PRE-PHYSICIAN ASSISTANT

TRAINING at UW OSHKOSH

A web site launched on January 10, 2003 in partial fulfillment of the UW Oshkosh Honors Program
by Jon Niewolny B.S. '02, admitted to PA school for May 2003
Edited & Maintained by Advisor Dana Vaughan

What is a Physician Assistant (PA)?     Back to the TOP

     The physician assistant (PA) profession is relatively new; consequently, many people are unaware of the roles and responsibilities of PAs.  Many struggle when asked about PAs, replying, “Isn’t that a professional nurse?” or “Don’t they assist physicians?”  Much of the problem is lack of exposure to PAs.  Since physicians far outnumber PAs and many communities still rely on the traditional model, in which physicians are the only primary care providers, contact with PAs is limited to more metropolitan regions.  Another reason is physicians’ lack of education regarding PAs.  As more physicians learn the value of utilizing PAs as part of their health-care team, PAs will grow in number and in recognition.              

History of the Profession    Back to the TOP

           For centuries, non-physician health care providers have been involved with health care delivery in other countries, carrying out functions normally under the scope of physicians.¹

The feldsher concept originated in Russia and was introduced to their military system by Peter the Great.  Formal training programs began in the late 1800s.  Because of a physician shortage, feldshers performed many of the physicians’ functions, such as treating and diagnosing common illnesses.  After retiring from the military, feldshers settled in rural areas of Russia and continued to contribute to the health-care practice; they even served remote areas of Alaska during the 1800s.¹  Present day feldshers continue to serve a complementary role with physicians in underserved areas.

            China’s barefoot doctors arose in 1965 out of need for physician substitutes.²  They were given a 2-3 month training course and allowed to work in hospital settings that provided additional supervision and training.  Many were used in rural villages to prevent occurrences of common diseases.  Present day barefoot doctors are not comparable to United States PAs and nurse practitioners because they possess a lower level of training and independence. 

    Feldshers and barefoot doctors were established in their respective countries before the physician assistant (PA) concept became a reality.  During the early 1960s, the PA concept gained attention from the medical community due to a lack of physicians and the services they provided.

Carter and Gifford (1995) describe the conditions in the United States that contributed to the development of the PA concept here:

1. An increase social consciousness among many Americans that called for the elimination of all types of deprivation in society, especially among the poor, members of minority groups, and women.

2. An increasing positive value attached to health and health care, which produced greater demand for health services, criticism of the health-care delivery system, and constant complaint about rising health-care costs.

3. Heightened concerns about the supply of physicians, their geographical and specialty misdistribution, and the workloads they carried.

4. Awareness of a variety of physician extender models, including the community nurse-midwife in America, the “assistant medical officer” in Africa, and the feldsher in the Soviet Union.

5. The availability of nurses and ex-military corpsman as potential sources of manpower.

6. Local circumstances in numerous hospitals and office-based practice settings which required additional clinical support professionals.³

     In 1965, Eugene Stead, MD, the chairman of medicine at Duke University, responded to the short supply of physicians by developing a 2- year program to train students with an “education and orientation similar to that of physicians with whom they would work. ”²  The first four PA students in the United States were ex-Navy corpsman.  The program’s goals were two-fold: to provide skills in assisting family practitioners or internists and to emphasize the development of lifelong learning skills to facilitate the ongoing professional growth of these new providers.²

 Many more ex-military medical corpsman followed suit, furthering the profession’s success.  The American public accepted the PA concept because the public recognized that successful PA training by ex-corpsman was one of the few positive things resulting from the Vietnam War.  The medical community benefited from this qualified applicant pool because the applicants were not being taken from other depleted health-care professions. 

            The number of PA programs in the United States expanded during the early 1970s due to an increase in federal funding.  Between 1971 and 1973, 31 new PA programs were established.  Soon accreditation of PA programs was needed because “physician assistant” was being used to refer to many types of informally trained medical personnel.  This accreditation established educational guidelines for PA programs.  In 1972, applications for accreditation were sent out, and 17 programs were ultimately accredited.  That same year, a certification exam was developed to ensure the quality of new PA graduates.  This accreditation of programs and certification of graduates is still in effect.  Programs gain accreditation through the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), and students become certified by successfully passing the Physician Assistant National Certifying Exam (PANCE).  Currently, in 2002, there are 134 PA accredited programs and an estimated 42,708 clinically practicing PAs in the United States.⁴

Nature of the Work     Back to the TOP

PAs are licensed professionals who practice medicine in all health care environments under the supervision of one or more physicians.  The extent of supervision is not limited to direct contact.  The PA and physician are allowed to work in consultation with each other via telephone or email.⁵  PAs may make house calls or go to nursing care facilities and report back to the physician.⁶  Alternatively, if physicians are present only part of the week, PAs can serve as the principal care provider.⁷  The general duties of a PA are determined by a State’s regulatory agency, although many of the specific tasks are determined by the supervising physician(s).

PAs fill almost every niche in health care including internal medicine, pediatrics, obstetrics/gynecology, geriatrics, and family medicine.  Specialization is also common, with many PAs choosing general or cardiac surgery, emergency medicine, or orthopedics.Duties performed by PAs include diagnostic, therapeutic, and preventative healthcare services.  They take medical histories, order and interpret laboratory tests and x-rays, and treat and diagnose illnesses.    

