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Interviewer: What role will physician assistants play in the evolution of healthcare? We'll talk about that next on The Scope.

Announcer: Health tips, medical news, research and more, for a happier healthier life, from University of University of Utah Health Sciences. This is The Scope.

Interviewer: The physician assistant profession is 50 years old this year. And today we're going to talk a little bit about the history, and also how they're going to be playing a greater role in healthcare in the future. Odds are if you're not using a physician assistant now, in the future, you very well may be. Jennifer Coombs is an Associate Professor of physician assistant studies at University of Utah and is also a physician assistant herself. In order to better understand where the profession will be going, tell me how physician assistants came to be because I think it's a fascinating story that grew out of a need.

Jennifer: Correct. Well, we like to say that the origin of our profession was the Vietnam War. There were returning military corps men and a physician at Duke University had the idea to train relatively rapidly providers that can work relatively independently but in collaboration with physicians.

What happened at Duke University was Dr. Stead, who was the founder of our profession, he found that he had a need to have someone in the office that can really help him, deeply help him, prescribe medications, see patients, come to him if there were any issues. And this is the stroke of genius that he had this idea, that he had when he saw how well trained these Vietnam veterans were and they came with so much experience.

Then, he had this idea to start training people. And it quickly moved from being Vietnam veterans and corps men to all sorts of other people who had amazing experience. We had, quickly, nurses. Nurses would go to nurse practitioner school. Nurses could also go to physician assistant school. We had respiratory therapists. We had physical therapists. We had paramedics, all sorts of experiences and backgrounds.

Interviewer: People already in the healthcare industry in one way, shape, or form.

Jennifer: Correct. And then they would be trained, and then they could go back and work with physicians and do everything, really, that their supervising physician did.

Interviewer: Right. So the physician was able then to see more patients because they had somebody that could prescribe or do a lot of the things that other staff of the hospital or doctor's office couldn't?

Jennifer: Right. Physicians then could see sicker patients, could see the more complex patients. And then everyone could be seen because, really, no one can do it all. I mean, this whole idea that physicians are going to be the managers of everything is absurd. And they need help.

Interviewer: What was the need that they needed to fulfill by creating this new role in health?

Jennifer: It is interesting because it continues to this day and I think the role is access and quality care. And that is provided on teams. We know that teams provide the best care. And teams aren't really a new idea. But PAs have really taken off, and they've bridged a gap that was needed. So if you have a child that has a fever in the middle of the night, you go to a quick clinic or an InstaCare, you might see a physician assistant, and that person is going to get you treated. It's going to get you excellent quality care and get you out of the door. And that just has been our thing, and we've done it well, and we just keep having more and more demand for our services.

Interviewer: Yeah. So the bottom line is to treat a lot of the things you or I might go to the doctor's office for, you don't need all the education that a doctor has. So how much training does a physician assistant have?

Jennifer: We are a two-year program, and you get a master's degree. Of course, people come with a tremendous amount of experience. People are usually a little older when they go to physician assistant school. And they come with an undergraduate degree. And then they go through the two-year program.

Interviewer: So the history kind of, maybe, sets us up for what the future is going to look like. We have a profession of medical professionals that don't need as much training, that can handle a lot of things that a regular physician could, that allow the physician then to focus on those more complicated cases as you said. So going forward, how will a physician assistant play a role in healthcare? How is healthcare evolving? How is it changing, that it's going to require good physician assistants?

Jennifer: I think one thing that is important in healthcare today is providing very, very quality safe care at a good value. And we talk about value a lot at the University of Utah. Physician assistants can provide very high-quality care. And we provide that service at a good value for the institution, a good value for the community. Physician assistants isn't as expensive to train as physicians. And so I think that's one thing that has been our bailiwick is quality care at a good value.

Interviewer: And correct me if I'm wrong, but I understand in healthcare there is going to become a shortage of primary care physicians. And we hear a lot in healthcare about how in the future, your primary care physician is going to be your kind of point of contact for care, but there is going to be fewer of them, which causes a problem because we've got a generation . . . a big population of people that are going to need more and more care. How are physician assistants going to fill the role?

