Clicky

Skip Navigation

Specializations Available to Physician Assistants

Table of Contents

  • One of the biggest advantages of the physician assistant role for both professionals and institutions is its versatility. The general medicine education PAs receive prepares them to excel in nearly any specialty area of the medical field. Let's take a closer look at the many specialization and sub-specialization options for physician assistants so you can get a sense of the many options available in this dynamic career.

  • Certificates of Added Qualifications (CAQs) for PA specialties

  • Because they receive a general medical education, physician assistants don't need additional education to work in the majority of specialty areas. However, there are voluntary certifications available through the NCCPA that can demonstrate your competency in the ten offered CAQ specialties. These include:

    You can follow the links above to see the specific skills and areas of knowledge needed to earn a specific CAQ. All of these additional certificates have similar requirements, however. Candidates must first accrue experience within the specialty where they aim to earn certification. Most specialties require 4,000 hours of experience (roughly the equivalent of two years' full-time practice). Only 3,000 hours of experience are required for the Emergency Medicine or Hospital Medicine CAQ, while only 2,000 hours are required for the Psychiatry or Palliative Medicine CAQ. In addition to experience, PAs must have earned at least 75 credits of continuing medical education (CME) focused on the specialty area in the six years prior to applying for their certificate, with 25 of those credits earned in the two years prior to application. These credits can also be used to maintain a general PA-C credential, which must be active at the time of application. Once these qualifications are met, a PA can apply for the CAQ exam. These exams are offered twice per year, in April and September, and are administered at the same Pearson VUE Test Centers where individuals can take the national certifying examination (PANCE). Within 90 days of receiving those exam scores, PAs also need to demonstrate they can apply that knowledge in the real world through a Patient Case Requirement. This is an attestation from a physician, PA program director, or senior PA who is familiar with the applicant's practice stating they have performed, or have the knowledge to perform, a range of key procedures within that area of specialty. Like PA-C certifications, CAQs are valid for 10 years. After that, the PA must renew the qualification by re-taking the specialty exam before the expiration of their current certificate. They also need to earn at least 125 CME credits focused on the specialty area within that 10-year cycle, which can also be used toward the maintenance requirement for the PA-C credential.

  • Primary care specialties

  • The PA role was started to support primary care physicians, and there are specialties within this area of healthcare, as well. Primary care includes all services and procedures that fulfill the general medical needs of patients. This includes screening tests to identify chronic diseases and illnesses, treatment of acute illnesses and injuries, preventative care to maintain patients' overall health and wellness, and management of long-term illnesses. Physician assistants that specialize in primary care may work in hospitals or clinics, but are just as likely to work in private physician offices, group practices, or other non-emergency healthcare settings. The setting where they work will determine their day-to-day environment, but in general they'll work more regular hours with fewer emergency calls or other high-stress scenarios. Patients may make appointments on short notice if they have an illness, but a solid portion of the appointments will be regularly scheduled check-ups. There are three common PA specialties focused on primary care: family medicine, pediatrics, and OB/GYN. Let's take a closer look at the typical scope and responsibilities of each of these roles.

    Family medicine

    Family medicine PAs are generalists who provide patient care for family members of all ages. While they typically have a lower-key work environment than other physician assistant specialties, family medicine can be one of the most challenging areas in the field, in large part because of the variety of ailments they're called on to treat. Family medicine practitioners are called on to diagnose and treat all types of non-emergency illnesses, injuries, and diseases, and don't always have access to the advanced diagnostic tools found in other facilities. The typical day-to-day will be a mix of wellness exams and checkups with acute visits, interspersed with making notes on patient charts, ordering and interpreting lab tests, and other administrative tasks.

    Pediatrics

    This is the only primary care related specialty for PAs that has an official CAQ available through the NCCPA. The procedures considered in the Patient Case Requirement of this qualification are a good summary of the typical pediatric PA job duties. These include taking patient histories, conducting physical exams of infants, children, and adolescents, providing preventative health counseling, administering medication, foreign body removal, and care of injuries like burns, lacerations, and broken bones.