According to the 1995 Plunkett’s Health Care Industry Almanac, “35 states and the District of Columbia . . . allow PAs to prescribe medications.”  In 2000, that number increased to 39 states.⁸  Today, 47 states (including the District of Columbia and Guam) allow PAs to prescribe medications.⁴  This increase exemplifies the rapidly changing PA profession and health care system of the United States.  PAs also treat minor injuries including casting, splinting, caring for burns, and suturing wounds.  Some may work in managerial positions and carry out duties such as ordering medical equipment and supervising medical technicians.⁷  PAs working in surgical subspecialties are commonly used as first assistants to surgeons in the operating room.⁸

PAs work on routine, time-consuming tasks, allowing physicians to spend time on more complicated cases.  This provides the potential for a more efficient and cost-effective health-care system, which reduces costs to both the patient and the health-care facility.  Since a facility pays a PA less in compensation and thereby provides additional patient services, the complementary arrangement allows physicians to work on more complex cases and eliminates the need to hire more physicians.  The potential number of patients seen by a given facility can be significantly increased.

    According to the American Academy of Physician Assistants (AAPA), the scope of a PA is defined by four criteria.⁹  First, the PA’s education and experience limits their job duties.  Most PA programs are about 2 years in length, compared to MD programs which are 4-6 years in length.  Less education translates to limited responsibility.

    Second, state laws were once defined through a checklist that listed the job functions a PA could perform, but today there is a more physician-regulated approach.⁹  For example, the AAPA describes Wyoming’s stance on regulation of the PA’s job responsibilities as follows:   The board does not recognize or bestow any level of competency upon a [PA] to carry out a specific task.  Such recognition of skill is the responsibility of the supervising physician.  However, a [PA] is expected to perform with similar skill and competency and to be evaluated by the same standards as the physician in the performance of assigned duties.⁹  Although the state gives PAs independence by not prohibiting specific tasks, they are held accountable for any duties delegated by the physician.  

    Third, facility policy regulates job functions carried out by the PA.  Privileges are usually granted by the facility in the same manner as the physician.  Finally, decisions are made by the supervising physician(s), allowing for a more flexible and efficient delivery of care.  Allowing the physician to have control of job functions is logical because the physician is most qualified to judge the needs of patients, and most responsible to observe PAs’ competencies.  

    The American Medical Association (AMA) has recognized and adopted the following guidelines for physician/physician assistant delegation of duties:

• The physician is responsible for managing the health care of patients in all practice settings.

• Health care services delivered by physicians and PAs must be within the scope of each practitioner's authorized practice as defined by state law.

• The physician is ultimately responsible for coordinating and managing the care of patients and, with the appropriate input of the PA, ensuring the quality of health care provided to patients.

• The physician is responsible for the supervision of the PA in all settings.

• The role of the PA(s) in the delivery of care should be defined through mutually agreed upon guidelines that are developed by the physician and the PA and based on the physician's delegatory style.

• The physician must be available for consultation with the PA at all times, either in person or through telecommunication systems or other means.

    The extent of the involvement by the PA in the assessment and implementation of treatment will depend on the complexity and acuity of the:

• patient's condition and the training and experience and preparation of the PA as adjudged by the physician.

• Patients should be made clearly aware at all times whether they are being cared for by a physician or a PA.

• The physician and PA together should review all delegated patient services on a regular basis, as well as the mutually agreed upon guidelines for practice.

• The physician is responsible for clarifying and familiarizing the PA with his supervising methods and style of delegating patient care.¹¹

 Working Conditions     Back to the TOP

            PAs are found in every environment within the health-care community including hospitals, clinics, long-term care facilities, medical offices, and even prisons.

PAs usually work in clean, comfortable environments.  They often stand or walk for long periods of time, and may work long shifts.  Some 15,103 clinically-practicing PAs surveyed in 2001 reported a mean work week of 45 +/- 7.95 hours.¹²  PAs commonly work weekends, nights, and holidays.  They must begin work early in the morning if performing rounds or assisting with surgery in hospitals.  Emergency PAs require either 24 hour shifts twice per week, or 12 hour shifts three times per week.¹³

Some PAs are also required to take call, or be available to come in to work if there is an immediate need for care outside business hours.  According to the 2001 census survey from the AAPA, 35.8% of respondents reported taking some call (15,097 clinically practicing PAs accumulating at least 32 hours/week).¹²

Employment       Back to the TOP

            Thirty percent of all clinically practicing PAs are currently employed by single-specialty group practices defined as health care facilities composed of one or more physicians who are specialized in one area of medicine, e.g. family practice, pediatrics, etc.  Another 23% are employed by hospitals.  Other employers include freestanding surgical care centers, long term care facilities, home health agencies, and correction facilities.

