The modern Physician Assistant (PA) is a licensed clinician trained to diagnose illness, develop treatment plans, and perform a wide array of procedures across nearly every medical and surgical specialty. This generalist education provides PAs with a broad and flexible skill set, making them highly adaptable providers in diverse healthcare settings. The procedures a PA performs often mirror those of a physician, but their scope is defined by a framework ensuring they operate within their established competency, experience, and the needs of the clinical team.
The Legal and Institutional Framework for PA Practice
The ability of a PA to perform any procedure is determined by a hierarchy of rules established at different levels of the healthcare system. The foundation of this scope begins with state laws and regulations, often referred to as the Practice Act, which outlines the general boundaries of the profession within that jurisdiction. These laws also determine the required relationship between the PA and the physician, ranging from supervision to collaborative arrangements. The second factor is the collaborative agreement between the PA and their supervising physician, which delegates specific tasks and procedures, ensuring the PA’s practice remains within the physician’s scope and the PA’s training.
The third layer is institutional credentialing and privileging, relevant for PAs working in hospitals or large clinic systems. For specific procedures, the PA must apply for and be granted clinical privileges by the medical staff and the institution’s governing body. This process verifies the PA’s education, experience, and procedural log, ensuring they are qualified to perform the requested tasks within that organization.
Common Procedures Performed in General Practice
PAs working in general practice, family medicine, and urgent care settings routinely perform a foundational set of procedures drawn from their generalist medical training. These are often minor surgical interventions or diagnostic tasks that streamline patient flow and allow for immediate treatment. This proficiency allows primary care physicians to focus on more complex management and referral cases.
Wound Care and Suturing
Laceration repair is a routine procedure for most PAs, involving the cleaning, debridement, and closing of wounds using sutures, staples, or adhesive materials. PAs administer local anesthesia, such as lidocaine, to ensure patient comfort before beginning the repair. They also handle the removal of closure materials during follow-up visits and manage complex wound dressings or packing infected sites.
Incision and Drainage (I&D)
The management of localized infections, such as abscesses, frequently falls to the PA in the outpatient setting. Incision and Drainage (I&D) is a common procedure where the PA surgically opens the abscess, drains the material, and packs the cavity with gauze to promote healing. PAs also perform the excision of simple, benign skin lesions, such as sebaceous cysts or lipomas, under local anesthesia in the clinic.
Orthopedic Procedures
In general practice, PAs manage minor musculoskeletal injuries and perform specific, non-surgical orthopedic interventions. This includes the reduction of minor joint dislocations, such as a dislocated finger or toe, and the application of splints or casts for simple fractures. PAs also perform therapeutic joint aspirations to remove excess fluid for pain relief or diagnosis, followed by joint injections, typically involving corticosteroids or local anesthetics.
Basic Diagnostic Procedures
PAs perform and interpret point-of-care diagnostic tests that inform immediate treatment decisions. They routinely perform and interpret electrocardiograms (EKGs) to screen for cardiac abnormalities and collect various lab specimens, including throat cultures and urine samples. PAs often order and perform the initial reading of diagnostic imaging, such as X-rays, to assess for fractures or foreign bodies, with final interpretation confirmed by a specialist.
Intravenous and Venipuncture Procedures
Establishing vascular access is a fundamental skill for PAs across all practice environments. This includes routine venipuncture for drawing blood samples and starting peripheral intravenous (IV) lines for fluid administration or medication delivery. In settings where they receive specialized training, PAs may also be credentialed to access advanced ports or perform phlebotomy from central venous catheters.
The Role of PAs in Surgical Settings
The surgical PA plays an expansive role covering the entire patient experience, from initial consultation through post-operative recovery. PAs are valued in the operating room (OR) as first assistants, a position requiring deep knowledge of surgical anatomy and procedural steps. They provide continuity that enhances team efficiency.
In the OR, the PA’s responsibilities include providing retraction, controlling bleeding using suction and cautery (hemostasis), and manipulating tissues. PAs perform complex technical tasks such as harvesting veins for cardiac bypass procedures and meticulous closure of the surgical site. Following the procedure, the PA writes post-operative orders, conducts hospital rounds, and monitors the patient’s immediate recovery, managing pain and watching for complications.
Advanced Procedures in Specialty Practice
The flexibility of the PA role allows experienced clinicians, often with post-graduate training, to perform highly specialized procedures in focused fields. These advanced competencies are defined by specialized training, such as a residency or fellowship, and are subject to institutional privileging.
In critical care or emergency medicine, PAs may perform life-saving procedures.
- Chest tube insertion for pneumothorax.
- Central venous line placement for vascular access.
- Endotracheal intubation to secure an airway.
Dermatology PAs routinely perform complex skin biopsies, cryotherapy, and excisions of cancerous lesions. Orthopedic PAs may perform advanced procedures like joint injections under fluoroscopic or ultrasound guidance.
The Importance of Training, Experience, and Credentialing
While state laws define the potential scope of practice, a PA’s actual ability to perform a procedure is governed by individual competency and institutional approval. All PAs must first pass the Physician Assistant National Certifying Examination (PANCE) and maintain national certification through 100 hours of Continuing Medical Education (CME) every two years. This certification demonstrates a generalized medical knowledge base but does not automatically grant procedural privileges.
A PA must be trained and assessed for competency in each specific procedure, often through direct observation by a supervising physician. Hospitals and clinics use credentialing committees to verify training logs and experience before granting the PA the privilege to perform a procedure independently. This rigorous approval process ensures PAs only perform tasks for which they have demonstrated a high level of skill and safety.
Procedures PAs Typically Cannot Perform Independently
The PA profession is founded on a team-based, collaborative model, which sets boundaries on independent action in complex situations. PAs are generally not authorized to perform major, complex surgical procedures as the primary surgeon without the physical presence or immediate availability of a collaborating physician. This includes highly technical operations such as open-heart surgery, neurosurgery, or complex abdominal procedures.
PAs also cannot independently administer general anesthesia, a function reserved for anesthesiologists or certified registered nurse anesthetists (CRNAs). While PAs can prescribe medications in all 50 states, the ability to prescribe certain highly controlled substances may be subject to stricter state-level limitations. These limitations ensure the PA operates within a defined structure of accountability and patient safety.