PhysicianPhysicianAssistantAssistant

CollaborativeCollaborativeRolesRoles

Roderick S. Hooker, PhD, PAOctober 2009

Department of Veterans Affairs

Dallas, Texas

Physician Assistants: A Workforce Policy Success?

• Over 4 decades observation: the PA concept has been shown to be a workforce policy success because….

• Patients acceptance; 66% of citizens recognize the PA role and 1/3 have been treated by a PA

• High levels of job satisfaction: – salary, – retention, – Work environment

• PAs complement physician practices and do not threaten physician roles/authority

• Global movement: the Netherlands, Canada, England, Australia, South Africa, Sub-Saharan Africa

• PA clinical mobility: across medical specialties and settings

PAs in Practice73,000

Source: AAPA 2009

2504,500

11,500

16,000

24,000

31,000

49,500

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

1970 1975 1980 1985 1990 1995 2000 2009

Distribution Physician Assistants: 2009

2009

• Canada• England• The Netherlands• Scotland• Taiwan• Australia• South Africa• Ghana

CANADA• The Canadian Forces converted their

medical assistant program to an accredited PA program.

• >100 PAs in uniform• 25 PAs in Manitoba• 40 Ontario 2009• 6 New Brunswick (2010)• Programs 2009:

– Canadian Forces Borden– University of Manitoba– McMaster University– University Toronto (2010)– Other

Canadian Forces Physician Assistants

• Somalia• Honduras• Israel• Persian Gulf

• Afghanistan• Bosnia• Kosovo• Haiti

Two-year program– Phase One Didactic

• 51 weeks • four semesters

– Phase Two Clinical rotations

• 49 weeks • 15 rotations

PA Program Base Borden

New PA Graduates* by Specialty, 1991-2007

0%

10%

20%

30%

40%

50%

60%

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Surgical Subspecialties

Family Practice

Other

Internal MedicineSubspecialtiesEmergency Medicine

General Internal Medicine

General Surgery

General Pediatrics

Pediatric Subspecialties

* PAs graduating in year immediately preceding the census reference year are considered New Graduates

Sources: AAPA Membership Census Survey, 1991-1995; AAPA Physician Assistant Census Survey, 1996-2007

PA Specialization• PAs have been shown to emulate the practice patterns of physicians• The current job demand for PAs is mainly from physicians in specialties and hospitals • Lifestyle plays a role in specialty selection

Source: Morgan PA, Hooker RS, Health Affairs, 2009 (in press).Source: Morgan PA, Hooker RS, Health Affairs, 2009 (in press).

Correlation of PA Salary with Doctor : PA Ratios

Specialty Change: A Unique Feature Among the Health Professions

• Virtually all doctors are postgraduate trained for a specialty (and remain in that specialty)

• NPs and other APNs are specialty trained

• PAs are capable of changing specialties (jobs) over the course of their working careers

Clinical Flexibility• The capability of PAs to change specialties over the

course of their career.• This capability is based on the premise that PAs work

closely with their employing physician and that the practice content of the PA is closely linked to the employing physician.

• This may be a desirable aspect of the PA profession for recruits and members.

• Provides extensive opportunities for lateral mobility and professional growth.

• Permits PAs to fill emerging niches in the medical workforce.

Mean Number of Years in Current Specialty, 2008

Source: AAPA 2008Source: AAPA 2008

How Many Types of Specialty Class Changes in a PA Career?

Source: American Academy of Physician Assistants, Annual Census Data, 2008. Source: American Academy of Physician Assistants, Annual Census Data, 2008.

Where Do Family Medicine

PAs Depart For?

Source: American Academy of Physician Assistants, Annual Census Data, 2008.Source: American Academy of Physician Assistants, Annual Census Data, 2008.

Specialty Changes: No Change, Within a Class or InterclassPercentages (Select Year Dyads)

Specialty Changes: No Change, Within a Class or InterclassPercentages (Select Year Dyads)

Source: American Academy of Physician Assistants, Annual Census Data, 2008.Source: American Academy of Physician Assistants, Annual Census Data, 2008.

Workforce Implications

• PAs appear to be responding to medical marketplace demands.

• PAs appear to be remarkably versatile clinicians capable of practicing in a wide range of medical settings and specialties

• PAs likely change specialty areas in part due to evolving medical marketplace demands (the availability of jobs) as well as career and lifestyle factors (personal considerations)

Number of PAs in the Workforce per Million Residents for the Highest and Lowest States, 2008

Source: Department of Labor Statistics: 2009Source: Department of Labor Statistics: 2009

Summary• PAs will remain in high demand for

the foreseeable future:– Population growth– Aging population– Doctor shortages– Technology– Other

• PAs will be drivers of improved care and standards of care

• Specialization of PAs will be in tension with the primary care basic education model

– Reductionism leans towards a specialist model

– Medical Home advocates will advocate for primary care models

• PA legislation will continue to improve

• Women will dominate the PA profession

• Issues about physician dependency will arise from time to time

• The PA model will undergo some changes internationally

• Evidence based medicine will drive PA utilization

Canada: Facing its future

“New models of care and new technologies will require specific training for rural settings. International experience must be used to mutual benefit in developing services of appropriate standard, which comply with local needs.”

D Godden

Director, Centre for Rural Health, Inverness