            Since the implementation of PAs in health care, most PAs work in primary care settings, defined as the specialties of family practice, general internal medicine, and pediatrics. There has been a shift towards PAs practicing in other specialty areas in correspondence with the emergence of diversified specialty-based practices.¹

 Earnings      Back to the TOP

The median annual income for clinically practicing PAs graduating in 2002 was $61,366.  The median for PAs with at least one year of experience was $69,567.  Several factors influence the salary earned.  Geography is an important factor, which may explain the localization of PAs to more populated areas.  Salaries are highest in the Western U.S., where higher densities of PAs are found.¹⁴ 

^{Another important factor is the area of medicine in which the PA is employed.  PAs graduating in 2000 earned the highest median income in emergency medicine and surgical subspecialties.14}

Physician/PA Relationship     Back to the TOP

            Most physicians are able to perform more effectively when working with PAs and this efficiency has led to the emergence of PAs in every area of medicine.  The effectiveness of this relationship is found in part due to the medical model of training received by the PA.  Because of the similarities in the training received, PAs and physicians exhibit a similarity in reasoning and problem solving that results in uniform delivery of health care.

PAs possess a willingness to work with physician supervision and seem to thrive under these conditions.  Anne Hletko, PA-C, of Appleton Cardiology Associates in Appleton, Wisconsin stated, “. . . the single most important thing for a PA to recognize is their limitations.”¹⁵  Hletko enjoyed the independence and high level of trust her supervising physicians had given her, while continuing to value the insight and advice they gave.

    The physician/PA team is effective in the operating room as well.  The familiarity and experience of the team can often reduce the time required for operating and anesthesia.¹⁶  While job shadowing at the Appleton Medical Center in Appleton, Wisconsin, I observed the relationship between Jill Borgardt, PA-C, and a cardiac surgeon in the operating room (OR).  Borgardt performed many important functions normally performed by other surgeons, such as preparing the patient for initial incision, suctioning, irrigation, and suturing.⁹

PAs are effective in the family practice setting as well as the OR.  A family physician recently described the PA’s role in his practice: “The PA makes himself invaluable by smoothing the ebbs and flows of our daily workload . . . we wonder how any practice can thrive without one.”¹⁷

A 2002 article found at the AAPA web site, entitled “Hiring a PA: The Benefits for Physicians and Practices”, describes a study to determine the effectiveness of employing “nonphysician practitioners (NNPs),” defined as PAs, nurse practitioners, clinical nurse specialists, and certified nurse midwives.  The study found that solo practice physicians employing NNPs experienced greater efficiency, having an average of one less work week per year, while supplying more office hours and increasing net profits of the practice by 18%.¹⁸

Job Outlook       Back to the TOP

            The number of job openings for PAs is expected to increase faster than average for all other occupations.  The job outlook for PAs is promising because physicians and patients now understand that PAs are competent health-care providers.  Regions that have difficulties attracting physicians (e.g. rural and inner city areas) provide the best employment opportunities for PAs.  Employment of PAs will increase due to expansion of health-care services and emphasis on cost containment.⁸  Physicians are employing more PAs which allows physicians to perform additional revenue-generating tasks.  “Telemedicine - using technology to facilitate interactive consultations between physicians and PAs - also will expand the use of PAs. ”⁷  HMOs and group medical practices will open the door for PAs since their compensations are lower than physicians.  State-imposed regulation of physician residents’ working hours will also provide an opportunity for PAs.

    The United States Bureau of Labor Statistics expects that the number of PA jobs in the United States will increase by 53% between 2000 and 2010, compared to a 15% increase for all jobs over that same period.⁷

            Physician assistant attrition, the reduction of membership from the profession, is very low compared to other health-related professionals.¹⁹  Nationwide and selected population surveys were conducted and an estimated 85% of all PA graduates are currently employed in patient care positions.  This is a positive characteristic of the profession that may indicate a high level of job satisfaction.

How Do You Become a PA?      Back to the TOP

             Becoming a certified PA is an involved process that requires some post-high school training, prior clinical/health care experience, matriculation to and graduation from an accredited PA program, and taking a certification exam.  The process can be as involved, if not moreso, than medical school.  With sound organization and careful preparation, you can increase the likelihood of acceptance to a PA program.

            There are several important factors to consider before applying to PA programs.  Since PA programs require a great deal of time and effort, employment while attending PA school is strongly discouraged.  Another important factor is one’s relationship status.  The time demands of the program can be very stressful on a spouse or significant other.  Making future plans about finances and relationships will aid in the successful completion of a PA program.

 Prior Education      Back to the TOP

            The academic requirements will vary depending on which school(s) is(are) selected.  PA programs offering a Master’s degree will require a Bachelor’s degree along with General Record Examination (GRE) scores.  PA programs offering a Bachelor’s degree will usually require about two years of undergraduate coursework (e.g. biology, chemistry, math, and social sciences).²⁰

            Many prospective PA students are confused regarding the major or degree of study recommended for PA programs.  This will also vary depending on which PA degree type (Master’s or Bachelor’s) is offered and whether the undergraduate school attended has a Pre-PA course of study.  Most undergraduate institutions do not offer an actual Pre-PA major; however, most offer all the necessary prerequisite courses to qualify for admission to a PA program (UW Oshkosh falls into this category).  Any given class of PA students is made up of a wide variety of academic majors.  Completing the program’s academic prerequisites is the only academic requirement, but a strong background in the sciences is recommended for added success in the PA program.²¹

Clinical/Health Care Experience    Back to the TOP

            One of the key differences between qualifying for admission to PA schools and other health-related professional schools is the required clinical/health care experience²²,defined as paid work or volunteerism that involves the health care industry or medical field.  The clinical/health care experience is quantified using clock hours.  Some PA programs require about 1,000 hours (equivalent to 6 months of 40-hour weeks), while others may require 2,000 hours (equivalent to 1 year of 40-hour weeks).  This figure can vary between PA programs, so applicants should learn this requirement early to ensure completion of this requirement.

