Physician assistants in orthopedic practice. A national study

Orthopedics is the third most common specialty practiced by physician assistants (PAs), but little is known at a national level about PAs backgrounds or specific contributions to orthopedic practices. We sought to describe, from a nationally representative sample, the demographic and practice characteristics of PAs working in orthopedics.

Surveys were sent to 1,200 PAs, identified from American Academy of Physician Assistants data, who reported orthopedics as their specialty between 2005 and 2007. Information was collected on demographic and educational background, PA training, current practice characteristics, clinical activities, and physician supervision.

After three mailings, the adjusted response rate was 55.8%. Of respondents, 45% reported working in general orthopedics, and the remainder in orthopedic specialties. A majority (76.5%) completed a 4- to 8-week rotation in orthopedic surgery during PA school, but most did not complete any advanced postgraduate orthopedic training. Orthopedic group practices were the most commonly reported employer type (57.6% of respondents). Respondents performed an average of 59 outpatient visits per week and 16 inpatient visits per week. A large proportion (87.6%) participated in surgery on a regular basis, most often working as first assistants. Many orthopedic generalists and specialists performed a broad range of clinical activities, including ones suggestive of general, rather than close and direct, physician supervision such as closing surgical incisions independently and taking first call.

PAs contribute to orthopedic care in many inpatient and outpatient settings and perform a wide variety of clinical tasks, often with only general supervision and little or no formal postgraduate training. Health workforce planning and the development of appropriate training models for PAs in orthopedics and other medical and surgical specialties require understanding the content of PA specialty practice.