Jennifer: Physician assistants are really well trained for primary care. They can take care of a variety of problems, but you're going to see PAs in all aspects of medicine. There are shortages of care in every specialty of care. And if you have a child that has epilepsy, it might be a physician assistant you can be seen over at Primary's initially, get in the door, then you might be referred. You might see a physician assistant over at the University of Utah Health Care, in neurology. And so they're everywhere. They're everywhere. They're in hospitalists, they're in surgery. They really just coming in and providing that care that's needed and opening up that access.

Interviewer: And in the future, as we move more to team-based care, what will the physician assistant role be in that team-based care?

Jennifer: Often, the physician assistant is a little bit of leader on that team so the physician may not come in the room. The physician might be only called in to help out if needed. I know that in rural areas, we have physician assistants that do everything and that are the leader of the teams. You're going to see PAs everywhere on every team.

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Interviewer: Something comes up and you can't get an appointment with your doctor, but you can see a physician assistant. Jennifer Coombs is a PA. Will I get just as good care from a PA as from a doctor?

Jennifer: Absolutely. PAs are very well-trained and qualified to see patients for quite certainly simple issues, but also complex issues. You're going to see PAs in neurology. You're going to see PAs in the nursing home. You're going to see PAs in family practice clinics.

Interviewer: Wow. So even in specialty care there are physician assistants.

Jennifer: Absolutely. They're doing procedures. They're doing absolutely everything that their supervising physician can do.

Interviewer: And I suppose patients are happy that they're able to get in and get their problem taken care of.

Jennifer: So research shows that patients are just as satisfied with PA-provided care as with physician care, especially when there's a time trade-off.

updated: March 25, 2021
originally published: January 30, 2019

Interviewer: What can a physician's assistant, or "P.A." do for you? We'll talk about that next, on The Scope.

Announcer: Medical news and research from University of Utah: physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: All right, you have called the doctor's office because you want to get an appointment, and the person at the other end of the phone says, "Well, the doctor isn't going to be able to see you, but we can have a physician's assistant see you," do you hesitate and think, "oh man, am I sacrificing some quality care?" It's a common question. Jennifer Coombs, who has been a P.A. for 21 years will hopefully be able to answer that and some other questions about physician's assistants. Thanks for stopping by.

Jennifer Coombs: Hi.

Interviewer: Did I make you bristle a little bit there?

Jennifer Coombs: No, I think there's a great question, and I want to talk about how P.A.s are utilized in a clinic and how patients have really come to accept physician's assistants now. We're an integral part of the healthcare system, and I think it's going to be all hands on deck here in the future with us. We have big, big healthcare needs that are going to need some very trained professionals that are going to be able to help people out there.

Interviewer: So help me understand, what exactly is a physician's assistant? I think most people get what a doctor is, but what is a P.A.?

Jennifer Coombs: A physician's assistant is a medical professional, we're nationally certified, we're licensed to practice in the state of Utah, we can prescribe medications, we can see patients for really, a lot of the issues that you're going to call and need to be seen for, you can have a P.A. see you. And most patients are really happy with the care that P.A.s are giving, and you can get in, you can get out, and get your needs taken care of.

Interviewer: So what's the educational difference between a physician's assistant and an actual doctor?

Jennifer Coombs: P.A.s are trained in the medical model, work very closely with their supervising physician, they have a great deal of autonomy, and we're trained in, it actually came out of a fast track medical model post world war II where they thought about training physicians in a little faster way. That is a didactic year and a clinical year. It's about three academic years, 2,000 clinical hours. It's a very rigorous program.

Interviewer: So, in a lot of cases, if I have the option of seeing a physician that has say 10 years of experience and a P.A. that has 10 years of experience for kind of a common issue, would the P.A. actually maybe even be better able to handle that because they've seen more of it?

Jennifer Coombs: Absolutely, P.A.s are very well trained and qualified to see patients for quite certainly simple issues, but also complex issues. You're going to see P.A.s in urology, you're going to see P.A.s in the nursing home, you're going to see P.A.s in family practice clinics.

Interviewer: Wow, so even in specialty care there are physician's assistants.

Jennifer Coombs: Absolutely, they're doing procedures, they're doing absolutely everything that a supervising physician can do.

Interviewer: So then what is the difference?

Jennifer Coombs: Well you know, I think just like any physician, if you have a need that that provider can't help you with, they're going to refer you. And they're going to refer you to the right person.

Interviewer: Mm-hmm.