            The clinical/health care experience can be achieved through work as a certified nursing assistant (CNA), home health aide, nurse, paramedic, medical technician, operating room technician, or respiratory, speech, or rehabilitation therapist.  This is by no means a complete list.  PA programs accept almost any type of health care experience imaginable, but do favor types of experience involving direct patient contact.  

PA Shadowing     Back to the TOP

            Arguably one of the most important things a student can do early on in his or her academic career is to job-shadow a PA.  Shadowing a PA allows the prospective applicant to gain knowledge and insight into the PA profession, which is not found in a textbook or on any web page.  Observing the profession first hand and behind the scenes will allow you to more effectively determine whether working as a PA is something you would find enjoyable.  If you determine that the PA profession is not your career goal, you will avoid wasting time, effort, and money.

PA program admissions personnel will look highly on shadowing experiences.  PA shadowing shows admission committees an applicant’s desire, determination, and initiative to become a PA.  The best method for contacting PAs is to call them directly.  Researching facilities thought to employ PAs online may be the most efficient way to obtain a PA’s office number.  Ask family members if they know of any PAs in the area who would be willing to shadow.  In certain instances, PAs may be difficult to locate for a shadowing experience.  In these cases, contacting the closest PA program in your state may be warranted.  PA programs can assist you with locating the closest practicing PAs.²²

The Graduate Record Examination (GRE)  Back to the TOP

            Most PA programs offering a Master’s degree will require applicants to complete the GRE.  The GRE offers two types of tests: the general test and the subject tests.  Most PA programs only require the general test.  The cost of the exam (in 2002) is approximately $100.00.

            The general test is a 4-hour, computer-based exam offered in the U.S., Canada, and many other countries.  It is composed of 3 portions: verbal, quantitative, and analytical writing.  All three sections are timed.  The first two sections consist of multiple choice questions.  The third consists of writing tasks.

            The verbal portion consists of 30 questions (with 30 minutes allowed for completion) that test your ability to analyze and evaluate written material and recognize and determine relationships among vocabulary words.²³  The verbal test includes subject matter in the areas of science, social science, and humanities.

            The quantitative portion consists of 28 questions (with 45 minutes allowed for completion) that test your basic mathematical skills and quantitative reasoning.  This section requires arithmetic, algebra, geometry, and data analysis.  There is no advanced mathematics (e.g. trigonometry, calculus) in this section.

            The analytical writing portion consists of two writing tasks.  You are required to present your perspective on an argument (45 minutes) and analyze an argument (30 minutes).  The perspective (or issue) task will give you a choice of two topics drawn by the computer randomly from a large pool.  In contrast, the argument task selects one mandatory topic.  The GRE uses a unique writing program to maintain fairness with individuals who have varying degrees of word processing knowledge. 

PA Programs     Back to the TOP

            Generally, PA programs are about 2 years in length.  They usually consist of one year of didactic (bookwork) training and one year of clinical training.  However, some (such as Marquette University’s PA program) consist of a 3-year Master’s level program.²⁴ 

Didactic training involves many courses intended to lay the student's foundation of knowledge, onto which the student will build during subsequent clinical rotations.  Didactic courses typically found in PA curricula include ethics, human gross anatomy (cadaver dissection), physiology, pathophysiology, pharmacology, and general medicine.  Free time is limited during this year.  Students can expect 8-16 hours of combined coursework and studying per day.²⁵

Clinical training involves working under the supervision of one or many physicians at various clinical locations (clinics, hospitals, university hospitals, emergency care centers, and long-term care facilities).  Programs usually divide the second year into 5-10 “clinical rotations.”  These rotations may consist of, but are not limited to, internal medicine, general surgery, family medicine, women’s health, pediatrics, and emergency medicine.  Most offer an elective rotation at the end of program that allows PAs to choose an area of medicine that interests them.  These rotations are designed to allow students to apply what they have learned during the first year.  Students find this challenging because they must learn how to work with various health-care professionals.²²

            There are a couple of options for undergraduates trying to gain information from PA programs.  One is to contact individual PA programs to receive their literature.  Another is to subscribe to the On-line Physician Assistant Programs Directory (OPAPD) which lists important information about PA programs, including program deadlines, prerequisites, and other pertinent information.  There is a yearly subscription fee, but it will save you time and effort.  The other option is to look up information on each program’s web site individually.  This option is more time-consuming than the second; however, it is free and more efficient than contacting each program for hard copies by mail. 

    There are 134 accredited PA programs, all of which are found on the AAPA web site.²⁶  Letters following schools indicate level of degree offered (C= Certificate of Completion, A= Associate’s Degree, B= Bachelor’s Degree, M= Master’s Degree).  The list has been modified to include each program’s home page.

