As managed care creates new mechanisms for the delivery of health services, it will inevitably put pressure on the role and function of health professionals. Physician assistants (PAs) will not be exempt from these changes. In fact, many of these shifts may strain the relationship between the PA and physician and other non-physician providers. There will be corresponding demands for changes in the scope of training, time in training, and pathways to professional practice. This report presents an overview of the physician assistant profession and the impact of managed care on PA practice. It concludes with recommendations about how to best train, reposition and deploy PAs within an evolving system of managed care.