WILMINGTON, Del. — Victoria Calo is just 20 years old and already has her life planned out.
The current University of Delaware junior will graduate with a degree in exercise science next year and then almost immediately return to the classroom as a graduate student in a physician assistant program.
At age 23, she'll have the chance to scrub into orthopedic surgeries, earning significantly more right out of school than a surgical resident. This means less student debt and a schedule that allows her to start a family, a consideration that's already factored into her decisions.
"I'll be in a position where I'm almost doing the same thing as a surgeon would be but less schooling, more flexibility and no crazy hours."
In Delaware, a state that is one of the few to not have a medical school, more and more young people are gravitating to the role of physician assistant over doctor. Several Delaware Millennials cite its flexibility, condensed schooling, and cost as major reasons why they chose to become PAs.
According to the Bureau of Labor Statistics, physician assistant is one of the fastest-growing occupations in the country. In the next decade, the bureau expects the number of PAs will grow nationally by 37%, much more quickly than other professions.
This comes at a time when experts predict a huge shortage of primary care physicians in the coming years.
As of May 2016, there were 440 physician assistants employed in Delaware — larger than the number of internists, psychiatrists, OB GYNS and surgeons in the state combined, according to the bureau.
Daniella Benson, president of the Delaware Academy of Physician Assistants, said that number is likely now closer to 600 practicing PAs in The First State.
Physician assistants aren't too different from doctors: They examine, diagnose and treat patients. They can conduct research and prescribe medicine. And they can work in all areas, including emergency medicine and surgery, Benson said.
But the autonomy a PA differs in every state: In Delaware, PAs can provide medical services under the supervision of a licensed physician and the two must have a written agreement about the physician assistant's scope of practice.
While the physician must be available for consultation, he or she is not required to be in the room with the PA as long as they can communicate electronically. The supervising physician can also delegate the PA to write prescriptions for drugs and controlled substances.
Unlike doctors, physician assistants don't have to commit to a specialty. They could work with an orthopedic surgeon one day and then decide to specialize in pediatrics the next.
And the pay doesn't hurt either: The national median compensation for a starting primary care PA is $80,000 to $90,000 versus $220,000 for a primary care physician.
While PAs have some flexibility, they often work "rigorous schedules," Benson said.
Physician assistants are required to complete continuing medical education every two years as well as take a national medical board exam recertification every six to 10 years.
Benson also noted that physician assistants do not want to replace physicians. PAs are interested in increasing access to care and improving patient outcomes, she said.
The position was created in the mid-1960s due to a shortage of primary care physicians in the United States. Now, as the country's population continues to age, experts say there's a greater need for this kind of medical professional.
A 2014 report on physician assistants by the National Governors Association said PAs will play an important role in the changing health care landscape because of their adaptability and lower cost.
Hemi Tewarson, director of health division at governor's association's Center for Best Practices, said the growth of PAs has helped address access gaps throughout the country, particularly in rural communities. PAs are better represented in those areas than physicians are, she said.
While doctors will always be a vital part of health care, Tewarson said there will be a continued interested in other medical professions, including PAs, dental hygienists, and community health care workers. These jobs will not only help address access concerns, but also give people a more "accessible career pathway" into the medical world, she said.
"We just need more options," she said.
Tewarson believes that PA programs have become a "great investment" for states experiencing physician shortages and for those that don't have an abundance of medical programs.
The only PA program in Delaware is through Arcadia University, which accepts about 100 students every year. The program lasts for two years, during which students complete classwork, lab components and clinical rotations.
Diana Noller, associate director of the program, believes more young people are interested in becoming PAs because of its "instant gratification."
"Some consider medical school but like the idea of getting out and practicing quickly," she said.
Noller finds that students are also "afraid to commit" to a specialty for the rest of their lives and prefer a job that allows for more work-life balance.
This is the case for Danielle Sugar, a sophomore at the University of Delaware who began shadowing PAs in high school.
During her first job shadow, with a neurosurgery PA, Sugar distinctly remembers noticing the pictures of his two kids on his desk. That PA then talked about how he was still able to spend time with his young children and pregnant wife when he got home from work, instead of reading a backlog of medical charts.
"It sealed the deal that this is exactly what I want to be," said Sugar, who is close to her large Italian family.
Johanna Detwiler first learned about physician assistants when she served in the Air Force more than a decade ago. As a public health technician who helped transport soldiers in need of medical care, she often worked with PAs when she was stationed in Iraq.
She watched PAs help tend to wounds of soldiers, many of whom had just lost their limbs in an attack minutes before. At the time, she thought they were doctors.
When she decided to go to college in her mid-20s, Detwiler knew she wanted to be a PA and was relieved she could get a specialized education in a relatively short period of time.
Detwiler, 33, became a licensed PA in August and specializes in emergency medicine at the MedExpress locations in New Castle County.
She described MedExpress as the "perfect place" to start her career since she sees patients with conditions ranging from the flu and broken bones to chronic kidney disease.
Three months into the job, Foster said she's still correcting her revolving door of patients about how she's physician assistant — not a doctor.
"They say, 'Thank you so much, doctor.'"
Follow Meredith Newman on Twitter: @merenewman