Applying to PA Programs    Back to the TOP

            Admission to a PA program is a highly competitive process.  Most students choose to apply to more than one PA program to increase their chances of becoming accepted to at least one.  Until recently, all PA schools had their own application process.  Prospective students had to fill out separate applications for each school.  In 2001, many PA programs chose to participate in what is called the Central Application Service for Physician Assistants (CASPA).²⁷  CASPA is an online tool that allows PA applicants to submit one online application and then designate to which PA programs the application is sent.  Currently, 69 of the 134 accredited PA programs are participating in the CASPA process.²⁸

            Completing the online application involves several steps.  The first is to set up an online account through the CASPA website.  There are detailed instructions to assist applicants with their questions regarding the application.  Any other questions not answered in the instructions can be directed to CASPA.  Filling out the application will require the completion of many sections including the following: Identification, Contact Information, Personal Data, Institutions Attended, Health-Related Training, References, Narrative Statement, Academic Record, Patient Contact Experience, Health-Related Experience, Employment, Community Service, and Your Programs.  

    Once the application is complete, the applicant is required to pay a processing fee that covers authentication and distribution of the application to the correct programs.²⁷  If programs are chosen that require GRE scores, applicants will be required to have GRE scores sent directly to the institutions, as CASPA is not an official GRE site.²⁹

            PA programs not participating with CASPA will require applicants to apply using the traditional method.  Most schools have several sections for the applicant to complete, including a general application form, academic prerequisites, health-care experience, and a narrative essay.  The general application form requires information such as your name, contact information, background, and possibly your transcripts.  The academic prerequisites will vary depending on the school.  According to the AAPA, PA programs look for hard-working, motivated individuals who typically possess a Bachelor’s degree and over 4 years of health-care experience.²⁷

    Schools will review the general application and, if the application materials are considered competitive, send a secondary application or notify the applicant of the program’s interest in him or her and arrange an interview.

            The interview generally consists of traveling to the school, meeting with PA faculty/staff and students, learning more about the program through informational sessions and tours, and finally participating in one or more face to face interview.  More information regarding interviewing can be found in the following section.

How Can UW-Oshkosh Prepare You?     Back to the TOP

             Many opportunities exist to not only strengthen your chances of being accepted to a PA program, but also to have a fun and worthwhile experience in college.  This section is intended to describe my experiences during my undergraduate years, which is my individual journey to admission to PA school.  My way is by no means the only way.  My views and opinions are just that, my views and opinions.  Keep in mind that everyone’s experience in college is different and people with varying degrees and backgrounds are accepted to PA school. 

I believe it will be beneficial for the reader to understand what it was like for me as a UW-Oshkosh student receiving little or no advice from upperclassmen early in my academic career.  If advice or direction would have been available, I would have been willing to experience even more of what UW-Oshkosh had to offer.

Curriculum       Back to the TOP

            I began college with no career objectives because I had not established any long-term goals.  I had an interest in the sciences from high school that led to my decision to major in biology.  My first 2 years could have been considered my “learning years.” By that, I mean that I learned about my interests and goals, as well as what the University had to offer. These interests in turn led to my long-term goal of becoming a PA.  My final couple of years consisted of working toward that goal by concentrating on my grades, work experience, and campus involvement.

            Before I made the commitment to PA school, I chose my classes as a result of my extracurricular activities, namely my participation in Men’s Track & Field my freshman year.  The repeated stress on my legs forced me to visit the athletic training room on campus.  As I iced my shins, I witnessed how student trainers helped injured athletes.  This inspired me. I talked with the head athletic trainer and decided to sign up for a minor in athletic training.

My plan was to become certified as an athletic trainer and, upon completion of my Biology degree, to enroll in a graduate program in Physical Therapy.  I began taking courses to fulfill my minor during my sophomore year.  I volunteered my time in the athletic training room as a student trainer, as this was part of the requirement for completion of the minor.  During this time, the Athletic Training program was undergoing a transition process that would convert the minor into an emphasis within the Physical Education department.  After a little more than one semester in the training room, I was forced to make a decision (as was everyone who had joined the program around the time of its transition).  I had 3 choices: (1) change my major from Biology to Athletic Training, (2) double major in Biology and Athletic Training, or (3) drop my Athletic Training minor and continue in Biology.

            To arrive at my decision, I consulted with faculty from each department and some physical therapy schools.  Each department supported their curriculum. However, when talking with physical therapy personnel, I got the impression that the sciences would prepare me more effectively.  Hal Strough, Athletic Training Director at UW-Oshkosh, discussed my options with me intently and patiently on several occasions.  During one such conversation, he suggested I think about PA school after graduation.  To this day, I owe him gratitude for introducing me to the profession.  

    I began learning about PA school and ultimately decided on dropping Athletic Training and pursuing a Biology degree.  I felt Biology would lay a better ground work for future medical coursework.  Athletic Training was very time intensive and I found that learning efficiently in the training room was difficult as a result of competition from other student trainers.  Finally, the Athletic Training Program was in a transition period, and since much of the Program was yet to be determined, I felt that was risky.  I do not want to give the impression that Athletic Training was or is a weak program, as I have not been involved with it since 1999.  I just felt that it was the right decision at the time for me.  Finally, my choice not to double major was based on my desire to finish in approximately 4 years, something I did not think I would be able to do with a double major. 