    Obstetrics & gynecology (OB/GYN)

    This specialty area of the PA profession cares for all aspects of womens' reproductive health. Obstetrics focuses on fertility and childbirth, including pre-conception procedures, care during a pregnancy, the delivery of the child, and care of both mother and child immediately after birth. Gynecology is focused on women's health outside of pregnancy. While there are differences between these roles, however, they're normally grouped together into a single specialty. These professionals can work in a variety of settings, including hospitals, outpatient clinics, family planning and birthing facilities, and other healthcare facilities. Their day-to-day tasks vary as widely, from performing routine examinations to emergency care during high-risk pregnancies.

  • Internal medicine and sub-specializations

  • Internal medicine is a field with a broad scope. These professionals need to understand all of the systems within the human body and how they work together. This wide view gives them the ability to diagnose and cure a range of illnesses and ailments, along with preventing diseases, devising treatment plans, prescribing medications, and managing chronic health issues. They may work in hospitals (where they're often known as hospitalists) or in outpatient clinics, long-term care facilities, or rehabilitation centers. Internists can practice as generalists or specialists, and the same is true of the PAs working under their supervision. Some of the subspecialties of internal medicine include:

    • Allergy & immunology
    • Cardiology
    • Endocrinology
    • Gastroenterology
    • Genetics
    • Hematology & oncology
    • Infectious disease
    • Nephrology
    • Neurology
    • Pulmonology
    • Rheumatology
    Generalist internal medicine PAs are experts in making diagnoses, often called on to treat complex issues involving multiple diseases or conditions, or for patients with underlying chronic health concerns. Because they have training in general medicine, even PAs who choose an internal medicine specialty are often called on to provide more general care, including patient education and disease prevention.

  • Emergency medicine and related specialties

  • Emergency medicine specialties are among the most high-pressure career options for physician assistants. These professionals often work in an ICU or emergency rooms, where the patients they see require immediate, life-saving care. This involves the same comprehensive patient care provided in outpatient settings but for patients who need more immediate intervention due to a life-threatening illness or injury. Physician assistants who work in an ER or ICU perform a wide range of duties. This can include diagnosing ailments to determine if the patient needs to be admitted and develop a treatment plan. They also provide ongoing care for those recovering from emergency surgeries and treatments, which can include administering medication, providing cardiac, pediatric, or trauma life support, removing foreign bodies, caring for burns and lacerations, and a range of other medical procedures. The variety of patient concerns PAs see in an emergency medicine setting make it one of the more exciting and fast-paced specialties.

    Critical care

    Related to emergency care, PAs in critical care help to maintain the continuity of patient care. They help to coordinate the efforts of the primary physician and attending nurses, as well as administering medications, making diagnoses, and performing therapeutic interventions.

    Urgent care

    Urgent care is at the intersection of primary care and emergency medicine, and is growing into a very popular PA specialty. Physician assistants working in urgent care centers often see more patients than those in emergency medicine, but don't provide trauma care, instead focusing on treatment of acute illnesses and minor injuries. They also often perform minor surgical procedures, and frequently work more independently than PAs in other settings, with less need to consult their supervising physician before making care decisions. This type of care may also be provided in settings like primary care clinics, student health centers, or hospitals.

    Hospital medicine

    Hospitals are the largest employer of physician assistants in the United States, with nearly 43,000 PAs practicing in this setting in 2018. Hospitalist PAs often work long hours. Since emergencies don't always happen during business hours, this can include evening and weekend shifts, and it can be a hectic and fast-paced work environment. The advantage of this role is the range of patients and cases PAs see in this setting, making it a great option for professionals who like variety in their work.

  • Surgical PAs and sub-specializations

  • Surgical PAs work under the supervision of surgeons, providing both preoperative and postoperative care to patients. A surgical specialty tends to have a higher physician assistant salary than other areas, likely one of the reasons it's among the most popular specializations. Along with preparing patients for surgery and helping them recover, surgical PAs provide diagnostic and preventative care. They may also serve as researchers or liaisons for surgical equipment or pharmaceutical companies, though the majority work in hospitals, including intensive care units and emergency rooms as well as dedicated surgical facilities. Surgical PAs may have a general scope, or they may take on a sub-specialization in a particular system of the body or procedure. Some of the most common surgical PA sub-specializations include:

    • Anesthesiology
    • Cardiovascular/cardiothoracic surgery
    • Bariatric surgery
    • Colon & rectal surgery
    • Neurosurgery
    • Orthopedic surgery
    • Otolaryngology
    • Plastic surgery
    • Thoracic surgery
    • Transplant surgery
    • Trauma surgery
    • Urology
    • Vascular surgery

  • Other specialties for PAs

  • Addiction medicine

    The ongoing opioid epidemic in the United States has made addiction medicine a fast-growing PA specialty. These professionals typically work in addiction treatment centers, though they may also be employed in settings like hospitals, correctional facilities, primary care clinics, or other settings where drug addiction treatment is needed.

