A PA student practices packing an abscess under the watchful eye of program director
Every year, more applicants want in.
Never mind that OU's physician associate program involves 15 straight months of intense coursework. Or that what follows is 15 grueling months of off-campus clinical rotations with no vacations and few days off.
Four top-notch applicants compete for each of 50 slots that open annually in a program able to recruit class after class with a 3.6 GPA average.
For those who make it, "it's the best two-and-a-half years of your life," says program director Daniel McNeill, P.A.-C, Ph.D. "They're also the worst two-and-a-half years of your life because of the intensity, but our attrition rate is actually low. We try to make sure students know what they're getting into."
What students are getting into is a program that will reward them with a Master of Health Sciences degree, an annual salary in the $75,000 to $100,000 range in one of the nation's fastest-growing health care professions and the freedom to work as a semi-autonomous health care provider under the supervision of a physician.
Also appealing is the variety of career paths that graduates can take, whether to private practice settings, emergency rooms or surgical suites. Half of Oklahoma's PAs are in primary care, and about 45 percent serve in rural communities, fulfilling an objective of the profession when it began in North Carolina.
The first PA training occurred in the mid-1960s at Duke University where internist Eugene Stead, M.D., was looking for people to overcome a health provider shortage in rural areas of that state. His first students were army medics who had extensive practical experience in Vietnam but little didactic training.
"The PA program was designed to give them the classroom education in physiology, anatomy, pharmacology and so on, with rotations in various clinical disciplines," McNeill said.
The OU PA program was modeled on the Duke experience when it opened in 1970 as the first degree-granting program west of the Mississippi. The original OU program was 25 months long. It offered a bachelor's degree until 1998 when the program was lengthened to 30 months and the master's degree first offered.
The student body has also undergone a transformation.
Two-thirds of today's PA students prepare for the program by taking a full load of bioscience prerequisites as undergrads. Many of the remaining entrants are changing professions, and more than a few already hold master's and doctoral degrees in scientific fields.
Eighty percent of the first-year students in OU's PA program are women, reflecting a trend that began over a decade ago. Approximately half of the program's alumni are now women.
McNeill says many PAs choose to become physician associates (also known as physician assistants) instead of physicians because they don't want to be the sole decision-maker. A PA always practices under a physician-supervisor.
For those who switch from another career, the choice between medical school and the PA program often comes down to "time and money," McNeill said. "Medical school and subsequent residency training is a minimum of seven years and a big debt. In PA school, it's 30 straight months, and then you're out. You're not independent, but you're out practicing."
In the first 15 months of the program, PA students receive about 75 percent of the curriculum topics taught to first- and second-year medical students, McNeill said.
The 25 percent difference in the two curricula is split between the didactic and clinical curricula. There are no courses in biochemistry or microbiology in a PA program that McNeill describes as "more clinically focused" than medical school. "Rather than teaching microbiology, we require it as a prerequisite with pathogenic microbiology, so that when our students get here, what we want to teach them is infectious disease."
Full-time clinical work for PA students starts with the 16th month and follows the medical student model of rotations with physicians at approximately 400 rural and urban rotation sites.
"We're dependent on the physicians who give their time to precept our students in a variety of primary care and specialty settings," McNeill said.
"Most of the physicians who precept for us do so because they like to teach. They are giving something back to the health care profession, and we get a lot of praise for how hard-working our students are. Students know they have such a short time to get in as much learning as they can."
McNeill said some rotations are 9-to-5, "but when you get out in primary care or surgery or emergency medicine, you're on rotation many more hours than 40 hours a week.
"In a typical small town, the PA student makes hospital rounds early before the preceptor does, seeing five to 10 patients and making notes," McNeill said. "Then the doc comes in, and the student does rounds again before both go to the clinic."
Student and physician make evening hospital rounds together. The physician goes home, and the student heads for quarters in or near the local hospital where he or she is on call to evaluate any new patients before the physician arrives.
"Some physicians want the student to shadow them for the first week and then give the student more autonomy. We don't want the student to shadow for an entire month because they're not learning to make decisions if they're always shadowing. We want the doc to put pressure on students to make decisions."
McNeill emphasizes the role of the physician assistant as someone who is trained to make decisions, diagnose and treat, "working autonomously but not independently". My own supervising physician and I know my level of competence and scope of practice, so we're in agreement with the health care services I provide. His supervision of those services is achieved by our working together in the same department and by his countersigning my encounter notes.
"One important focus of PA training is to teach students to be able to recognize situations that are outside their level of training or comfort level and to bring in the supervising physician."
The PA program is a division of the Department of Family and Preventive Medicine, and the ten PA faculty members work in the Department's urgent care clinic, student and employee health clinics, or geriatric clinic.