    The Biology program was undergoing a make-over right around the same time.  They changed their major requirements and created a menu of three emphases from which to choose.  I opted for the Cell/Molecular/ Professional emphasis.  

This raises an important point regarding curriculum at college.  When a student arrives as a freshman, s/he enters under the authority of a certain Bulletin year (my Bulletin year was 1998).  The undergraduate Bulletin contains a detailed description of the requirements for each major.  If the department subsequently changes any major requirements before the student completes his/her chosen program, the department cannot hold the student to the new requirements.  S/he must only complete those degree requirements in effect during his/her Bulletin year.

I was not required to complete the added requirements present in the new Bulletin, but felt that doing so would strengthen my undergraduate education.  As a result, I voluntarily adopted the new requirements for the Cell/Molecular/Professional Emphasis. 

            High school had not prepared me for choosing classes by myself, so that was stressful for the first few semesters.  Talking to advisors can be very important for successful scheduling and completion of your degree on time.  Later, the freedom for decision-making became enjoyable.  To conclude, here is a summary of my transcripts to give you an idea of what courses I had and when I took them:         

Sample B.S. Program in Biology:       Back to the TOP

   Courses I particularly found interesting and valuable for PA school included General and Developmental Psychology, General and Organic Chemistry, Survival/First Aid, Human Anatomy, Human and Animal Physiology, Introductory and Advanced Cell/Molecular Biology, Genetics, Neurobiology, Bacteriology, Immunology, Biochemistry, and Statistics.  Many other quality courses exist; however, these courses were the most interesting to me.

Some advice on curriculum from a UWO student now in PA school: "Dr. Vaughan, I just thought I would send you a quick note to forward my email address to for any students that are interested in the PA program at Marquette or the profession in general. The first year has been very difficult and the class load for this semester is very heavy!  We have: Physiology, Micro and Lab, Neuroanatomy and Lab, Pathology, and Molecular Pathology. I knew that it was going to be very time consuming but I really had no idea until I got here!  I am really enjoying the courses though. All I can say is, if you don't like science, don't be a PA!"

Advising     Back to the TOP

Academic advising consists of people trained to instruct, guide, and give advice to students who have questions regarding completion of University requirements and changing majors and minors.  My advice to you is to learn how to read your STAR report, which is an academic summary of your progress that every student receives each semester.  Do your homework and spend time reviewing the requirements often.  Mapping out a 4-year plan of coursework early in your academic career is a beneficial technique for staying on track.  Revise and evaluate this plan each semester.

Seeking the help of faculty advisors, professors from your respective department, can be very beneficial.  They not only are experts on the requirements for your major, but can give a description of each class found within the department.  Seeking out professors and meeting with them to discuss each class before scheduling it was something I found particularly beneficial.  Most professors are glad to tell you about their classes, for at UW Oshkosh, their number one obligation is their students.  You will find some faculty members more helpful and friendly than others, so do not become discouraged if one of them is not so helpful.  Establishing a good relationship with one or more faculty members can be very beneficial when needing a reference.

Dr. Dana Vaughan of the Biology Department currently serves as the Biomedical Pre-Professional Advisor.  She advises students who have ambitions of becoming physicians, PAs, physical therapists, dentists, and many other health-related professionals.  Dr. Vaughan served as my advisor and was extremely helpful in mapping out my curriculum (as was listed above in the section Curriculum).  She not only provided me with one of my letters of recommendation for PA school, but her recommendations also helped me receive numerous awards and scholarships throughout my undergraduate years.

 University Honors Program      Back to the TOP

            I discovered the University Honors Program while reading through a student handbook my freshman year.  The handbook stated that, if you were a freshman who graduated in the top part of your class, you would be eligible to enroll in the Honors Program.  Unfortunately, my high school grades did not qualify me for the program.  Instead, I became eligible after completing my freshman year of college.  I joined the Honors Program during my sophomore year and consider it one of the best decisions I made.

            Belonging to the University Honors Program offers many benefits.  Occasionally, freshman and sophomores are denied their scheduling choices due to full classes (priority for scheduling is determined based on number of credits earned).  University Honors students have the opportunity to schedule classes before the general student body, which virtually guarantees you a spot in all classes.

Honors courses primarily consist of general education courses and since these courses have a limited capacity, the smaller class size allows for more teacher-student interaction.  The courses were not necessarily harder than their non-Honors counterparts; they just focused on depth rather than breadth.  Thinking deeply about a few topics, rather than completing a lot of busy work, was emphasized.  This allows students to become thinkers rather than machines turning out a lot of low quality work.  The faculty who teach Honors courses want to teach those courses.  They know that students selecting these courses are eager to learn and appreciate education.  Their attitude toward the class and students was generally better than that of professors in non-Honors general education courses.

 Extracurricular Activities      Back to the TOP

            I joined Men’s Track & Field as a freshman.  This was a good opportunity to meet people with the same interests and establish good relationships.  However, the time commitment was substantial.  Track & Field consisted of an indoor and an outdoor season.  Although practices didn’t start until January, athletes were encouraged to train during the fall semester.  I found college track to be more competitive and demanding than high school track.  Since I had a disappointing season, I decided to give up track to concentrate on academics.

