David Barlow was considering medical school, but the prospect of leaving his family for a few years to pursue a residency program in another state didn't feel right. Then his wife saw a newspaper story about a new program for physician assistants at Augsburg College in Minneapolis (augsburg.edu).

That was 15 years ago. Barlow entered the program, eventually taught PA students as adjunct faculty at Augsburg and now works in urgent care for WestHealth in Plymouth (westhealth.com).

PAs in demand

The demand for physician assistants is strong and will only increase as the result of three factors, according to Dawn Ludwig, PA, director of the Augsburg program. One is health care reform, which will likely spur the need for more primary care services. PAs may examine patients and prescribe medications under the supervision of a physician, easing that physician's work load, Ludwig said.

The other scenario is an increase in the use of PAs in medical specialties, particularly orthopedics, Ludwig said. PAs may assist orthopedic surgeons in the operating room, relieving the need for a second surgeon, and may also provide pre- and post-operative care. The PA may examine a patient referred from primary care with a fracture, apply the cast and remove it without the orthopedist ever needing to see the patient, she added.

The third factor is a trend toward decreasing the number of hours medical residents may work. The current limit imposed by the American Council for Graduate Medical Education is 80 hours per week, averaged over a four-week period. The council is considering reducing that number to 60 hours per week. With residents' hours reduced, Ludwig predicts a need for more PAs to fill in patient care gaps in hospitals and clinics.

"The job market has shifted," she said. "I see the job market as being rich for PAs right now."

The learning curve

Augsburg offers the only PA program in Minnesota, a three-year master's degree program in which the curriculum mirrors that of medical students, without the residencies. The last 18 months are devoted to clinical rotations.

The mean starting salary in Minnesota is $75,657 for primary care. PAs working for specialists will probably work more and earn an additional $10,000 to $15,000, Ludwig said.

Barlow said he enjoys urgent care work because it's like family practice. He said PAs must get along with people and not be "too much of a cowboy." He added, "You absolutely have to know your limitations and know when to ask for help and not be afraid to ask for help. I think that's probably the most important thing."