• Roderick S Hooker and James F Cawley.
• Email: rodhooker6@gmail.com.
• Am J Manag Care. 2021 Nov 1; 27 (11): 498-504.

AbstractThe introduction of the American physician assistant/associate (PA) was predicated on the belief that the nation's health care needs had outpaced the supply of physicians. The notion that the medical experience of veterans could be utilized in the civilian sector was at the forefront of discussion. From 1965 to the third decade of the new century, the PA has become established in this role and has become an integrated part of society. As of 2021, more than 125,000 PAs are in clinical practice; most (76%) are female, with a mean age of 41 years. PAs work in 65 distinct areas of medicine and surgery, with a quarter in the primary care disciplines. The most visible practice settings are family medicine, surgical subspecialities, emergency medicine, and orthopedics. Sites of PA employment include primary care offices, emergency departments, and inpatient settings. PAs work as hospitalists and intensivists, with some skilled in cardiac catheterization and traumatology. Increasingly, PAs are utilized in graduate medical education, supporting the continuity of care across hospital teaching wards. In a wide range of studies, the evidence demonstrates that PAs produce care indistinguishable from that of a physician in general medicine. When care by PAs for patients with complex and chronic diseases is compared with physician care, the outcomes are the same but the labor cost is considerably lower. The economics of PAs favor their employment, and patient satisfaction is the same as that with doctors. In 2021, at least 11,000 PAs graduated from 277 accredited programs. This graduation rate is increasing, with 20 more programs in development. Predictive modeling by the Bureau of Labor Statistics suggests that the employment growth of PAs will continue beyond 2030.

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