            Another activity I participated in was tutoring.  I tutored the introductory biology course (Biology 105) for 2 semesters.  This was a good résumé builder and helped solidify the basic concepts of biology.  If there is an activity you find interesting, but are unable to find it anywhere on campus, ask people.  I took the initiative to ask if the department needed a tutor and they gave me the opportunity.  Although I did not receive any compensation, it served as volunteer time for my PA application. 

 Employment       Back to the TOP

            Since I was involved with Track & Field and Athletic Training my freshman and sophomore years respectively, I did not seek employment while attending college until my third year.  My interests in helping people, plus my exposure to the nursing assistant profession through my significant other, led me to take a nursing assistant course during the summer of 2000, following my second year at UW-Oshkosh.  I took the course at Lakeshore Technical College in Cleveland, WI.  The course lasted approximately 6 weeks and was scheduled at night, which allowed me to maintain my temporary job in my hometown throughout the summer.  I applied for and was offered a job as a Certified Nursing Assistant at Evergreen Retirement Community (ERC) in Oshkosh when returning to school that fall.

            Before accepting the job, I researched various nursing care facilities in Oshkosh.  I found one that had a low patient-to-CNA ratio.  Since I was new at the profession and was also attending school, reducing the number of residents to care for reduced my stress. 

Some of my CNA job responsibilities included providing physical and psychological care for residents, and documenting those cares.  I performed a wide range of duties including transferring, bathing, assisting with toileting, dressing, grooming, feeding, and taking vital signs of residents.  I also served meals and cleaned resident dining facilities.

 Research Experience        Back to the TOP

            Research experience is highly regarded in PA school.  There are many opportunities to research at UW-Oshkosh.  Many professors in the Biology Department look for undergraduate research assistants.  Students often become lab assistants for professors they had in a prior class.

            I researched for Dr. Toivo Kallas of the Biology Department.  He supervises a microbial genetics laboratory.  Although I was not very familiar with that area of biology, I participated in a summer research project between my fourth year and final semester. My project consisted of attempting to isolate a protein native to the cyanobacterium Chlamydomonas.  I learned how to perform many new research techniques and developed skills at previously known techniques.  Research experience shows initiative and a desire to apply concepts learned in the classroom.  This experience is analogous to the clinical year of PA school.

 PA Shadowing        Back to the TOP

            Most PAs are glad to have students learn more about their profession.  The PAs I shadowed thought my interest in their profession was a compliment.  I had very good experiences when job shadowing PAs, although they were difficult to contact.  The key to scheduling PA job shadowing experiences is to talk directly to PAs.  I made the mistake of contacting the secretary of a PA, and they never returned my call.  Search the Web for clinics and hospitals in the geographical area you want to shadow.  The sites will usually contain the PA’s contact information such as an email address or office telephone number. 

It is a good idea to prepare questions before shadowing. This shows the PA that you have a serious interest and are knowledgeable of the profession. The PA may serve as one of your letters of recommendation for your application to PA school.

              My other job shadowing experience was done in a family practice setting.  This experience was very different from the first.  PAs in primary care practices have more patient interaction, deal with more varied cases, and have more independence.  Surgery requires patience and manual dexterity, while family practice emphasizes a good bedside manner.

 The Interview       Back to the TOP

            The interview was one task I found particularly nerve-racking.  I placed a lot of stress on myself and felt I could have done better.  I believe that preparing for the interview is one of the most important things you can do to become a successful applicant.  There are several important things you can do when preparing for the interview. 

First, learn as much as you can about the school (the interviewers may never ask you direct questions about the school, but the added knowledge can never hurt).  This can be accomplished by researching the school’s web site. 

Next, learn everything you can about the interview.  Ask the PA program the following questions: Will there be multiple interviews?  Who will be interviewing me?  How many other applicants will be interviewing that day?  How long will the interview last?  What type of interview is it? 

Finally, reflect upon yourself and your experiences.  Prepare for the basic types of questions interviewers will ask (e.g. why do you want to become a PA?  What are your strengths/weaknesses?)  Lists of questions for PA interviewing can be found on the Web.  

Conclusion       Back to the TOP

            The PA profession is relatively young and growing in stature every day.  It is an exciting profession that consists of responsible and caring professionals.   The job offers intellectual and physical challenges that provide the PA with a fulfilling career.

            Becoming a PA is a highly competitive and involved process requiring superior grades, prior health-care experience, and a strong science background.  Tailor your academic career and extracurricular activities to fit your own interests.  Everyone’s hobbies and interests will take them in different directions.  Gaining a lot of different types of experiences will only strengthen your chances for becoming a PA.

