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Halcyon Days for PAs
Increasingly, physician assistants are an integral part of the medical team.

blank Drew Diskin
  Marcia Updike examines a patient in the emergency department.

Marcia Updike recalls the night her mother, a nurse, brought home two physician assistants from the veterans hospital where she worked. At 17, Updike was then an aspiring nurse, but her mother encouraged her to pursue “the newest thing.” Over dinner, the guests talked up their profession, which got its start in 1965 after Vietnam vets who served as military medics returned home and began filling a niche in American medicine.

Intrigued, Updike heeded her mother’s advice and in 1979 completed one of the country’s only four-year programs. Back then there were only about 10,000 PAs nationally. Today, there are 68,000, according to the American Academy of Physician Assistants, and it’s the fourth fastest growing profession in the country.

An emergency medicine PA for the past nine years, Updike is one of 210 physician assistants on the East Baltimore and Johns Hopkins Bayview campuses. Job requirements vary with each department, but PAs can be found in specialties as diverse as surgery, pediatric oncology and neurology. And, because they can perform 85 percent of physicians’ duties, PAs are becoming an invaluable resource, especially since the reduction in medical residents’ work hours went into effect in 2003. Considering the predicted doctor shortage and an aging population, physician assistants—along with nurse practitioners—will play a pivotal role in patient care, as posters will proclaim during Physician Assistant Week, Oct. 6 – 12.

The field has already gained wide acceptance, says Updike, 51. When she was fresh out of school, she recalls having to beg a skeptical pediatrician to let her do a rotation in his office. “He wouldn’t let me touch patients,” she says. “Now, I coach first- and second-year medical residents.”

Updike’s ED colleague,  Tami Ritsema, says she’s been encouraged to assess any one of the 200 patients, no matter how complex, who show up each day. “I examine them, order their tests, write prescriptions,” she says, “but I also don’t hesitate to ask one of the physicians to look at a patient when I’m not sure how to proceed.”

In addition to putting in long hours in the ED, Ritsema, 40, also works part time in neurology. “It’s fantastic having Tami as our PA,” says John Griffin, former director of neurology and director of the Brain Sciences Institute. “She’s intellectually curious and brings an enthusiasm to educating patients. “She pays attention to the whole person and has been able to pick up subtle cues that can lead to serious diagnoses.”

Even as physician assistants gain more credibility, they’re seeing greater professionalism in their careers, notes Updike, who earned an MBA at Hopkins. Hopkins Hospital and Bayview are home to one of the nation’s few surgical and emergency residency programs, respectively. Each requires 12-months’ intensive study of techniques and patient care, with a rigorous on-call schedule. Clinical research and other opportunities for Hopkins PAs are also gaining momentum.

Ritsema, in fact, will travel to St. George’s University in England next February to serve as a guest lecturer for the inaugural year of its physician assistant program. For the past several years, England has imported American PAs to reduce health care spending. Ritsema, who has a master’s degree in public health, will collaborate on one of four PA training programs. “It’s very exciting to see history in the making,” she says. “A few British students will rotate through Hopkins—they don’t have the opportunity to train with a graduate physician assistant yet in England.”

As for patients’ confidence in the profession, that too has grown, though she cites lingering skepticism. “I can perceive in a minute if a patient shows concern after seeing my badge,” says Updike. “I immediately try to allay their fears by telling them that if they prefer a doctor, it’s not a problem.” But, she notes, only a couple have taken her up on it.




Johns Hopkins Medicine

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