A physician assistant or physician associate (PA) is a type of non-physician practitioner. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes between smaller jurisdictions such as states or provinces. Depending on location, PAs practice semi-autonomously under the supervision of a physician, or autonomously perform a subset of medical services classically provided by physicians.
The educational model was initially based upon the accelerated training of physicians in the United States during the shortage of qualified medical providers during World War II. Since then, the use of PAs has spread to at least 16 countries around the world. In the US, PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and serve as a principal healthcare provider. In many states PAs are required to have a direct agreement with a physician. In the UK, PAs were introduced in 2003. They support the work of the healthcare team, but are dependent clinicians requiring supervision from a physician. They cannot prescribe medications nor request ionising radiation investigations (e.g., x-ray) in the UK. PAs are widely used in Canada. The model began during the Korean War and transitioned to the present concept in 2002. Skills and scope of privileges are similar to those in the US.
Title and professional identity The occupational title of physician assistant and physician associate originated in the United States in 1967 at Duke University. The role has been adopted in the US, Canada, United Kingdom, Republic of Ireland, Netherlands, New Zealand, India, Israel, Bulgaria, Myanmar, Switzerland, Liberia, Ghana, and by analogous names throughout Africa, each with their own nomenclature and education structure. In Malawi they are called clinical officers. Most of them study clinical medicine at the Malawi College of Health Sciences and other colleges within the country. Australia trialled the introduction of the role of Physician Assistant; however, currently PAs cannot register with the Australian Health Practitioner Regulation Agency (AHPRA), are not recognised under the Medicare Benefits Schedule (MBS) or the Pharmaceutical Benefit Scheme (PBS), and their wider implementation is not supported by the Royal Australian College of General Practitioners (RACGP). In 2021, the American Academy of Physician Assistants voted to rename itself the American Academy of Physician Associates (AAPA) and adopted "physician associate" as the preferred professional designation. U.S. state governments such as the one in Oregon have begun to implement statutory changes to reflect the name change in Oregon. The move has been controversial; critics of the name change feel the word "associate" could be misleading for patients trying to understand PAs' scope of practice, while proponents feel it better conveys the profession's collaborative and independent roles. Jurisdiction Title Abbreviation Test Certifying Authority United States Physician Associate/Physician Assistant PA-C Physician Associate National Certification Exam National Commission on Certification of Physician Associates with accompanying state-level certification. Canada Canadian Certified Physician Assistant CCPA Entry to Practice Examination Physician Assistant Certification Council of Canada with accompanying provincial certification United Kingdom Physician Assistant (in England and Wales)Physician Associate (Scotland) PA-R Physician Associate Registration Assessment (PARA)from September 2025Physician Associate National Examination (PANE)2007-2025 Royal College of Physicians Republic of Ireland Physician Associate PA none none Kenya Clinical officer CO Clinical Officers Licensing Examination Clinical Officers Council South Africa Clinical AssociateWorld Health Organization. Classifying health workers. Geneva, WHO, 2010. Malaysia Assistant Medical Officer Malaysia Medical Assistant Board (Lembaga Pembantu Perubatan Malaysia) India "Physician Assistant"& "Physician Associate" Both are now known as "Physician Associate"(NCAHP ACT 2021, Government of India) PA National common Entry and Exit Examination. NCAHP, Ministry of Health and Family Welfare, Government of India. Germany Physician Assistant PA None None China Assistant Doctor Papua New GuineaHealth Extension Officer Former Soviet Union Feldsher Israel Physician Assistant PA-R
Services Depending on jurisdiction, a physician assistant or associates may: conduct patient interviews and take medical histories conduct physical examinations, including the interpretation of clinical signs order and interpret diagnostic tests and exams (As per International labour Organisation code) diagnose illnesses formulate treatment plans coordinate and manage care perform medical procedures prescribe medications (As per International labour organisation norms if any) conduct clinical research provide patient counselling offer advice on preventative health care first assist in surgery Can serve as a clinical tutor/Demonstrator, assistant professor, associate professor, or professor (depending on academic qualifications along with experience). In Administrative sector, can serve as principal/Director, Dean etc. as per experience & Qualifications.
Scope of practice and regulation Physician assistant scope of practice vary by country and state. Physician assistant practice laws in a majority of US states have been updated in recent years to give PAs more autonomy and reduce onerous supervision language. A few states now allow PAs to practice under a "collaborative" agreement rather than with direct physician supervision. In the UK, the General Medical Council (GMC) has become the official regulator of physician associates in December 2024. England's 2025 Leng Review also recommended standard national policies, including a specific supervision model and a unique PA uniform to distinguish PAs from doctors.