What Are Some Important Sources of Information?    Back to the TOP

 American Academy of Physician Assistants (AAPA)
950 North Washington Street
Alexandria, VA 22314-1552
Phone: 703/836-2272
Fax: 703/684-1924
Email: aapa@aapa.org
http://www.aapa.org/

Association of Physician Assistant Programs (APAP)
950 N. Washington Street
Alexandria, VA 22314-1552
Phone: 703/548-5538
http://www.apap.org/

Central Application Service for Physician Assistants (CASPA)
P.O. Box 70958
Chevy Chase, MD 20813-0958
Phone: 240/497-1895
https://secure.caspaonline.org/

Graduate Record Examinations (GRE)
GRE-ETS
P.O. Box 6000
Princeton, NJ 08541-6000
1-609-771-7670
http://www.gre.org/ttindex.html

Student Academy of the American Academy of Physician Assistants (SAAAPA)
950 North Washington Street
Alexandria, VA 22314-1552
http://www.saaapa.aapa.org/

References     Back to the TOP

 1.      Cawley JF, Hooker RS. Physician Assistants in American Medicine. New York: Churchill Livingstone Inc.; 1997.

2.      Ballweg R, Stolberg S, Sullivan EM. Physician Assistant: A Guide to Clinical Practice. Philadelphia: WB Saunders Company; 1994.

 3.      Gifford JF. Alternatives in Health Care Delivery: Emerging Roles for Physician Assistants. St. Louis; Warren H. Green, 1984.

 4.      (AAPA) American Academy of Physician Assistants. 10 October 2002. Facts at a Glance. http://www.aapa.org/glance.html Accessed 16 October 2002.

 5.      S. Kavanaugh. Personal communication; 3 September 2002.

 6.      Plunkett JW, Plunkett ML. Plunkett’s Health Care Industry Almanac. Dallas: Corporate Jobs Outlook; 1995.

 7.      Chao EL, Orr LL. Occupational Outlook Handbook 2002-2003 Edition. U.S. Department of Labor Bureau of Labor Statistics; 2002.

 8.      Wright JW. The American Almanac of Jobs & Salaries 2000-2001 Edition. New York: Avon Books, Inc.; 2000.

 9.      J. Borgardt. Personal communications; 16 June 2002.

 10.  (AAPA) American Academy of Physician Assistants. 2 April 2002. Physician Assistant Scope of Practice. http://www.aapa.org/gandp/scope-practice.html Accessed 16 October 2002.

 11.  American Medical Association.  Guidelines for Physician/Physician Assistant Practice. 1998 Policy Compendium. Chicago, Il.

 12.  (AAPA) American Academy of Physician Assistants. 15 October 2002. 2002 AAPA Physician Assistant Census Report. http://www.aapa.org/research/02census-content.html  Accessed 16 October 2002.

 13.  Wischnitzer E, Wischnitzer S. Health-Care Careers for the 21^st Century. Indianapolis: Jist Publishing; 2000.

 14.  Income for PAs who graduated in 2000. http://www.aapa.org/research/01pa-income-grads.html Accessed 16 October 2002.

 15.  A. Hletko. Personal communications; 18 April 2002.

 16.  (AAPA) American Academy of Physician Assistants. 4 April 2002. The Physician-PA Team. http://www.aapa.org/gandp/team.html. Accessed 16 October 2002.

 17.  Iliff, D. “Solo Practice: The Way of the Future.” The Journal of Family Practice Management 1998; 5:16.

18.  (AAPA) American Academy of Physician Assistants. 29 April 2002. Hiring a PA: The Benefits for Physicinas and Practices. http://www.aapa.org/gandp/hiringPA.html Accessed 16 October 2002.

 19.  Cosgrove HR. Encyclopedia of Careers & Vocational Guidance. 10^th ed. Chicago: J.G. Ferguson Publishing Company; 1997.

 20.  University of Iowa-Physician Assistant Program Website. 30 October 2002. Prerequisites of the M.P.A.S. Program. http://www.medicine.uiowa.edu/pa/PAWebNew/admissio.htm Accessed 30 October 2002.

 21.  Finch University PA Program Website. 20 November 2002. Physician Assistant. http://www.finchcms.edu/srhs/passt/pa5.cfm  Accessed 20 November 2002.

 22.  (SAAAPA) Student Academy of the American Academy of Physician Assistants. 01 January 2002. What is required to get into PA school? http://saaapa.aapa.org/prepa/requirements.htm Accessed 29 October 2002.

 23.  (ETS) Educational Testing Service. GRE Information and Registration Bulletin. Graduate Record Examinations Board, ETS; 1 October 2002.

 24.  Marquette University College of Health Sciences. 30 October 2002. Department of Physician Assistant Studies. http://www.marquette.edu/chs/pa/index.html  Accessed 5 November 2002.

 25.  E. Adrid. Personal Communications. 21 October 2002.

 26.  (AAPA) American Academy of Physician Assistants. 20 November 2002. Online program directory. http://www.aapa.org/pgmlist.php3  Accessed 20 November 2002.

 27.  (SAAAPA) Student Academy of the American Academy of Physician Assistants. 06 June 2002. Central Application Service for PAs (CASPA). http://saaapa.aapa.org/prepa/CASPA.htm  Accessed 29 October 2002.

 28.  (CASPA) Centralized Application Service for Physician Assistants. 1 April 2001. CASPA Participating Programs. https://secure.caspaonline.org/html/participating.htm  Accessed 16 October 2002.

 29.  (CASPA) Centralized Application Service for Physician Assistants. 1 April 2001. General Instructions. https://secure.caspaonline.org/html/ins_gen_instructions.htm  Accessed 16 October 2002.

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Last updated 06/02/06.