    Dermatology

    PAs in dermatology focus on diagnosing and treating skin conditions using either medication or surgical intervention, as well as providing preventative care and patient education. They normally work in private practices and health care clinics as opposed to hospitals or other general care facilities. While they still work under a supervising physician, they are also often given more autonomy to give diagnoses and treatments independently than other PA roles.

    Hospice & palliative care

    PAs in palliative care and hospice medicine often work with elderly patients, as well as patients of all ages who have serious, chronic, and advanced illnesses. They may work in long-term care facilities like nursing homes, or may take this role in a primary care practice or hospital setting. Along with helping patients manage the symptoms and progression of chronic illnesses, they help to educate both patients and their family about proper care and treatment, with an emphasis on compassionate care and communication.

    Occupational medicine

    This specialty is focused on workplace injuries. PAs in occupational medicine work in collaboration with physicians to order tests like x-rays and blood work, diagnose injuries and illnesses, prescribe the appropriate medications, and provide treatment and counseling to help patients recover and get back to work. They may work in hospitals, rehabilitation facilities, community health centers, or a variety of other settings.

    Ophthalmology

    This is one of the rarer specialties for PAs, largely because physician assistant programs give little to no instruction in eye care. The majority of physician assistants in this specialty work in dedicated ophthalmology clinics, where they assist with preparing patient physicals and preoperative histories, as well as with screening and diagnosis of eye diseases.

    Pathology

    The requirements for pathology PA education are different than with most specialties. Pathologist assistants must have graduated from a PA program accredited by the NAACLS and obtain ASCP certification before they can practice. Once certified, pathology PAs often work in university and research hospitals, though they may also be employed in forensic pathology labs, reference laboratories, government healthcare facilities, or private laboratories.

    Psychiatry

    Physician assistants who specialize in psychiatry often serve as a bridge connecting the patient's physical and mental health treatment. The Association of PAs in Psychiatry is a great resource for PAs who specialize in mental health. These PAs may work in psychiatric hospitals and in-patient facilities, where their responsibilities include performing intakes and admissions, managing patient treatment during their stay, and planning follow-up appointments and ongoing care after they're discharged.

    Radiology

    When other medical professionals need x-rays, CT scans, MRIs, and other imaging, they turn to radiologists. This can make radiology a high-pressure PA specialty since these tests are often needed as quickly as possible. The majority work in hospitals, though they may also work in outpatient care facilities, diagnostic labs, or doctor's offices.

  • FAQs

  • Can I choose multiple specialty areas?

    Absolutely! According to the AAPA's annual salary report, about 6-7% of PAs change specialties in any given year.

    What are the highest-paying PA specialty areas?

    Based on data from the AAPA, PAs specializing in cardiovascular surgery earn the highest salaries, averaging $137,000 a year. This is followed by thoracic surgery ($129,000), emergency medicine ($124,000), dermatology ($120,000), and addiction medicine ($120,000).

    What are the most popular PA specializations and sub-specializations?

    The largest portion of PAs work in primary care, which accounts for 23.7% of the physician assistant workforce according to the 2021 NCCPA Statistical Profile of Certified PAs. This is followed by family medicine (17.7%), emergency medicine (11.8%), and orthopaedic surgery (10.8%), with the remaining specialties comprising 5% or less of the total workforce.

    Which PA specialties are the most in-demand?

    Even though a lot of physician assistants already work in primary care, there are still ample career opportunities in that field. This demand is being driven by the ongoing shortage of primary care physicians, particularly in underserved rural populations. There is also a growing demand for physician assistants in fields related to aging and the elderly, including palliative care and geriatric medicine.