Jennifer Coombs: So I think that we're all out there trying to get the patient the proper care that they need. I'm certainly going to see a patient, and if they have a need to see a urologist, I'm going to refer them to that urologist because that's something that I can't necessarily do. So I think P.A.s can coordinate care and they can provide care, and they're doing it all, again, with the supervising physician as someone that they can talk to, bounce ideas off of. The supervising physician often bounces ideas for their patients off the P.A.

Interviewer: Sure. I'm going to ask you kind of about a stereotypical question that I believe a lot of people have. So as a P.A., why did you decide to stop there and not go on to medical school?

Jennifer Coombs: You know, that is a question that almost every P.A. gets asked. You get asked that in the interview to P.A. school, you get asked that in the clinic, and a lot of people say, "well, aren't you going to be a doctor some day?" They just assume that. And you know, the thing is it's just a great profession. So many P.A.s, you ask them, "would you want to be a doctor?" or you know, "are you considering being a doctor?" They're so happy doing what they're doing, you could provide so much care. If you had to do it over again, you'd be a P.A..

Interviewer: All over again, huh?

Jennifer Coombs: And I guess what happens is, patients come in, they see you, you talk to them, they're very pleased with the visit, and usually it never comes up again.

Interviewer: Gotcha, gotcha. So in your mind, what makes being a P.A. so much better than being a physician?

Jennifer Coombs: Well, I'm not a physician, so I don't know how it would be to be honest.

Interviewer: But you see what their lives are like.

Jennifer Coombs: I think P.A.s are in a sweet spot of medicine, which is that, I can always say, "well you know, let's get some help with this," and you know, you might end up grabbing your supervising physician, bringing him in the room to see the patient with you. You just feel like you're right in the middle of a really effective team, and I think that makes for a very satisfied patient, and a very satisfied provider.

Interviewer: And it seems to me that with healthcare, it's kind of going towards a direction of more team based care if I understand correctly.

Jennifer Coombs: Absolutely, and the thing is, in this country we're going to have a lot of people who have health insurance, hopefully, and we also have an aging population, and that means that we're going to have to see people. And we need to provide access to care. That's a big part of what's going to have to happen. And so the physician can't do it all, they're going to need help. And I think that one of the things that's really been great is that P.A.s have been able to come in and fill needs in lots of different spaces, in specialty care, in primary care, and I think it's a concept that has worked well for close to 50 years now, and the reason is because of the team.

Interviewer: So as a consumer of healthcare, if somebody says, "the doctor can't see you, but we can get you in to see a P.A.," I shouldn't worry about that at all.

Jennifer Coombs: I don't think you should worry about it at all, I love seeing my P.A., and I like taking my kids to see a P.A., I think that we provide very good care.

Interviewer: Anything that I left out? Any final thoughts or anything that you would like to add?

Jennifer Coombs: So the bottom line is that research has shown that patients accept and enjoy seeing a P.A. just as much as they like seeing their regular physician, especially if there is a time trade off.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope; the university of Utah health sciences radio.

Interviewer: It's one of the hottest careers in medicine right now. It's one of the hottest careers in the country right now. We're going to find out what that is coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: It's one of the best master's degree you can get for jobs. What is it? We're going to find out right now. We're with Jennifer Coombs. She's been a P.A. for 21 years, a physician's assistant. That career is hot, hot, hot right now. Why is that?

Jennifer Coombs: I think we're in a new cost effective world. P.A.s provide care for patients in a very cost effective way. I like to say we're good in good times and good in bad times. If you want to see a physician, there's a shortage of physicians, P.A.s are going to be, I think, increasingly utilized in our world.

Interviewer: How long have physician's assistants been around?

Jennifer Coombs: Nearly half a century. Physician assistants came out of the Vietnam War. There was a physician who saw returning military medics and all that they could do. He had this idea maybe we could train these people that have an incredible amount of experience to help the physician and really do a lot of the work that the physician can do.

Interviewer: It's a master's program. It's a master's degree to become a P.A. if I understand correctly. I was reading a 'Forbes' article and the salaries are pretty decent.

Jennifer Coombs: Salaries are good. Salaries are good out west. Salaries are good across the country. There are certainly more programs opening up. There's a lot of desire to be a P.A. I like to joke with my husband that I can't go to a wedding, I can't go to a funeral without somebody coming up to me and saying hey, I want to be a P.A., or I have a friend who wants to be a P.A.

