During a typical day in the pediatric emergency room at Los Angeles County/USC Medical Center, Richard Bradley sets fractured arms, reviews charts and treats children suffering seizures. In between, he teaches and does research.
Although his workload sounds like that of a doctor, Bradley, 48, is actually a physician assistant, a 20-year veteran in a field just recently dubbed a "hot" health care career.
PAs, as they're known, are No. 38 on a recent Money magazine list of "The 50 Hottest Jobs in America," landing below physicians and physical therapists but above pharmacists.
Today, 30,000 PAs practice in the United States, about 2,000 of those in California, according to estimates by the American Academy of Physician Assistants, a Virginia-based professional organization.
By the year 2000, PA ranks will swell to 42,000 or more, predicts Lynn Caton, a PA in Vancouver, Wash., and president-elect of the academy. The Bureau of Labor Statistics predicts a 34% growth rate for PAs through the year 2005, compared to 22% average growth for jobs overall. Starting salaries average $40,000--for a typical workweek of 40 or 44 hours--and the salary averages $55,000 for those with experience. Specialty work commands even more.
Driving the demand are a number of factors. PAs' smaller-but-respectable salaries make them more economical than physicians and a boon in the new health care environment. And their flexibility serves them well.
Says Caton: "PAs fit into almost every [health care] arena. PAs can deliver 80% to 90% of primary care."
More than a third of PAs are in family medicine. Others practice in the areas of general surgery, surgery sub-specialties, orthopedics, industrial medicine, pediatrics, internal medicine, obstetrics/gynecology and emergency medicine.
PAs conduct physical exams, diagnose and treat ailments, order and interpret lab tests, counsel patients on preventive health, stitch wounds, set fractures and assist in surgical operations. PAs always practice under the supervision of a licensed physician, although the physician does not have to be on the premises.
Physician assistants perform many of the same health care roles as nurse practitioners, and the two occupations are sometimes confused by the public. Both PAs and nurse practitioners are licensed, but there are educational differences. Nurse practitioners have earned an RN degree and either a bachelor's or master's degree. They have completed a nurse practitioner program, usually requiring another two years.
Generally, PAs have at least two years of college and previous experience in health care before completing a PA program, usually requiring another 24 months.
Schools offering physician assistant programs no longer need to recruit students. Since the first PAs graduated from Duke University in 1967, the number of accredited programs has grown to 61.
Even so, the flood of applicants is overwhelming, program administrators say.
"We had 500 applicants for 50 slots this year," says Janice Tramel, senior faculty member at the USC PA program, who was a nurse before becoming a PA herself and then a faculty member.
The programs include classroom instruction and clinical rotations, according to the American Academy of Physician Assistants.
PA programs, at $3,000 to $18,500 a year in California, total a fraction of medical school costs. The national average for tuition is $8,000 a year, according to the academy. Most programs offer financial aid.
A typical student is Eural Gordon, 30, a first-year PA student at USC who was already a registered nurse when he entered the program. He says he wanted "to broaden my scope and have more control" in his work. When he graduates, he wants to treat the underserved or be a generalist.
Karen Smith, 39, was in premed studies when she worked in an emergency room and got acquainted with PAs there. She switched to a PA program and graduated 17 years ago. She works in urgent care for two Los Angeles-area HMOs, with no hint of midlife malaise. What keeps her interested? "The overall joy of knowing you are helping people in the realm of a rather groundbreaking profession."
These days, PA graduates field an average of seven job offers, according to Nancy Hughes of the academy.
To maintain national certifications, PAs must complete 100 hours of continuing medical education every two years and take a national recertification exam every six years.
And, should inertia set in after a few years of working as a PA, there are many job-switching options: to go from inpatient to outpatient, one specialty to another, a rural setting to an urban one. And therein, say students and PAs, lies some of the attraction.
As the number of PAs has grown, so has respect for the profession. During his first few years of practice, a dozen or so patients seemed uncomfortable about receiving care from him, recalls Caton, 45, the Vancouver veteran of 20 years as a PA.
But that's changed drastically, he says.