According to Google, some of the most common questions people have about physician assistants (PAs) are the following:
“Is a physician assistant a doctor?”
“Can a physician assistant prescribe medication?”
“What are physician assistants not allowed to do?”
As someone who has been practicing as a PA for almost three years now (and in graduate school for a few years prior to that), it can be hard to remember what it was like to first look into this profession! Whether you’re an aspiring PA or simply curious we’re going to answer some of the top questions about PA scope of practice to dispel some of the mystery surrounding this profession.
Here’s a bit of PA history…
If you’re unfamiliar with the PA profession, here’s a fun fact: the first class of PAs graduated from Duke University in 1967! While that may seem like a long time ago to some of us, PAs haven’t really been around all that long, and it’s actually a relatively recent career path.
This means a lot of people— patients and aspiring PAs alike—still have questions about what we do. To many, PAs are something of an enigma, and they don’t understand how we interact with other healthcare workers they are more familiar with, such as doctors and nurses.
So, without further ado, here’s some helpful information about PA scope of practice!
👋 Hey Pre-PAs: Want to get a headstart on your PA school prep so you can show up confident on day 1? Check out our Pre-PA Qbank with 800 questions covering anatomy, physiology, medical terminology, and more!
1. “Is a physician assistant a doctor?”
The short answer here is: NOPE. However, since PAs provide patient care alongside physicians in many settings, the distinction may be confusing for some patients. I often describe the role of a physician assistant to patients that ask as an “extension of the doctor’s hands.”
PAs practice under physicians, working closely and collaborating often. Quite frequently, PAs make executive decisions on patient care independently, and they receive the training to do this appropriately and confidently. However, the option to collaborate with their supervising physician is always there.
It can vary by specialty!
The amount of collaboration between the physician and physician assistant varies in different specialties. For example, I work as a cardiac surgery PA. I collaborate with my supervising physician, the surgeon, on almost every patient. While I do order tests and provide care independently, we do rounds every day on each patient and discuss their daily care plans. In addition, we work closely in the operating room where the surgeon operates and the PAs act as first-assistants.
You should know, though, that not all PAs work as closely with a supervising physician. PAs working in areas such as primary care or urgent care may see the patient entirely independently and only collaborate with the physician for chart review at the end of the interaction. PAs in various office settings may have their own patients, and only discuss care with the physician as needed. A lot of times the need for frequent collaboration decreases as the experience of the PA increases.
So even though PAs aren’t doctors, we do work very closely with them (sometimes independently) and are often confused with them.
PAs are often confused as NPs
Plus, the confusion doesn’t end there—another group of healthcare workers PAs are often confused with are nurse practitioners (NPs). Both PAs and NPs are mid-level healthcare workers, and their roles in most settings are very similar. The key differences are in their education and areas of practice, but in many positions, they work alongside each other in similar roles.
For a side-by-side comparison of the PA vs NP professions, check out this post Physician Assistant vs Nurse Practitioner: Which Path is Right for You?
2. “Can a physician assistant prescribe medication?”
Short answer: yes, absolutely! Physician assistants can see patients and prescribe medications, in both inpatient and outpatient settings.
Physician assistants can prescribe most medications. Just like physicians, in order to prescribe opioid pain medications, PAs need to obtain a drug enforcement administration (DEA) number. This is required for all providers due to the potential for misuse and dependence of these substances.
The DEA ranks controlled substances on a scale of IV (least likely for misuse) to I (most likely for misuse). Schedule I medications (such as heroin) have no acceptable medical use.
While the prescriptive authority of PAs varies in each state (discussed more below), 44 states authorize PAs with a DEA number to prescribe anything scheduled II to IV. There may be limitations or variations to PA prescriptive authority, which is oftentimes at the state level.
3. “What are physician assistants not allowed to do?”
In most states, the PA scope of practice is determined with the supervising/collaborating physician at their specific practice site. There are a few things that physician assistants cannot do in any state, including independent practice without a supervising or collaborating physician, working independently in the operating room, and prescribing schedule I medications.
In certain states, PAs cannot prescribe any systemic sedatives, such as those used for sedation in the operating room.
4. “What can physician assistants do?”
I could spend a really long time discussing all of the amazing things PAs do in their roles. Physician assistants see patients, diagnose them, and determine the appropriate treatment option. There’s a wide range of PA specialties available, so you may see them first-assisting in the operating room, leading a code team in the hospital, or acting as a primary care provider for their own patients.
One thing to note is that many specialty skills you can acquire as a PA require credentialing and hands-on training. For example, a couple of skills I have gained through training that I didn’t have upon graduation include endoscopic vein and radial harvesting, open vein harvesting, arterial line insertion, central line insertion, and chest tube placement.
The approval process varies, but institutions require training and documentation of multiple successful attempts prior to credentialing PAs to perform these procedures.
Final Thoughts
PAs have a graduate-level medical education and undergo countless hours of classroom and hands-on training. They’re licensed medical providers who examine, diagnose, and treat patients under the supervision of a physician.
While there are always some patients that may not be comfortable with a mid-level provider, most are genuinely just curious to understand our role. If you’re currently practicing as a PA or aspiring to start, be prepared to get some of these questions and be ready to answer them!
Looking for more information about the PA profession? Check out these other posts on the Rosh Review blog!
