Photos by ERIC BRADY The Roanoke Times

Jefferson College of Health Sciences physician assistant student Melanie Hinkle works on Robert Peters during an emergency response drill held last week at the college's classroom space at Carilion Community Hospital.

Laura Wilson, a physician assistant student at Jefferson College of Health Sciences, works with a mock disaster victim during the college's emergency response drill held last week.

Ashley Coffman (right), a physician assistant student at Jefferson College of Health Sciences, works with Megan Theimer (left) and Jessica Lore during an emergency response drill last week at the college's class space at Carilion Community Hospital.

Doctor shortages, an aging population and national health care reform have raised the profile of physician assistants, one of the fastest-growing professions.

In Roanoke, a surge of applicants seeking entrance into one of the four physician assistant education programs in Virginia has been just one of the results of the profession's climb.

Just five years ago, Jefferson College of Health Sciences had 150 people apply to attend its physician assistant program. Last year, 546 applied.

Expectations are that as many as 650 people will vie for 40 spots in the class that begins in the fall 2011.

"Unfortunately for you guys, it has become a very competitive field," said Wilton Kennedy, director of the physician assistant program at Jefferson College, during an information session for prospective students last week. "This is just a reflection of the times and the economy."

Kirstin Harrell, 22, said she considers herself lucky to have gotten into the Jefferson College program on her first attempt. A native of Texas, Harrell graduated from Virginia Tech last spring. She said she has a friend who is applying for the third time to get into a program.

The competition is heavy at other physician assistant programs in the state. At Shenandoah University in Winchester, 596 people applied for 38 spots. At James Madison University in Harrisonburg, the admissions process was changed for this year's class after the school saw the number of applicants reach 591 in 2008. With more stringent prerequisites, the school saw its applications dip to 368 in 2009. The fourth program is at the Eastern Virginia Medical School in Norfolk.

For Ona Hill of Roanoke, the field offers an opportunity to advance in the health care field.

Hill, 26, graduated with a bachelor of science in health sciences in 2007 and has been working as a physical therapist assistant since.

"In those three years, I've realized I want to do more and I'm not getting what I need out of my job," she said. "I love medicine. I also know I will be needed and in the long run I know I have job security."

Hill was one of about 17 people to attend last month's information session for prospective students at Jefferson College. Like many of the interested prospects, she fit the profile of those considering being a physician assistant.

The vast majority are women. The class of 2011 at Jefferson has 30 women and 10 men. The average age is 25; however, the oldest is 43 and there are often people who have been in established careers interested in a change.

It's a master's degree program and graduates typically earn about $76,000 a year in their first jobs. The mean income for all physician assistants was $93,105 in 2009, according to the American Academy of Physician Assistants.

The profession consistently ranks among the top-growing fields in the country. In November, CNNMoney.com listed physician assistants as the second-best job in the country when factoring in pay and growth prospects. Systems engineer came in first.

And in December, the U.S. Bureau of Labor Statistics said the employment of physician assistants is expected to grow 39 percent from 2008 to 2018.

In the Roanoke Valley, the growth in the profession has translated into more jobs. Kennedy said that both Carilion Clinic and Lewis-Gale Medical Center have added more physician assistants to their medical staffs. He also has seen several independent medical practices become increasingly interested in physician assistants.

Both local hospital systems have increased the number of PAs they use over the years. HCA Southwest Virginia, which includes Lewis-Gale, has 61 physician assistants on its active medical staff.

"We believe the job prospects for the PA are steady," said HCA Southwest Virginia spokeswoman Joy Sutton. "Over the last couple of years we've noticed an increase demand for their services as well as for other extenders, like nurse practitioners, who can provide that routine care and help us to see more patients."

Sutton said the need for PAs was especially true in primary care to help meet the demands of an aging population.

Carilion employs 79 physician assistants. That's five more than last year, and Carilion is currently recruiting to fill nine full-time positions, six of which are new. Jefferson College is owned by Carilion.

Still, the data on the profession's growth was gathered before President Obama signed the Patient Protection and Affordable Care Act overhauling the nation's health care system. But those who follow the industry say the new law could drive more demand for the profession.

"PAs are well positioned for getting involved with a new health system," said Robert Hadley, an associate professor with the Jefferson program. "But ultimately, PAs go where the jobs are."

Because physician assistants have to work under the supervision of a doctor, they tend to follow the same specialties as doctors. That means about 25 percent work in family practice, with the majority specializing in everything from various surgical areas to pediatrics.

For Harrell, the key to finding a job is educating doctors about the benefit of working with a PA.

"I've always been told it's one of the fastest-growing professions, so I'm not concerned," she said. "I think it will be great if we can convince a doctor to hire us and show them how great PAs are, what they can do for the medical field. I think it's a win-win situation. ... We can see more without having to be paid as much."

No one has been able to quantify just what impact health reform will have on the profession. But with an estimated 32 million more Americans acquiring health insurance within a few years, the recently passed federal health reform law means the demand for health care providers in general is likely to grow. It's especially true for primary care, an area that not only medical schools are targeting, but also one that has caught the attention of nurse practitioners and PAs.

"That is something that all medical professions are looking at. It is a concern," said Howard Glassroth, a spokesman for the American Academy of Physician Assistants. "We all feel the need to somehow provide incentives for primary care."

Hill, the prospective student, also is considering going to medical school, but is weighing the costs and time involved in both. "This is shorter, two years verses four years. That's a big difference and it also means a difference in the cost," she said.

Tuition and fees at Jefferson currently total an estimated $56,000 for the 27-month program. Because it's a private college, it isn't the least expensive option in the region. At JMU, where 25 spots are available, tuition and fees are $24,191 for in-state students and $69,669 for those living outside Virginia, according to the program's Web site.