Finding your niche

Introduction

Physician assistant (PA) education is modeled on the broad, generalist design of physician education. PA students learn each organ system and how they interrelate as a whole body system to promote health and well-being or to cause alterations in function. Students also learn about population-based and systems-based delivery of health care. Most PA students spend their clinical experiences “rotating” through selected medical and surgical specialties to obtain the breadth of knowledge that has led to the success of our profession. Although this education system prepares a student well to enter into many disciplines, new graduates may perceive that they are a “jack of all trades but master of none.” This breadth of knowledge provides flexibility to individual PAs as they navigate through their careers; however, it can present obstacles for the PAs who wish to develop a unique clinical focus that may add value to their practice and allow them to excel as a clinician. This chapter will explore one way that a PA can add value to their practice: the development of a PA practice niche.

As science advances and more is learned about each disease process, the practice of medicine and the delivery of health care continues to become increasingly complex. Physicians have responded to these changes by developing more specialized practices. As a consequence, many physicians spend a significant amount of time after residency completing fellowships that provide subspecialty training. No longer are patients simply treated by an orthopedic surgeon; instead, they are treated by an orthopedic knee specialist. Patients with uterine cancer are increasingly treated by a gynecologic oncologist instead of a general obstetrician-gynecologist. With the increasing depth of knowledge required for subspecialty practice, how can generalist PAs distinguish themselves? They certainly can increase their depth of knowledge in one specialty field of medicine; however, they can also develop a niche that either complements those of their collaborating physicians or brings a whole new dimension to their practice.

What is a physician assistant practice niche?

Simply defined, a niche is a position particularly suitable for the person occupying it. In our context, a niche represents a position within PA practice that is particularly suitable for the talents and skills that an individual PA may already possess or those they wish to develop. A practice niche may represent a specialty within a specialty, such as a PA who practices solely labor and delivery within a larger obstetrics and gynecology group, or it may represent a specific skill that a PA has developed over time, such as point-of-care ultrasound, that may be applied to several different practice settings. PAs and PA students should always be vigilant to identify ways of improving patient outcomes by considering whether there is a need for a particular knowledge base or skill within their practice. Cultivating a practice niche is one way PAs can distinguish themselves among the ever-growing fields of specialty care, increase their value to both their individual and group practices, and improve patient outcomes along the way.