Interviewer: In that 'Forbes' article median career, in the middle of your career, salaries are around $80,000. Is that true?

Jennifer Coombs: That is true, yes. It's a very good salary right out of school. P.A.s have a fair amount of debt, about half the debt that a medical student will have.

Interviewer: Okay. The question is a lot of people might hear those dollar signs and think this might be the career for me, but it probably takes a certain kind of person that would do well in this career. What is that person?

Jennifer Coombs: You definitely have to be called, I think, to medicine. Medicine is something that is going to require long hours and is going to require someone who really likes people and really has a desire to serve people. We're looking for that in the profession. I think we end up finding that because people who want to be a P.A., I often joke with our applicants, you become ambassador for the profession because your family's going to say why do you not want to be a doctor.

Interviewer: Yeah, sure, why don't you want to take it to the next step.

Jennifer Coombs: Pretty much everybody who's interested in being a P.A. has to be able to answer that question and defend it to their friends and family. They say you're bright enough, you get great grades, you could go to medical school. The person has to be able to say you know what, P.A.s are really happy. They ask P.A.s would you do it again. Most P.A.s say yes I'd do it again. School is rigorous, but you feel like you come out with a great deal of knowledge and you're ready to hit the ground running. You have autonomy out in practice. You work with physicians who respect you. Patients, for the most part, respect you and value your care. It's a really good job.

Interviewer: Yeah. The joke is a lot of physicians tend to be Type A personalities. Would the same thing be true for P.A.s, or is it a little bit more of a mellow crowd?

Jennifer Coombs: Definitely the P.A. crowd is usually a very personable group of people.

Interviewer: Yeah.

Jennifer Coombs: Yeah. Definitely high on people skills.

Interviewer: If somebody was interested in a career in becoming a physician's assistant, besides school and applying for schools, what are some of the things that they should do, say, somebody who is in high school? Or, there are a lot of P.A.s that become P.A.s in their 30s or 40s, aren't there? How could you prepare, I guess, is the ultimate question.

Jennifer Coombs: I think the most important thing to prepare for P.A. school is to get some health care experience. I know even high schools have pre-professional training and they have certified nursing assistant training that you can get. You can go to the community college and take courses to become a medical assistant. Get in some kind of training right away so that you can get some medical experience. You've got to know that you're going to want to work with people that are sick.

Interviewer: Yeah.

Jennifer Coombs: That is ultimately what you're going to be doing. That means there are going to be all kinds of people that you're going to work with. There are people that aren't going to be in good moods. It's tough work itself, so you have to get that early experience to know that's what you want to do.

Interviewer: What's the day to day of a P.A.?

Jennifer Coombs: P.A.s work in a variety of settings. You might be in a family practice office. In the office you're going to get there early so you can look over your charts and usually do a huddle with the medical assistants in your clinic. You look at your schedule. Then, you start seeing patients, and your day never reflects the schedule.

Interviewer: That's funny.

Jennifer Coombs: And, you have to be able to roll with the punches. Usually you have to do several things at once. I know a lot of the P.A.s that I see out in clinic, they're on the phone fielding a phone call, charting, and oftentimes talking to their supervising physician or one of the medical assistants. They're doing, like, three things at once.

Interviewer: My perception was that physician's assistants just were in family practice, but there are also specialty opportunities for physician's assistants?

Jennifer Coombs: They're intensivists at the hospital. They're in nursing homes. They're in neurology, urology. You can find P.A.s in every specialty. That's the other thing, too, is there are shortages of physicians in all specialties. If you have a child that has epilepsy and you want to get in to see a pediatric neurologist, it's nearly impossible. There are P.A.s working in those areas, and you might end up seeing a P.A. That gives you access. It gives you access to this Tier One system that we have.

Interviewer: Yeah, and it will give you access to a professional that could very possibly answer the question you had anyway it sounds like.

Jennifer Coombs: Absolutely, and coordinate your care, refer you on.

Interviewer: Very nice. Any final thoughts on somebody considering a career as a P.A.?

Jennifer Coombs: There are 187 programs right now that are accredited. I think you have to be able to apply to several programs in order to get in, and then the requirements are different at different programs. You have to be a good consumer of the school and what that school has to offer. At the University of Utah we have one of the oldest programs in the country. We have a very high quality program. Right now we're the only program in the state of Utah.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.