ankles, they are mentors and partners and friends.

However, navigating the PA-MD relationship is not always easy. Last time I counted, I was contracted to 49 individual supervising physicians. That group includes dozens of personalities, preferences and quirks that factor into my clinical practice.  Try these tips to get the most out of your PA-physician collaboration:

Respect the Scope: Good employers will allow PAs to practice at the top of their license at all times. However, this must still fall within the scope of the supervising physician. While PA independence is at an all-time high, make sure you don't find yourself outside the limits of your physician's scope of practice. That can be a very lonely place.

Close the Loop: After you have worked with a new physician, reserve a few minutes to get feedback about your performance. Almost every clinician will respect this proactive approach. Often, this will also provide an opportunity to let the physician know how they can help you grow in your practice. This form of "closed-loop" communication will foster trust and a stronger clinical team.

Be Direct: If there is an issue with a supervising physician, address it early and professionally. You can brush aside small troubles, but a real problem will eventually boil over into workplace conflict. Correct a misunderstanding as soon as possible. If you set a high standard of respect in the workplace, the PAs following behind you will benefit from your leadership.

Pick Your Battles: Unfortunately, there are still people who do not want to work with PAs. Luckily, this minority of physicians who oppose our profession shrinks by the day. Don't focus on trying to convert the non-believers. If your professionalism, hard work and clinical skills don't speak for themselves, that battle cannot be won. However, you should still expect to be treated with courtesy and respect in the workplace.


I love this post and I agree for the most part.  Many of us enter the field for its flexibility and many have to accept the fact that PAs have it pretty good.  After discussions with a PA I shadow I understand there is a large discussion on the autonomy of the PA.  Many PAs want to branch out, like Paula discussed, from their partnership with the physician.  I understand it is hard in rural areas but you chose the PA profession for flexibility-- if you are worried about losing a job in a rural area then why didn't you become a doctor.  By asking for more autonomy as a PA, like NPs have, we would essentially be asking to become a doctor.  PAs would be treated like doctors... We would likely need residencies to practice and sub specialties would need specific licensing.  This goes against one of the largest benefits of the PA profession--  flexibility and freedom.  I should just go to medical school if that happens... Probably get my MBA a well so I can run a business and have no time for my family or a well balanced life either.  I hope the PA profession does not go this way.  It would be a shame if I attend PA school and that happens.  

Austin, Pre PA student August 18, 2013 12:53 PM
Amherst MA

Dave, I appreciate your comment, but I disagree. The vast majority of PAs now work in either general surgery or a medical or surgical specialty. Our generalist training does not automatically grant us competency in these areas. Our profession trains competent clinicians, but in most cases we are not trained to be more competent than a specialty-trained physician.

But there's a reason a first year PA can work the same job and command (roughly) the same salary as my colleague with 8 years of critical care experience. We may not have the same level of competency, but we both work in a system designed for well-trained generalists to function safely and effectively in specialty practice.

Many problems I can solve on my own. Some I can use my fellow (an inherently more experienced clinician) as support and for even fewer I go to my staff physician (a specialist with years of training and experience). The PA profession expands care to millions because of a system that pairs us (in varying degrees of cohesion) with other well-trained professionals. It's a genius system and it works to our advantage and our patients'. Why should we pretend it doesn't exist?

Ian, I agree. Interprofessional collaboration is a good idea and fortunately a concept growing in popularity.

Paula, I can understand your frustration. It is a limitation of the current system and unfortunately one of the logistical exceptions I alluded to in my blog. I hope there are more options to bring care to underserved populations in the future. It is an area worthy of discussion and exploration.

Harrison Reed August 14, 2013 9:15 PM

The PA/MD partnership does not work well in rural and isolated areas.  PAs are dependent on a physician and thus dependent on them for their livelihood when the PA works in rural America.  I will lose my job immediately if my MD collaborator leaves his position.  This is one of the ugly truths to the PA profession that is not widely taught in PA school. The 3,000 patients in my clinic would lose access to care if this happened.

Yet the PA programs promote us as an answer to rural care and to serve the underserved, the indigent, the migrant workers and those in the inner cities. How will this be addressed by our professional organizations?  We do not have the ability to independently keep our careers if our physician collaborator decides it will be that way.

I am not aware of another medical profession that is at the mercy of another except the NP profession.  That is why the NPs seek "independent" practice.  It is time for the PA profession to grow up and to seek cutting the apron strings from the physician professional organizations who controls all of what we do.  Do I like working with my physician collaborator?  Absolutely!  And our relationship is just that...a collaborative one.  

All medical professionals collaborate and it is an ethic we should all hold...  None of us should work in a silo.  But we have the ability to practice with an "independent" license and it is something that all PAs should consider and work for to advance our profession.

In My Humble Opinion.  

Paula August 9, 2013 7:57 PM

Mr. Reed I agree - In many years of advocacy and leadership, countless meetings with Government, Physicians, Medical Groups, and Nursing Associations I have learnt that what makes our profession unique is our ability to say we need someone else, not all the time but sometimes. Our strength is more than knowledge when someone is always smarter.  Our strength is not procedures which given time anyone can learn.  Our strength is that we accept that our profession is able to change, adapt and achieve what is required because we work as a team.  

Ian Jones a Canadian PA

Ian Jones, PA Studies - Program Director, Univ. of Manitoba August 9, 2013 8:57 AM

The single most important secret is your competence. Sorry but it's not the mythical MD/PA partnership. The NPs have it also so it must be the same or better secret for them. More NPs are collaborated with than PAs are supervised. And we do not acknowledge that.

Our secret is our training is excellent. Don't hand your power to any other profession.


Dave Mittman August 8, 2013 6:19 PM

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