The career of physician assistant came about when corpsmen who returned from Vietnam wanted to use their medical experience on the home front. PAs, who work under the supervision of physicians, have come a long way since then.

Up until a decade ago, most went into family medicine, but they've been branching out into other areas of medicine ever since. Several in the Twin Cities work in hospital medicine, under the supervision of hospitalists.

Dana Kirkemo was the first PA to work with hospitalists at North Memorial Medical Center in Robbinsdale ( 10 years ago. Technically, she works for North Clinic (, whose physicians are either hospital- or clinic-based.

"A majority of my time is doing admissions, histories and physicals. The histories and physicals when a patient comes into the hospital are vital," Kirkemo said. "Timing is also important because physicians can't always drop everything they're doing to see a patient in the emergency room. So we as PAs fill in this gap."

The only educational program in the Twin Cities for PAs is at Augsburg College in Minneapolis ( Specific training to work with hospitalists is on the job, according to Kirkemo and Paul Talarico, a PA who works with Hennepin Faculty Associates, a physician group at Hennepin County Medical Center in Minneapolis (

"PAs in general are trained and recertified every six years in general medicine. Whether they choose to subspecialize or not is up to them," Talarico said.

Talarico works in internal medicine and carries his own patient load. He organizes a care plan, prescribes medication and reviews the plan with the physician. If the patient's medical complexity is beyond his skills, Talarico will consult sooner. "As you get more experience that necessity becomes less and less," he said.

Talarico stressed that physician assistants weren't created to steal physician's jobs. "If we're doing our job correctly, we should work as a great extender to the physicians who supervise us," he said. "We can provide excellent care and I do pride myself on my ability to put together a plan of care that does my physician proud."

Kirkemo has found that the job can be stressful and unpredictable, but she enjoys caring for a wide variety of patients.

"You have to have thick skin and be very detail-oriented," Kirkemo said. "And if you are willing to educate yourself on the job, you learn from your consultants, you learn from physicians, you learn from patients."