Physician Assistants in Internal Medicine Subspecialties

In addition to general internal medicine, PAs commonly practice in one of the 13 internal medicine subspecialties. According to the 2013 National Commission on Certification of Physician Assistants Statistical Profile of Certified Physician Assistants, of the survey respondents, 7.7% ( n = 4178) indicated that they practiced in one of the internal medicine subspecialties. Physician assistants in one of the subspecialties can expect a similar base salary as general internal medicine. This information can be accessed through the American Academy of Physician Assistant (AAPA) Salary Report, published annually by the AAPA.

Internal Medicine Rotation

The general internal medicine rotation offers PA students the opportunity to expand their knowledge regarding common acute and chronic illnesses in adult patients as well as screening and preventive medicine. The rotation broadens the depth and breadth of the student’s medical knowledge base about the disease process and the pharmacotherapeutics used in the management of disease. The rotation reinforces clinical skills in patient interviewing; physical examination; and interpretation of ancillary testing, case presentations, and detailed written documentation. The student benefits from working in a team-based environment while using clinical reasoning skills. The rotation assists the student in developing skills necessary to assess accurately clinical situations, develop a differential diagnosis list, and arrive at a working diagnosis. The experience may be mostly outpatient based or hospital based or a combination of both environments.

What to Expect and Know

Expectations and student responsibilities depend on the rotation site and the preceptor. Generally speaking, the PA student should have basic knowledge of a broad spectrum of acute and chronic illnesses and be a self-directed learner. The student should be able to perform a thorough patient history and comprehensive physical examination confidently. The development of a concise differential diagnosis list based on the history and physical examination will guide the student in ordering and the interpretation of appropriate diagnostic tests. The PA student will formulate an assessment, plan, and the appropriate patient education and follow-up. Each case is presented to the preceptor by clearly identifying the patient’s chief complaint, history, pertinent physical examination findings, assessment, plan, and follow-up. The presentation needs to be well organized and provide the preceptor with the essential information regarding the patient encounter. The student should be prepared to answer questions about each case as well as ask appropriate questions of the preceptor to augment the learning experience. At the conclusion of an internal medicine rotation, the student should gain broader knowledge of the pathophysiology of acute and chronic disease, improve his or her skills in developing a comprehensive differential diagnosis list, confidently order and interpret diagnostic testing, and have a solid understanding of the role of pharmacotherapeutics in the management of disease.

Clinical Environment

Practice settings for PAs in internal medicine range from outpatient clinics to hospitals, skilled nursing facilities, or a combination of all. The job of the PA in the inpatient setting is to care for patients who are typically acutely ill. It requires the PA to participate in daily rounds on the patients either independently or part of a multidisciplinary health team. Effective organizational skills are essential in managing multiple hospitalized patients. It can be helpful to develop a system for keeping patient data at your fingertips. It may be the responsibility of the PA to perform the initial complete history and physical examination on all newly admitted patients. This information must be meticulously gathered because it may affect the initial management of a patient. The role of the PA in the hospital setting may include direct communication with patients and their families. It is important for PAs to feel comfortable and confident when discussing all aspects of the management of hospitalized patients.

Many PAs in internal medicine, especially in smaller communities, care for patients residing in skilled nursing facilities. This may require the PA to round on patients and manage their care through effective communication with the nursing staff, patients, and many times, families. In certain situations, nursing home patients are transported to the outpatient clinic for routine care. A patient may not have a family member accompanying him or her or may have difficulty with verbal communication, so it is important that written orders for the nursing staff at the facility are clear and concise.

The ambulatory clinic setting requires the ability to work autonomously while using critical thinking skills in the assessment and management of disease. Time management, organizational skills, and the ability to think on your feet are vital in the outpatient clinic setting.