Carlos da Silva

Author Bio

Carlos da Silva is a highly skilled and compassionate physician assistant with over a decade of experience in the healthcare industry. He has a passion for providing exceptional patient care and staying up-to-date on the latest medical advancements. In his free time, Carlos enjoys hiking, cooking, and spending time with his family.

One of the biggest advantages of the physician assistant role for both professionals and institutions is its versatility. The general medicine education PAs receive prepares them to excel in nearly any specialty area of the medical field. Let’s take a closer look at the many specialization and sub-specialization options for physician assistants so you can get a sense of the many options available in this dynamic career.

Certificates of Added Qualifications (CAQs) for PA specialties

Because they receive a general medical education, physician assistants don’t need additional education to work in the majority of specialty areas. However, there are voluntary certifications available through the NCCPA that can demonstrate your competency in the ten offered CAQ specialties. These include:

You can follow the links above to see the specific skills and areas of knowledge needed to earn a specific CAQ. All of these additional certificates have similar requirements, however. Candidates must first accrue experience within the specialty where they aim to earn certification. Most specialties require 4,000 hours of experience (roughly the equivalent of two years’ full-time practice). Only 3,000 hours of experience are required for the Emergency Medicine or Hospital Medicine CAQ, while only 2,000 hours are required for the Psychiatry or Palliative Medicine CAQ.

In addition to experience, PAs must have earned at least 75 credits of continuing medical education (CME) focused on the specialty area in the six years prior to applying for their certificate, with 25 of those credits earned in the two years prior to application. These credits can also be used to maintain a general PA-C credential, which must be active at the time of application.

Once these qualifications are met, a PA can apply for the CAQ exam. These exams are offered twice per year, in April and September, and are administered at the same Pearson VUE Test Centers where individuals can take the national certifying examination (PANCE). Within 90 days of receiving those exam scores, PAs also need to demonstrate they can apply that knowledge in the real world through a Patient Case Requirement. This is an attestation from a physician, PA program director, or senior PA who is familiar with the applicant’s practice stating they have performed, or have the knowledge to perform, a range of key procedures within that area of specialty.

Like PA-C certifications, CAQs are valid for 10 years. After that, the PA must renew the qualification by re-taking the specialty exam before the expiration of their current certificate. They also need to earn at least 125 CME credits focused on the specialty area within that 10-year cycle, which can also be used toward the maintenance requirement for the PA-C credential.

Primary care specialties

The PA role was started to support primary care physicians, and there are specialties within this area of healthcare, as well. Primary care includes all services and procedures that fulfill the general medical needs of patients. This includes screening tests to identify chronic diseases and illnesses, treatment of acute illnesses and injuries, preventative care to maintain patients’ overall health and wellness, and management of long-term illnesses.

Physician assistants that specialize in primary care may work in hospitals or clinics, but are just as likely to work in private physician offices, group practices, or other non-emergency healthcare settings. The setting where they work will determine their day-to-day environment, but in general they’ll work more regular hours with fewer emergency calls or other high-stress scenarios. Patients may make appointments on short notice if they have an illness, but a solid portion of the appointments will be regularly scheduled check-ups.

There are three common PA specialties focused on primary care: family medicine, pediatrics, and OB/GYN. Let’s take a closer look at the typical scope and responsibilities of each of these roles.

Family medicine

Family medicine PAs are generalists who provide patient care for family members of all ages. While they typically have a lower-key work environment than other physician assistant specialties, family medicine can be one of the most challenging areas in the field, in large part because of the variety of ailments they’re called on to treat. Family medicine practitioners are called on to diagnose and treat all types of non-emergency illnesses, injuries, and diseases, and don’t always have access to the advanced diagnostic tools found in other facilities. The typical day-to-day will be a mix of wellness exams and checkups with acute visits, interspersed with making notes on patient charts, ordering and interpreting lab tests, and other administrative tasks.

Pediatrics

This is the only primary care related specialty for PAs that has an official CAQ available through the NCCPA. The procedures considered in the Patient Case Requirement of this qualification are a good summary of the typical pediatric PA job duties. These include taking patient histories, conducting physical exams of infants, children, and adolescents, providing preventative health counseling, administering medication, foreign body removal, and care of injuries like burns, lacerations, and broken bones.

