Physician Assistants in the US Health Workforce

Presented to: National Health Policy Forum November 15, 2013 James F. Cawley, MPH, PA-C, DHL(hon) Professor and Director, PA/MPH Program School of Medicine and Health Sciences Professor of Prevention and Community Health School of Public Health and Health Services The George Washington University

PAs: A Workforce Policy Success in the U.S. • Over the past 50 years, the PA concept has been shown to be a remarkable

workforce policy success:

– Prescribing in all states – Reimbursement through all third-party payers – High demand in the medical marketplace – Utilization and new roles are expanding – Clinical flexibility

• Patients accept PAs; a poll showed that 66% of citizens recognize the PA role and

one-third have been treated by a PA (AAPA, 2007) • The career is attractive with high levels of job satisfaction — mean salary is

$102,000/year. High levels of job and career satisfaction among PAs. • One obvious factor: PAs complement physician practices and do not threaten

physician roles or authority • The PA concept is spreading globally with programs now in Canada, England,

Scotland, Australia, Saudi Arabia, Ghana, and the Netherlands • PAs have shown remarkable clinical mobility across medical specialties and

settings

Hooker, RS, Cawley, JF, Asprey, DP. Physician Assistants: Practice and Policy, 3rd Edition. Philadelphia: FA Davis, 2010.

PA Population: 2012

3 Source: Hooker, Sen, and Williams, The Lewin Group, 2012.

(N = 77,859)

Profile of PA - 2013

Characteristic 2013 Licensed PAs ~90,000 Female 65% Primary Care 33% Age (mean) 42 years Length in Practice (mean) 9 years Length in Current Specialty (mean) 4 years Inpatient Hospital Unit 18% Emergency Department 14% Hospital Based (includes OR, Outpatient, ED, and Inpatient)

47%

Hooker & Muchow, 2013: Provider 360 Database, AAPA 2013 Census.

PAs A physician assistant (PA) is nationally certified and state licensed to practice medicine as part of a physician-led team. PAs are educated at the graduate level and practice in nearly every medical specialty and setting. Scope of Practice •Obtain medical histories •Conduct physical exams •Diagnose and treat illnesses •Order and interpret tests •Counsel on preventive healthcare •Assist in surgery •Write prescriptions •Make rounds in nursing homes and hospitals * PAs’ responsibilities correspond to their supervising physicians’ practice.

PA Workforce is Youthful and Female

0

500

1,000

1,500

2,000

2,500

3,000

20 25 30 35 40 45 50 55 60 65 70 75Age

PA Supply by Age and Sex, 2013

Female

Male

Supply of PAs

• There are 182 accredited PA programs in the US with an additional 60 programs in the accreditation pipeline

• The vast majority of total PA graduates (over 100,000) are in active clinical practice = 89,500

• There are approximately 7000 annual PA graduates

• Annual attrition is low = 2.9% annually (est)

Shortages projected for both primary care and subspecialists

Primary Care Subspecialties

2010 9,000 4,700

2015 29,800 33,100

2020 45,400 46,100

Hofer et al 2011; Hooker 2012; Lewin for AAMC, 2011; Huang & Finegold 2013

Primary Care in America: Percentage of Providers Identified in Primary Care

20

30

40

50

60

70

80

90

100

NPs PAs

MD/DOs

Trends in Emergency Medicine • The role of NP/PAs in

emergency medicine is varied but spans the same degree of care as doctors

• Many PA/NPs staff “fast-track” (urgent care)

• In US EDs, there is one PA/NP for every five doctors

• ED: fast growth for PAs since 2000

• Team based care studies are needed to understand the dynamics and interaction of the players

Hooker, Cipher 2008

PAs on Inpatient Services • Can provide the full

range of clinical services required

• No decline in quality of care

• Enhance the educational experiences of residents

• Provide an element of continuity to inpatient services

Cawley, J.F., Hooker, R.S. The Effects of Resident Work Hour Restrictions on Physician Assistant Hospital Utilization. Journal of Physician Assistant Education 2006, 17:41-43.

US PA and NP Graduates Per Year (1992-2020)

Hooker et al 2013; 2011 PAEA & AACN data

The Effect of Health Reform Demand: • Enrollment of 30 million newly insured • Aging population • Sustainability of chronic diseases • New technology (pharmacy, techniques, tools) • Quality and cost-effectiveness imperatives • Electronic health records • Consolidation of small and medium size

practices • Hospitalization

Supply • Physicians: 18,000 – 25,000 new graduates • PAs: 7,000 new graduates annually • Young profession (mean age = 42) • Career span: 35 years

Going Forward

• PAs are a vital and flexible component of the US health care workforce

• The supply of PAs is expected to grow steadily over the next decade

• PAs are team-oriented, have training as medical generalists, and seek a practice stance closely aligned with physicians

References • American Academy of Physician Assistants. Annual Census, 2009. Alexandria, Virginia, AAPA, 2009. • Grumbach K, Hart LG, Mertz E, Coffman J, Palazo L. Who is Caring for the Underserved? A

Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington. Annals of Family Medicine 2003;1(2):97-104.

• Hooker, RS, Cawley, JF, Asprey, DP. Physician Assistants: Practice and Policy, 3rd ed. Philadelphia: FA Davis, 2010.

• Mullan. F. “Workforce Issues in Health Care Reform: Assessing the Present and Preparing for the Future. Testimony to Senate Finance Committee”, March 12, 2009

• Cooper RA: New directions for nurse practitioners and physician assistants in the era of physician shortages. Academic Medicine. 2007; 82: 827–828.

• Hooker RS, Cawley JF, Leinweber W. Physician assistant career mobility and the potential for more primary care. Health Affairs. 2010; 29 (5); 880-886.

• Morgan PE, Hooker RS. Choice of specialties of physician assistants in the United States. Health Affairs. 2010; 29 (5); 887-892.

• Cawley, JF, Hooker, RS. Physician Assistants: the US experience. J Health Services Research & Policy 2003 8:67-68.

• Cawley, J.F. Physician Assistants and Title VII Support. Academic Medicine 2008; 83(10):1040-1048. • Jones, P.E. Physician Assistant Education in the United States. Academic Medicine 2007;82:882-887. • Blumenthal D. New steam from an old cauldron – the physician-supply debate. NEJM 2004. 350

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