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Finding Your Ideal Job as a Physician Assistant
1. Consider and Identify Your Preferences
Consider the type of specialty you are interested in (e.g., primary care, surgery, pediatrics), and think broadly about why these specialties interest you. What was it about this specialty that you found fascinating or intriguing as a physician assistant (PA) student or practicing PA. Is this interest extended to other specialties, or are you sure only one specific specialty offers you the fulfillment you're looking for?
Determine the work environment you prefer (e.g., hospital, clinic, private practice). While many specialties offer practice experience in various environments, most jobs will have you focus your time in a specific practice setting. Interested in surgery? Jobs exist with time in the operating room, inpatient floor, intensive care unit, and clinic. Are you looking for a job that exposes you to all of those practice areas, or would you prefer to work in only one or two environments? Read job descriptions thoroughly and make your expectations clear.
Reflect on your desired patient demographic (e.g., age group, health conditions). Specialties and practice environments can also offer variety of patient demographics. For example, inpatient medicine can be divided into pediatrics, adult care, intensive care, and geriatric care.
Consider these examples specifying all preferences in regard to specialty, environment, and population:
Internal medicine, full-time in clinic, primarily seeing adult patients
Inpatient hospitalist, full-time inpatient, floor status, primarily seeing adult patients
Emergency medicine, full-time in a low-acuity bay, primarily seeing pediatric patients
Cardiothoracic surgery, hybrid of operating room (50%) and clinic (50%), primarily seeing adult patients with advanced cardiovascular disease
Orthopedic surgery, hybrid of operating room (50%) and clinic (50%), primarily seeing pediatric patients with spine conditions
Interventional radiology , full-time in procedure suites, primarily seeing adult patients with pre-op evaluation
2. Research Potential Employers
Look for organizations that align with your values and career goals. Not sure which organizations those might be? Review our Jobs by State pages to look through job boards from each state's largest employers and health systems, review their mission statement, consider their funding (501c3 vs private) and stance towards uninsured patient populations, and search for evidence of PA and advanced practice provider (APP) recognition and promotion. Try to glean their onboarding processes, support for APPs, and benefits for employees.
Check reviews and ratings from current and former employees, or better yet, reach out to a current employee of the health system (if at all possible). Someone who's worked at an institution will absolutely have helpful insight into how that system supports PAs.
Network with other physician assistants to gain insights about various workplaces. Stay open-minded about which employers and health systems may have jobs you're interested in. It's best to hear from as many PAs from as many health systems as possible. Even if a health system aligns perfectly with your goals on paper, they may have leadership in specific departments that are a better or worse fit for your career. Not every department or every job at a large health system is the same. Try to get specific insight and learn what you can to better advocate for yourself.
3. Evaluate Job Listings
Carefully review job descriptions for details on hours, patient load, and the mix of time spent in various environments. If the job description is very vague, or does not specify these details, be ready at the interview to confirm what you're interested in and what the job offers.
Look for listings that emphasize work-life balance and supportive work environments. Remember, boundaries are not profession-specific. If you want a job and employer that will encourage boundaries between work and your personal life, you must seek and advocate for such. Jobs that are especially helpful in keeping boundaries? Those that have full support 24/7, so that when you leave, you leave the work in someone else's capable hands, and the job doesn't need to come with you (i.e. shift work, operating room work, clinic jobs with protected time and clear "closed" hours).
Pay attention to any specific requirements or preferences stated by the employer. If the job requires being on call, don't assume the call time will be uneventful or easy. If the job requires nights and weekends, don't assume you can negotiate your way out of that. Be prepared to advocate for yourself, but also be prepared to compromise. Know what priorities are most important to you and which you can consider with an open mind.
Identifying Safe Hours and Appropriate Patient Care Load
1. Prepare for Negotiation
Gather information on industry standards for hours and patient loads in your desired specialty and practice environment. Want to work in orthopedic surgery, mostly in the OR, but keep your days to 8 hours or less? Be prepared to look long and hard for that opportunity. Want to work in an internal medicine clinic 40 hours a week? You'll likely find a dozen jobs offering that experience, and it'll be up to you to decide which best meets your needs.
Prepare to articulate your skills and experiences. Remember, your skills are not just those you earned in PA school. Pre-PA experience, clinical rotation experience, and job experience (once a practicing PA) carry much more meaning than just the clinical medicine you practiced. Take time to write down the skills you developed through your professional life. Try to simplify those skills into short statements that lead with an action verb, and add them to your curriculum vitae (CV) or resume. For example:
Oriented and onboarded to five inpatient specialties with novel electronic health record (EHR) utilization and varied patient populations
Advanced procedural skills to achieve competency in performing minimally-invasive bedside procedures for adult patients without supervision
Know your worth in numbers. Review your financial impact with your current employer and know what your billing, patient volume, and efficiency provide the practice.
Practice your negotiation skills with a mentor or peer. Consider meeting with a career consultant to personalize your CV and hone your interview and negotiation skills. One or two meetings may end up resulting in negotiating for several more thousands of dollars per year.
