The federal government is the largest single employer of clinically active physician assistants (PAs) in the United States, with > 3,000 PAs in 2008. PAs are present within the Departments of Defense, Veterans Affairs, Health and Human Services, Justice, and Homeland Security. Most are civil servants or hold a commission in the uniformed services. Most employing agencies have expanding needs for PAs. This overview presents a framework of how PAs are being used and the critical roles they play in the federal health care system. Because civilian job opportunities for PAs are plentiful, the federal system is seeking strategies for recruitment and retention. A centralized plan may be one useful recommendation.