Due to the lack of the house staff availability and the intention to reduce the number of neurosurgical resident training program in the United States, the Department of Neuroscience has pioneered a new strategy to deliver care to the patients it serves. In 1998 we established the first Neuroscience Physician Assistant Program in the country. This is a program with the goal of creating mid-level practitioners fully competent to render under appropriate supervision, many of the functions relegated to House Officers. Our physician assistant must complete training certification from the National Commission on Certification of Physician Assistants. In addition, he/she has to complete an orientation and a core curriculum Specialized Neuroscience Training monitored by the department faculty, including the neuroradiologist and neuro intensivist. These practitioners play an important role assisting our faculty in providing neurology and neurosurgery on-call 24/7 service for emergencies, in-house and daily ambulatory care.