Orthopedic surgeon Dr. Dowling and his physician assistant Colleen Kelly...

Orthopedic surgeon Dr. Dowling and his physician assistant Colleen Kelly of Long Island Spine Specialists of Commack on Tuesday November 3, 2009. Credit: Newsdayphoto by Pablo Corradi

In the old days, orthopedic surgeon Thomas J. Dowling Jr. often found himself working side by side with a fellow surgeon in the operating room. One would perform the surgery, the other would assist.

This limited the doctors' availability for office visits, sometimes causing patients to wait weeks for an appointment. "If you're in back pain, you don't want to wait that long," Dowling says.

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In 1996, four years after Dowling founded Long Island Spine Specialists in Commack, the practice began to hire physician assistants, or PAs, to meet growing patient demand. PAs can handle appointments or assist in the operating room, says Dowling, whose five-physician practice also has four PAs.


Midlevel medical professionals such as PAs and nurse practitioners, or NPs, are an attractive option when adding a physician to a practice would be cost-prohibitive. For instance, Mae Caime, executive director of Dowling's practice who hires PAs, says their annual insurance premiums range from $5,000 to $10,000, whereas a surgeon's insurance would cost $130,000.

The average salary for a PA in 2008 was $89,987, according to the American Medical Association. The American Academy of Nurse Practitioners reports that the 2008 mean full-time NP base salary was $84,250.


"There is still a public perception that's unclear about who we are, what we do and what we're capable of," says Carol D'Abbraccio, an NP at the Huntington Medical Group in Huntington Station. In New York State, both types of professionals work in concert with a doctor - not in place of one.

PAs complete a postgraduate program typically lasting 24 to 32 months, followed by a national certification exam, which must be kept current with continuing medical education. They also must take a recertification exam every sixth year, and they are required to complete 2,000 hours of clinical rotations. NPs complete a four-year nursing program and a graduate program, as well as clinical training.

Andrew Patane, an internist who provides primary care at Huntington Medical Group, says this level of knowledge and ability makes NPs a "valuable asset" to the practice.

Anita Sadaty of Long Island New York Obstetrics and Gynecology in Great Neck says having a PA reduces the strain by covering last-minute appointments when the doctors' schedules are booked. "Our PA always works with a physician on site," she says. "If any problem comes up that she is not perfectly comfortable with, we are there to help."

Pat Rogienski, a patient at Long Island Spine Specialists, says she appreciates the extra help from her doctor's assistant. "The PA can spend more time with me," she says.

>> Click here for Castle Connolly's Top Doctor listings.

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