Obstetrics & gynecology (OB/GYN)

This specialty area of the PA profession cares for all aspects of womens’ reproductive health. Obstetrics focuses on fertility and childbirth, including pre-conception procedures, care during a pregnancy, the delivery of the child, and care of both mother and child immediately after birth. Gynecology is focused on women’s health outside of pregnancy. While there are differences between these roles, however, they’re normally grouped together into a single specialty. These professionals can work in a variety of settings, including hospitals, outpatient clinics, family planning and birthing facilities, and other healthcare facilities. Their day-to-day tasks vary as widely, from performing routine examinations to emergency care during high-risk pregnancies.

Internal medicine and sub-specializations

Internal medicine is a field with a broad scope. These professionals need to understand all of the systems within the human body and how they work together. This wide view gives them the ability to diagnose and cure a range of illnesses and ailments, along with preventing diseases, devising treatment plans, prescribing medications, and managing chronic health issues. They may work in hospitals (where they’re often known as hospitalists) or in outpatient clinics, long-term care facilities, or rehabilitation centers.

Internists can practice as generalists or specialists, and the same is true of the PAs working under their supervision. Some of the subspecialties of internal medicine include:

  • Allergy & immunology
  • Cardiology
  • Endocrinology
  • Gastroenterology
  • Genetics
  • Hematology & oncology
  • Infectious disease
  • Nephrology
  • Neurology
  • Pulmonology
  • Rheumatology

Generalist internal medicine PAs are experts in making diagnoses, often called on to treat complex issues involving multiple diseases or conditions, or for patients with underlying chronic health concerns. Because they have training in general medicine, even PAs who choose an internal medicine specialty are often called on to provide more general care, including patient education and disease prevention.

Emergency medicine and related specialties

Emergency medicine specialties are among the most high-pressure career options for physician assistants. These professionals often work in an ICU or emergency rooms, where the patients they see require immediate, life-saving care. This involves the same comprehensive patient care provided in outpatient settings but for patients who need more immediate intervention due to a life-threatening illness or injury.

Physician assistants who work in an ER or ICU perform a wide range of duties. This can include diagnosing ailments to determine if the patient needs to be admitted and develop a treatment plan. They also provide ongoing care for those recovering from emergency surgeries and treatments, which can include administering medication, providing cardiac, pediatric, or trauma life support, removing foreign bodies, caring for burns and lacerations, and a range of other medical procedures. The variety of patient concerns PAs see in an emergency medicine setting make it one of the more exciting and fast-paced specialties.

Critical care

Related to emergency care, PAs in critical care help to maintain the continuity of patient care. They help to coordinate the efforts of the primary physician and attending nurses, as well as administering medications, making diagnoses, and performing therapeutic interventions.

Urgent care

Urgent care is at the intersection of primary care and emergency medicine, and is growing into a very popular PA specialty. Physician assistants working in urgent care centers often see more patients than those in emergency medicine, but don’t provide trauma care, instead focusing on treatment of acute illnesses and minor injuries. They also often perform minor surgical procedures, and frequently work more independently than PAs in other settings, with less need to consult their supervising physician before making care decisions. This type of care may also be provided in settings like primary care clinics, student health centers, or hospitals.

Hospital medicine

Hospitals are the largest employer of physician assistants in the United States, with nearly 43,000 PAs practicing in this setting in 2018. Hospitalist PAs often work long hours. Since emergencies don’t always happen during business hours, this can include evening and weekend shifts, and it can be a hectic and fast-paced work environment. The advantage of this role is the range of patients and cases PAs see in this setting, making it a great option for professionals who like variety in their work.

Surgical PAs and sub-specializations

Surgical PAs work under the supervision of surgeons, providing both preoperative and postoperative care to patients. A surgical specialty tends to have a higher physician assistant salary than other areas, likely one of the reasons it’s among the most popular specializations. Along with preparing patients for surgery and helping them recover, surgical PAs provide diagnostic and preventative care. They may also serve as researchers or liaisons for surgical equipment or pharmaceutical companies, though the majority work in hospitals, including intensive care units and emergency rooms as well as dedicated surgical facilities.

