Patients often have questions about working with physician assistants (PA). We asked Kennedy Robinson, a talented PA from our Milton Care Center, to demystify the process.

As with all content on our blog, the following is educational, not medical advice. Always consult your medical provider regarding your unique healthcare needs. 

Could you explain the educational background required to become a physician assistant and how it differs from a medical doctor?

KENNEDY ROBINSON: A key difference in training between a medical doctor and a physician assistant (PA) is the depth and length of training.

Similar to medical school, most physician assistant (PA) programs require a bachelor's degree and prerequisite courses in anatomy, biology, chemistry, genetics, statistics, and psychology. PA programs require "direct patient care hours," with many programs requiring around 1800 to 2500 hours (or 6 to 12 months of full-time work) of hands-on patient care prior to admission in jobs like medical assistant, EMT, RN, or surgical technician.

Most PA programs last two to three academic years, as opposed to four years of medical school, with half of the program focused on didactic "classroom" learning and the other half focused on clinical hours/rotations.

The didactic portion of PA programs is similar to the first one to three years of medical school. It includes learning anatomy and physiology, healthcare delivery, physical diagnosis and patient evaluation, pharmacology principles of medicine, and applied clinical studies.

The PA school's clinical year(s) include rotations lasting four to eight weeks in primary care, internal medicine, emergency medicine, surgery, pediatrics, women's health, family medicine, psychiatry, and electives.

On the other hand, residency for a medical doctor is a much longer clinical training phase and can be followed by a fellowship.

Like physicians, PAs are nationally certified. After graduating from a PA program, PAs must sit for the Physician Assistant National Certifying Examination (PANCE) to achieve their national certification and use the PA-C designation. Then, PAs must apply for a physician assistant license in the state where they plan to practice.

What is the scope of practice for a PA in urology, and how does it differ from the responsibilities of a urologist?

KENNEDY ROBINSON: Urologists can perform surgeries. PAs can assist in surgeries as a first assist but cannot perform them independently. In these guidelines, the American Urological Association (AUA) discusses its views on using advanced practice providers (APPs) like physician assistants.

The AUA "endorses the use of APPs in the care of patients with genitourinary disease through a formally defined, supervised role with a board-certified urologist under the auspices of applicable state law."

The AUA goes on to say that the APP's role in a urology practice can vary and depends on the practice's specific needs. (At GBU, I see urology patients independently and refer complex cases to the urologists I work with directly, Dr. Lin and Dr. Gould. While I have training in first assisting in the OR, I personally do not assist in the OR in my current position.)

The AUA notes that advanced practice providers like PAs commonly perform the following procedures:

• Circumcision
• Cystoscopy
• Hydrocele aspiration
• Intravesical Botox
• Prostate biopsy
• Testopel injection
• Vasectomy
  
  

(From this list, PAs at GBU are most likely to perform cystoscopy, hydrocele aspiration, and Testopel injections.)

Other procedures include percutaneous tibial nerve stimulation (PTNS), difficult bladder catheterizations, and urodynamics. This isn't an exhaustive list, either. PAs always defer to the level of training and scope of practice.

Can physician assistants prescribe medications?

KENNEDY ROBINSON: Yes. Physician assistants can order any medication as long as the PA maintains their national and local drug licenses through the Drug Enforcement Agency (DEA) and, in my case, the Commonwealth of Massachusetts Department of Health and Human Services.

Can you walk us through a typical day in your role as a PA in the Milton Care Center?

KENNEDY ROBINSON: We are very busy at our Milton Care Center, so I typically see patients scheduled on Dr. Lin's and Dr. Gould's patient caseload on Mondays, Tuesdays, and Thursdays. On Wednesdays and Fridays, I see patients scheduled directly with me for various procedures, new patient visits, follow-up visits, and post-op visits.

I am also responsible for medication refills, prior authorizations, and responding to patient phone calls and portal messages. Additionally, I provide direct support to the secretarial staff and medical assistants.

How do you collaborate with Dr. Lin and Dr. Gould, and what does that partnership look like on a daily basis?

KENNEDY ROBINSON: There is a strong collaboration between myself and Drs. Lin and Gould to work together as a team in the Milton Care Center. I can ask them questions, consult with them about patients, and receive increased training daily. To patients, this can often look like seeing patients alongside the MDs or presenting patients to the MDs and formulating a plan together. Both doctors rely on me to increase the efficiency in providing patient care.

What common misconceptions do patients have about PAs, and how do you address them?

KENNEDY ROBINSON: A common misconception is that a physician assistant is a physician's assistant, as in an assistant to the physician. While the name can be confusing, PAs are midlevel providers who work in conjunction WITH a medical doctor under their supervision as part of a larger team.

As a PA, I can see patients, prescribe medication, and order and interpret labs, images, and tests. While there is always a supervising physician I can consult, they do not have to be physically present in the office with me. This gives PAs a lot of autonomy with the added benefit of a supervising physician who oversees what I do and is always available for a sounding board, teaching, or recommendations.

What advantages do you feel PAs bring to patient care at GBU?

KENNEDY ROBINSON: Time and accessibility. Time can be a massive barrier to delivering thoughtful and efficient patient care. I am available in the Milton office Monday through Friday to see patients and triage messages while Drs. Gould and Lin may not be available for many reasons (for example, planned or emergency surgeries, personal time off, etc.).

I often tell people that while Dr. Gould and Dr. Lin have their own patients, all the patients in Milton are "my" patients since I interact with everyone who comes through the office at one time or another. It might be during in-person patient visits, on the phone triaging symptoms, refilling medications, or reviewing lab results.

How do you see the role of PAs evolving in the healthcare system, particularly in specialties like urology?

KENNEDY ROBINSON: The following correctly sums up where things stand currently. The AUA reports, "According to a 2019 study from the Association of American Medical Colleges (AAMC), the projected physician shortage is between 46,900 and 121,900 physicians by 2032, including both primary care (between 21,100 and 55,200) and specialty care (between 24,800 and 65,800). However, the supply of physician assistants (PAs) and advanced practice registered nurses (APRNs) is projected to continue to increase."

Read past articles featuring our talented physician assistants and nurse practitioners.

We have a team of talented physician assistants and nurse practitioners at GBU. Below are links to other articles they've written or contributed to:

• What Does a Physician Assistant Do?
• What is a Nurse Navigator?
• How is a Nurse Practitioner Different from a Doctor?
• What are Urodynamic Studies?
• Black Men & Prostate Cancer: What to Keep in Mind
• Catheter Care at Home: What You Need to Know?