2. Discuss Work Hours
Be clear about your availability and any non-negotiable commitments. If you need a job that requires absolutely no call, weekends, or holidays, prepare to lose out on some shift work opportunities and jobs in the OR. Think you've found a job that fits your interests and non-negotiable criteria? Amazing! But also make sure those non-negotiables are confirmed by contract and not up for reconsideration during your employment.
Express your desire for a schedule that allows for a healthy work-life balance. Your employer should be the one promoting your ability to set boundaries and leave work at work. If discussing work-life balance lessens your candidacy in the eyes of an employer, that employer is probably not the best one for you.
Ask about flexibility in scheduling and options for shift work. Shift work notoriously involves 24/7 coverage of a clinic or care center or service, but there are many types of jobs, and it's possible (especially if the practice hires many PAs or APPs) that they may allow for an exception or specific schedule based on your needs. Many employers encourage fairness in work hours between all team members, so consider asking, if offered the opportunity, what other team members' experiences have been with their hours and time at work.
3. Assess Patient Care Load
Inquire about the average number of patients seen per day and the expectations for care. Think broadly about this. 40 patients in an 8-hour workday implies seeing 5 patients an hour, or 12 minutes a patient, with no breaks for lunch or rest. What is the service you are providing? Are you a new graduate or seasoned PA? How much time do you believe you'd need to chart review a patient's history, see the patient, provide their recommendations and complete any necessary paperwork, and document the encounter? Will you have scribes, a voice-assist or AI-assist software for note-writing, or any dedicated administrative time to catch up on tasks? Will you have additional requirements such as following up on labs, messages, imaging studies, RN questions, and other requests throughout the day? Be prepared to discuss how these tasks are covered and with what time. Prepare to negotiate to protect the time you need.
Discuss your comfort level with patient load and the quality of care you aim to provide. Is the employer open to a prolonged onboarding period in which your template has longer visits allotted or your assigned patients or cases reduced for a period of time? How long is the onboarding period, who leads it, and by what metrics are you considered "ready" for a full schedule? Negotiate for the time you need to provide safe patient care.
Suggest a trial period to assess the appropriateness of the patient load. Many jobs do not protect the onboarding period. Be prepared to advocate for what you need, and consider negotiating for a 3- or 6-month follow-up in which you can discuss increasing or decreasing your workload based on experiential feedback.
Finding the Right Mix of Patient Care
1. Define Your Ideal Patient Care Mix
Consider the types of procedures and treatments you are passionate about. Research the acuity and prevalence of those procedures to help discern which jobs offer that experience.
Think about the balance between acute and chronic care you wish to provide. Is ongoing care and relationship development an important part of providing care for you? Or do you prefer acute care settings with no long-term follow-up?
Evaluate the importance of preventative care versus reactive care in your practice. What about healthcare, public health, and the provider-patient relationship do you find most rewarding? What stimulates your intellectual interest, and what do you enjoy most practically? An interest in neuroscience does not necessarily imply providing neurologic care to patients post stroke is most likely to be fulfilling. But perhaps a strong background in public health and interest in preventive medicine fosters a deep love of primary care and antibiotic stewardship, such that a role in family medicine or urgent care is most fulfilling to you.
2. Communicate Your Preferences
During interviews, express your interests in specific types of patient care, and work to understand the patient population you'll be caring for. Remember, the interview is as much for you as it is for the employer. You should both be getting what you want.
Ask about opportunities for continuing education and professional development to optimize your orientation to the patient population and clinical care you'll be providing.
Discuss the potential for involvement in diverse patient care scenarios. It is possible that certain employers may be interested in expanding their care population into a realm you are most expert or interested in. For example, promoting a clinic that offers survivorship care to patients seen by oncologists may allow for you to grow the clinic and promote PA autonomy in care of that population.
3. Assess the Fit
After receiving an offer, consider if the role aligns with your defined patient care preferences. Review your non-negotiables and consider what compromises, if any, you'd be making.
Evaluate the support systems in place for managing patient care effectively, and consider broadly the possibility that the job may be less supportive (will it still meet your needs?) or more supportive (it's always fair to also consider a best case scenario!).
Be open to revisiting negotiations if the initial offer does not meet your expectations. Many employers expect a response to an offer that isn't just "I'll take it!" Negotiation is a common and known component of hiring.
Conclusion
Finding the right job as a physician assistant involves a combination of self-reflection, research, and effective negotiation. By clearly defining your preferences and advocating for safe hours, an appropriate patient care load, and a desirable mix of patient care, you can secure a position that aligns with your professional goals and personal well-being.
Interested in learning more about negotiating salary, benefits, and overall reimbursement for your productivity as a PA? Subscribe to the PA Jobs Career Mentorship & Education newsletter for more mentorship from Jamie Martin, PA-C, a dermatology PA with 11+ years experience.
Interested in learning more about practicing as a PA in dermatology? See Jamie Martin's "Day in the Life" video (featured on Instagram and YouTube).
Bonus Feature! Skin Care Recommendations from a Dermatology PA
Morning Skin Regimen**
Evening Skin Regimen**
**Please note, this does not constitute medical advice. This post is not sponsored, but some links are affiliate links to Amazon.com products.