Surgical PAs may have a general scope, or they may take on a sub-specialization in a particular system of the body or procedure. Some of the most common surgical PA sub-specializations include:

  • Anesthesiology
  • Cardiovascular/cardiothoracic surgery
  • Bariatric surgery
  • Colon & rectal surgery
  • Neurosurgery
  • Orthopedic surgery
  • Otolaryngology
  • Plastic surgery
  • Thoracic surgery
  • Transplant surgery
  • Trauma surgery
  • Urology
  • Vascular surgery

Other specialties for PAs

Addiction medicine

The ongoing opioid epidemic in the United States has made addiction medicine a fast-growing PA specialty. These professionals typically work in addiction treatment centers, though they may also be employed in settings like hospitals, correctional facilities, primary care clinics, or other settings where drug addiction treatment is needed.

Dermatology

PAs in dermatology focus on diagnosing and treating skin conditions using either medication or surgical intervention, as well as providing preventative care and patient education. They normally work in private practices and health care clinics as opposed to hospitals or other general care facilities. While they still work under a supervising physician, they are also often given more autonomy to give diagnoses and treatments independently than other PA roles.

Hospice & palliative care

PAs in palliative care and hospice medicine often work with elderly patients, as well as patients of all ages who have serious, chronic, and advanced illnesses. They may work in long-term care facilities like nursing homes, or may take this role in a primary care practice or hospital setting. Along with helping patients manage the symptoms and progression of chronic illnesses, they help to educate both patients and their family about proper care and treatment, with an emphasis on compassionate care and communication.

Occupational medicine

This specialty is focused on workplace injuries. PAs in occupational medicine work in collaboration with physicians to order tests like x-rays and blood work, diagnose injuries and illnesses, prescribe the appropriate medications, and provide treatment and counseling to help patients recover and get back to work. They may work in hospitals, rehabilitation facilities, community health centers, or a variety of other settings.

Ophthalmology

This is one of the rarer specialties for PAs, largely because physician assistant programs give little to no instruction in eye care. The majority of physician assistants in this specialty work in dedicated ophthalmology clinics, where they assist with preparing patient physicals and preoperative histories, as well as with screening and diagnosis of eye diseases.

Pathology

The requirements for pathology PA education are different than with most specialties. Pathologist assistants must have graduated from a PA program accredited by the NAACLS and obtain ASCP certification before they can practice. Once certified, pathology PAs often work in university and research hospitals, though they may also be employed in forensic pathology labs, reference laboratories, government healthcare facilities, or private laboratories.

Psychiatry

Physician assistants who specialize in psychiatry often serve as a bridge connecting the patient’s physical and mental health treatment. The Association of PAs in Psychiatry is a great resource for PAs who specialize in mental health. These PAs may work in psychiatric hospitals and in-patient facilities, where their responsibilities include performing intakes and admissions, managing patient treatment during their stay, and planning follow-up appointments and ongoing care after they’re discharged.

Radiology

When other medical professionals need x-rays, CT scans, MRIs, and other imaging, they turn to radiologists. This can make radiology a high-pressure PA specialty since these tests are often needed as quickly as possible. The majority work in hospitals, though they may also work in outpatient care facilities, diagnostic labs, or doctor’s offices.

FAQs

Can I choose multiple specialty areas?

Absolutely! According to the AAPA’s annual salary report, about 6-7% of PAs change specialties in any given year.

What are the highest-paying PA specialty areas?

Based on data from the AAPA, PAs specializing in cardiovascular surgery earn the highest salaries, averaging $137,000 a year. This is followed by thoracic surgery ($129,000), emergency medicine ($124,000), dermatology ($120,000), and addiction medicine ($120,000).

What are the most popular PA specializations and sub-specializations?

The largest portion of PAs work in primary care, which accounts for 23.7% of the physician assistant workforce according to the 2021 NCCPA Statistical Profile of Certified PAs. This is followed by family medicine (17.7%), emergency medicine (11.8%), and orthopaedic surgery (10.8%), with the remaining specialties comprising 5% or less of the total workforce.

Which PA specialties are the most in-demand?

Even though a lot of physician assistants already work in primary care, there are still ample career opportunities in that field. This demand is being driven by the ongoing shortage of primary care physicians, particularly in underserved rural populations. There is also a growing demand for physician assistants in fields related to aging and the elderly, including palliative care and geriatric medicine.