December 9, 2015 –  Guest Commentary by Jennifer Coombs, Ph.D, PA-C

Related to our just published “Recent Trends and Characteristics of the Physician Assistant Workforce” data brief, we have invited Jennifer Coombs, Ph.D, PA-C, to provide insight into the trends and data we have shared.

Physician Assistants (PAs) are expected to play an increased role in health care delivery. Insurance coverage changes with the Affordable Care Act (ACA) and changes in delivery care models, as well as other health care trends will demand more health care providers. This data brief using figures from the American Community Survey (ACS) shows the rapid rise in the number of trained PAs from 2003 to 2103, involving a virtual doubling of the profession.  Care of patients in retail clinics, increased use of PAs in surgery and surgical subspecialties, and shortfalls of primary care physicians are fueling the demand for PAs.

PAs are employed in almost equal numbers in both outpatient and inpatient settings.  Their demand in these dual settings has outstripped supply. Both APRNs and PAs are growing in their supply as well as their demand. Changes in technology in medicine and health information technology has made PAs and APRNs safe and cost effective providers of a variety of sources of medical needs.  PAs are employed in smaller numbers in smaller numbers in other settings, including long-term care, home health and other settings. 1

PA salaries are a continued indication of the health of the profession.  Average salaries for PAs in hospital settings are greater than 85,000, and in outpatient settings averages including primary care practices are greater than 80,000 dollars for new graduates. Overall PAs are trained at a master degree level academically and salaries reflect the demand for PAs rather than the educational level.

PAs are primarily white and female. Concern over the lack of diversity of the PA profession has garnered attention from the Physician Assistant Education Association (PAEA) with calls and initiatives to train a more diverse work force.2

Scope of practice laws continue to improve for PAs and APRNs. PAs maintain a collaborative relationship with the physician.  Constant physician presence is not required.  The laws in all 50 states allow for PAs to prescribe most medications and controlled substances in most states.  Calls for less restrictive scope of practice regulations are increasing among APRNs and PAs. There is evidence that even modest broader scope of practice regulations would result in increased access to APRNs and PAs.3

Studies show increased use of PAs and APRNs can reduce health care costs.  Shifting tasks to PAs and APRNs can result in high quality care with greater efficiency.  Medicaid and Medicare reimburse PAs and APRNs at 85% of a physician for the same service.  PAs and APRNs promote a high level of patient satisfaction with health maintenance and disease preventive counseling activities.4 Reduced time in training resulting in less educational debt also promotes cost savings. 5

While physicians are facing shortages and higher numbers of providers reaching retirement age, the number of PAs under age 35 has increased over the last 10 years.  While the PA profession is “getting younger” the needs of elderly population of the US are growing.

This data brief is useful for workforce researchers and health policy analysts as the US moves forward with health care reform, increasing access to health care insurance, increasing aging of the population, and decreasing supply of primary care providers. The PA profession is growing and changing along with other populations of providers to meet the health care needs of this nation.

Jennifer Coombs, Ph.D, PA-C, is an Associate Professor in the Department of Family and Preventive Medicine, Physician Assistant Program at the University of Utah School of Medicine. She also serves as a reviewer for the Journal of the Physician Assistant Association (JPAE) and currently serves on the Executive Editorial Board of the Journal of the American Academy of Physician Assistants (JAAPA). 

 

Bibliography


 

1.   Everett CM, Thorpe CT, Palta M, Carayon P, Gilchrist VJ, Smith MA. Division of primary care services between physicians, physician assistants, and nurse practitioners for older patients with diabetes. Med Care Res Rev. 2013;70(5):531-541.

2.   Mulitalo KE, Straker H. Diversity in Physician Assistant Education. The Journal of Physician Assistant Education. 2007;18(3):46-51.

3.   Hooker RS, Muchow AN. Modifying State Laws for Nurse Practitioners and Physician Assistants Can Reduce Cost Of Medical Services. Nurs Econ. 2015;33(2):88-94.

4.   Dill MJ, Dill MJ, Pankow S, Erikson C, Shipman S. Survey Shows Consumers Open To A Greater Role For Physician Assistants And Nurse Practitioners. Health Affairs. 2013;32(6):1135-1142.

5.    Snyder J, Nehrenz G, Danielsen R, Pedersen D. Educational debt: does it have an influence on initial job location and specialty choice? J Physician Assist Educ. 2014;25(4):39-42.