Hospital physician assistants: past, present and future [corrected]

Expansion of the roles of PAs into the hospital setting has been the most significant recent trend in the healthcare field's use of these professionals. Initially intended to be primary-care providers, PAs have moved into the institutional domain with ease and in large numbers to assume roles as medical and surgical inpatient house-staff and as assistants to specialists and subspecialists. In most instances, they have adapted to these types of roles without formal training beyond the normal two-year educational period. PAs in hospitals have been proven to maintain or improve the existing level of quality and access to medical care, have been shown to be cost-effective in the delivery of inpatient services, and have displayed extensive clinical versatility among the various medical disciplines. Hospitals' use of PAs came about through changing forces in the health-personnel supply pool and mandated adjustments in the patterns of graduate medical education. Employing PAs has permitted hospitals to maintain the required levels of patient care in a cost-effective way, has allowed residency programs to balance the numbers of specialty-trained physicians, and has thereby contributed to a more balanced supply of specialists in overcrowded fields. The use of PAs has also contributed to increasing the continuity of care on hospital services and to measures that enrich the quality of residency education for physicians in training. To accommodate PAs as inpatient providers, medical-staff bylaws have been amended to recognize the education and expertise of PAs and to provide their institutional sanction to perform inpatient duties under the supervision of physicians.(ABSTRACT TRUNCATED AT 250 WORDS)