Choosing the Right Specialty as a Physician Assistant

Choosing a specialty as a Physician Assistant/Physician Associate (PA) can be quite a journey. With so many fascinating areas of medicine to explore, each comes with its own set of challenges and rewards. Beyond the medical knowledge, each specialty offers unique work environments and patient populations to consider.

While it may seem like narrowing down a specialty is the top priority after graduation, it can be helpful to let the type of practice guide your decision. You might discover that more than one specialty aligns with your career goals, or that your ideal job is in a field you hadn’t initially considered! In this blog post, I’ll share my approach to selecting a PA specialty by looking at work settings, patient demographics, patient volumes, and styles of patient care.

Understanding PA Specialties

As a PA, you have the opportunity to work in nearly every medical field. According to the NCCPA 2023 Statistical Profile, the most common specialty for PAs is primary care, with 22.3% practicing in that area. Following closely are family medicine (16.5%), emergency medicine (10.8%), orthopedic surgery (10.7%), and dermatology (4.3%). However, even within these specialties, the work environments can vary widely, with PAs experiencing different schedules, patient care experiences, and practice styles.

When I was deciding on my specialty as a PA, I first focused on the areas that truly interested me. However, I soon realized that my preferred work environment played a more significant role in my final decision.

Work Environment Considerations

Hospital Setting

Working in a hospital can be fast-paced and demanding, exposing PAs to a variety of cases. A typical day might involve patient exams, presentations, rounding, consults, new admissions, discharge planning, and, of course, those much-needed coffee breaks! If you thrive in a dynamic environment and enjoy teamwork, specialties like emergency medicine, hospitalist medicine, inpatient surgery services, or critical care might be the perfect fit for you.

For example, PAs in emergency departments may manage 30-40 patients a day, dealing with trauma cases and acute medical conditions that require quick thinking and adaptability. This specialty is ideal for those who excel under pressure and enjoy a varied workday.

Outpatient Clinics

If you prefer a more stable and predictable setting, an outpatient clinic could be a better choice. Here, PAs primarily manage chronic conditions, conduct routine check-ups, and focus on preventive care. Specialties like family medicine allow for deeper long-term relationships with patients, emphasizing communication and counseling.

In outpatient clinics, you can expect to see about 20 to 30 patients daily. While there’s still variety in visit length and detail, the overall pace is more predictable, allowing for meaningful conversations with patients and fostering a sense of continuity and trust over time.

Patient Population Preferences

Pediatric Patients

If you have a passion for working with children, pediatrics might be the perfect specialty for you. Pediatric PAs engage with patients from infancy through adolescence, requiring strong clinical skills and effective communication with both children and their parents. In pediatrics, communication is not just a skill: it’s the foundation of successful outcomes.

Working with pediatric patients allows PAs to educate families, advocate for preventive healthcare, and provide support to those who may not know about available resources. In the current healthcare climate, pediatric PAs play a vital role in promoting public health and healthy lifestyle habits, while also advocating for necessary medical interventions.

Adult Patients

The majority of PA roles focus on the adult population, which ranges from age 18 to over 100. Most of your clinical training and PA school coursework will center around treating adult patients. While this doesn’t mean that caring for adults is the "default" choice, it can make applying your training easier as a new graduate.

Geriatric Patients

If you find joy in working with older adults, geriatric medicine could be an excellent specialty for you. Geriatric PAs address complex medical issues related to aging and often coordinate care among multiple specialists. Multidisciplinary care is increasingly important as older patients benefit from various services, such as speech therapy, physical therapy, and comprehensive medical management.

Caring for geriatric patients often requires a team-based approach, insight into both chronic diseases and acute injuries, and a deep understanding of patient autonomy and quality of life. Geriatric populations are managed in both inpatient and outpatient settings, with the demands varying based on the practice environment.

Volume and Type of Practice

High-Volume Environments

If a busy workday excites you, consider specializing in urgent care or emergency medicine. These high-volume practices see a constant influx of patients, ensuring that every day is dynamic and fast-paced.

For instance, PAs in urgent care might see over 40 patients in a single shift. This constant flow provides a rich learning environment, where PAs can sharpen their skills through diverse cases each day. Efficiency, camaraderie, and constant flexibility allow PAs in urgent care to successfully manage their workload and provide the care patients need.

Low-Volume, Specialized Care

On the flip side, if you prefer a more relaxed setting with deeper patient connections, specialties like rheumatology or endocrinology may be ideal. These practices typically experience lower patient volumes, allowing for thorough consultations and complex care plans.

The personal interactions in these settings can be incredibly rewarding, as can mastering the education techniques needed to present and treat challenging disease states. While moving into a subspecialty right after graduation may seem risky, especially if you’re worried about forgetting aspects of your general training, if you’re genuinely interested in a specific area, you might be surprised by the breadth of practice and variety available. Even specialized clinics provide excellent care, and working with rare diseases can deepen your understanding of clinical medicine while allowing you to forge meaningful connections with patients.

Your Path to Choosing a PA Specialty

Choosing a specialty as a PA is an exciting yet challenging process. By thoughtfully considering work environments, patient populations, and different practice settings, you can align your career with your passions. Remember, each specialty has its own unique traits, and the best choice is one that fulfills your aspirations while enabling you to make a meaningful difference in patients' lives.

Ultimately, your journey to selecting the right PA specialty is personal. It combines your professional goals with a commitment to improving healthcare. Trust your instincts and experiences as you navigate this important career decision, and remember that every step you take is part of your growth as a skilled professional.

Ready to choose? See job opportunities, resources, CME, fellowships and more on our PA Jobs by Specialty pages.