Workplaces Physician assistants or associates train to work in settings such as hospitals, clinics and other types of health facilities, or virtually via telemedicine. PAs are commonly found working in teaching and research as well as hospital administration and other clinical environments. PAs may practice in primary care or Health Sciences specialties, including emergency medicine, surgery and cardiology.
Employment growth and compensation Physician assistant job growth in the 21st century has been substantial. In the United States, the U.S. Bureau of Labor Statistics reported that "demand for PAs is expected to grow 27% from 2022 to 2032, much faster than the average for all occupations". Median annual wages for U.S. physician assistants have increased to over $130,000 and are higher still in surgical and emergency medicine subspecialties. A number of sources have reported that the increasing demand for physician assistants is a result of physician shortages in primary care and increased use of team-based models of care.
Training Physician assistant (or associate) education is shorter than the medical degree required to become a physician (MD/DO). Most PAs in the United States have completed 4 years of undergraduate training followed by 2–3 years of Master's-level training, including both didactic training and clinical training. The didactic portions usually include microbiology, genetics, clinical anatomy and physiology, clinical pathophysiology, clinical medicine, clinical pharmacology, patient history & physical exam, clinical problem-solving, women's health, and applied clinical skills. The clinical year usually entails of 4-8 week rotations in surgery, family medicine, emergency medicine, OB/GYN, psychiatry, internal medicine, pediatrics, and other rotations depending on the school. In total, most United States PA Master's programs come out to about 100 semester credit hours (ranging from 95 to 122) or 150 quarter hours.
After training and graduation, most PAs in the US take the PANCE for board certification. The PANCE is a 300-question exam (five 60-question blocks) covering a wide variety of medical topics, assessing for entry-level competency of a PA. Unlike an MD, a PA's training typically does not involve residency training, although this is increasingly offered in a variety of specialties.
Renewal of certification is usually required every few years, varying by jurisdiction. In the US, many states require PAs to submit CME hours to demonstrate they are staying up to date for licensure renewal. The National Commission on Certification of PAs (NCCPA) requires 100 CME hours every 2 years to maintain certification. Every 10 years, the NCCPA requires PAs to take the PANRE (four 60-question blocks taken at once) or PANRE-LA (taken between years 7 and 9 of practice, consisting of twelve 25-question blocks), an exam that aims to test the competency of practicing PAs.
Some PAs go on to get doctorates (DMS/DMSc/DScPAS). These doctorates are professional doctorates most similar to a Doctor of Nursing Practice (DNP), but do not necessarily increase medical knowledge or scope of practice. While programs based in the United States have some level of variability, these doctorate programs are largely focused in academic research, health administration, and health leadership education.
Diversity and representation The PA profession in the United States continues to have recruitment and diversity issues, with the physician assistant workforce remaining predominantly white and male. A 2025 report by the Milbank Memorial Fund discovered that approximately 3.5% of recent PA graduates self-identified as Black, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander, while about 6.4% of recent graduates self-identified as Hispanic.
This was in contrast to the findings of the 2025 AAPA Salary Report, in which over 85% of certified PAs self-identified as White. In response, professional organizations such as the AAPA have developed a diversity award as well as expanded existing programs which allow students from minority groups easier access into the profession.
History In 1961, Charles Hudson recommended that the American Medical Association create new medical provider certifications. Eugene A. Stead of the Duke University Medical Center assembled the first class of physician assistants in 1965, composed of four former US Navy Hospital Corpsmen. He based the curriculum of the PA program on his first-hand knowledge of the fast-track training of medical doctors during World War II. Two other physicians, Richard Smith at the University of Washington, and Hu Myers at Alderson-Broaddus College launched their own programs in the mid-late 1960s. J. Willis Hurst started the Emory University Physician Assistant Program in 1967.
The Liberian model of PAs was a curriculum intended for graduates to work in areas absent of physicians as physician substitutes. Advisors for this program included UNICEF, American physicians, and Agnes N. Dagbe, MS, RN, a Liberian nurse educated in the US. Additional training was done in the USSR. The Liberian government inaugurated the program in 1965 with Dagbe as PA program.
Beginning in January 1971, the US Army produced eight classes of physician assistants, at 30 students per class, through the Academy of Health Sciences, Brooke Medical Center (academically accredited by Baylor University).
In 2017, approximately 68% of physician assistants in the United States were women and approximately 32% were men.
The profession expanded globally. It can now be found in Afghanistan, Canada, Germany, Ghana, India, Israel, Liberia, the Netherlands, New Zealand, Saudi Arabia, and the United Kingdom. As a profession, physician assistants have greatly influenced the theory and conceptualization of socially accountable health professional education.
Jurisdictions
Australia