physician assistant specialties

PA Specialties That are Like Being a Doctor, and Those that Aren’t

Let’s talk a little bit about PA specialties.

As I’ve mentioned elsewhere, being a physician assistant is similar to being a doctor.

In fact, it’s so similar that when I meet people from other countries, it’s much easier to just tell them I’m a doctor than to try and explain the difference between a doctor and a PA. (Most of them have never heard of PA’s, so they just can’t seem to wrap their head around the idea, no matter how much I try to explain it.)

Why do I mention this?

I think it’s a good foundation for understanding the following:

There are basically two categories of PA specialties: those where you do the same things the doctors do, and those where you don’t.

PA Specialties that are the same as being a doctor

In many cases, being a PA literally is the same as being a doctor (or about 99%).

I’m referring to just about every outpatient setting. That means anything outside the hospital, like a family practice clinic (or really any type of clinic).

For example, when I did family practice (for about a year), I can’t think of anything that was different between the job that I did and the job the doctors were doing (other than the occasional paperwork that specifically required their signature).

When I worked in urgent care, there was also no significant difference. I was typically alone in the clinic (with just a medical assistant and front desk clerk), but if there had been a doctor there we would have been doing exactly the same thing.

Even in the hospital, some PA’s do an identical job to that of physicians.

For example, working as a hospitalist (taking care of patients who spend multiple days in the hospital) wouldn’t really be any different as a PA versus as a doctor, in most cases.

So if you want to basically be a doctor (and tell your friends in foreign countries that you are in fact a doctor, haha) you should probably consider the types of specialties described above.

In contrast…

PA Specialties that are NOT the same as being a doctor

The big difference comes in when you talk about more surgical or procedural specialties.

Surgical Specialties

In any specialty where you would be doing surgery, you’ll be limited as a PA.

For example if you work with a spinal surgeon, you’ll never be the lone or primary surgeon doing a spinal operation.

That means you’re basically relegated to being “first assistant” (if you even go to the operating room), or maybe just doing pre-op and post-op visits with patients in the clinic. You may also round on patients in the hospital (i.e. check on them each morning, and order tests or treatment as needed). But you won’t ever do the surgery by yourself. You can only assist.

The same thing is true for any other type of surgical specialty (like orthopedics, urology, ob/gyn, etc).

That doesn’t necessarily mean you shouldn’t work in a surgical specialty… But you should at least be aware of these things going in.

Emergency Medicine

There are some non-surgical specialties that still do a lot of “advanced” procedures. One of these is emergency medicine.

That’s my specialty.

In the various emergency rooms where I’ve worked, I do most of the same things that the physicians do, and I have a fairly similar knowledge base. However, I don’t usually get involved in any of the advanced procedures.

What do I mean by advanced procedures?

Things like intubation, placing central lines, placing chest tubes, or even doing spinal taps.

I also don’t typically run codes (like when a patient comes in with a cardiac arrest, or a stroke). We leave that to the supervising docs.

So there are specific situations, and specific types of procedures, that PA’s don’t normally do in the emergency room.

(I’ve heard this is different in some places, like on the East coast, where physician assistants more commonly intubate or put in central lines, etc. But in the places I’ve worked, we don’t really ever do this.)

By the way, we do often do a lot of other more “minor” procedures, like putting in stitches are cutting open abscesses, for example.

ICU

Similar to the ER, in the ICU there are some advanced procedures that PA’s don’t typically do.

Again, this includes intubation, placing central lines, etc.

I’m sure there are exceptions to this, but it seems more common that these procedures are reserved for ICU doctors.

Final thoughts

When you consider what specialty you might want to work in as a physician assistant, realize that in some cases you’re almost exactly like a doctor, and in other cases (mainly surgical specialties) you are relegated to a sort of second-class citizen, with rather different responsibilities.

Others (like ER and intensive care), are kind of a “middle ground”. You’ll do just about anything a physician would do, with only a few exceptions.

I still like working in the emergency room despite the limitations that exist there, and I would take it over family practice any day of the week (too much paperwork!). Even though I don’t do the so-called “advanced” procedures, or run codes, I still do a lot of other procedures and hands-on stuff, which can be pretty fun. I also do all the other stuff–evaluating patients, ordering tests and treatment, writing prescriptions, and so on–same as any physician.

If after reading this you’re still not sure what type of specialty you want to go into, the best thing to do is try and shadow a PA in that specialty for a few days (or more). Then you can see what it’s really like, in person.

If you have any other questions, feel free to hit me up. Thanks for reading!