Growth and Change in the U.S. Physician Assistant Workforce Eric H. Larson, Ph.D. MEDEX Northwest University of Washington...
Outline <ul><li>Origins of the PA profession </li></ul><ul><li>Growth of PA profession 1967-2005 </li></ul><ul><li>Nationa...
What’s a PA? <ul><li>A graduate of an accredited PA program authorized to practice medicine under the supervision of a lic...
1967:  Problems/Opportunities <ul><li>Rural Health Access </li></ul><ul><li>Physician Burn-out </li></ul><ul><li>Returning...
Founders of the PA Profession
Growth of the  PA profession  1967 - 2005
PA Graduates by gender 1967-2005
Rural-Urban PA/Population ratios 1980-2003
MD/PA Population Ratios 1980-2005
PAs in Primary/Specialty Care: 1974-2003
Highest degrees granted  by PA programs 1987-2006 -----134 5.2 2.2 18.7 73.9 2006 ------ 126 ------ 89 ----- 59 ----- 51 -...
Selected Characteristics of the Current PA Workforce
In 2005....... <ul><li>71,216 PAs had been trained </li></ul><ul><li>58,665 PAs were in clinical practice  </li></ul><ul><...
PA Pop. Ratios by area type, 2003
PA Employer Types, 2007
PA Primary work settings, 2007
Work settings of hospital-based PAs
Issues in PA Workforce Research “ Prediction is very difficult, especially  about the future.” --Niels Bohr
Three Key Issues in PA Workforce Research  <ul><li>Provider Supply & PA Contribution to Care  </li></ul><ul><li>Geographic...
Provider Supply <ul><li>Who gets counted? </li></ul><ul><ul><li>Provider/population ratios </li></ul></ul><ul><li>How shou...
Productivity - how much do PAs do?  Nationally representative sample shows: <ul><li>Overall, 61 OP visits per week   (74 f...
Headcount vs FTE - Washington generalist  providers 1998-99  (1 FTE= 104 visits)
Geographic Distribution of PAs <ul><li>Rural/Urban </li></ul><ul><li>Underserved Areas </li></ul><ul><li>Regions and State...
PA Pop. Ratios by area type, 2003
Number of active PAs  -  2003
Number of active PAs per 100,000 - 2003
Number of active primary care PAs per 100,000 - 2003
Specialization <ul><li>The frontier of PA workforce research in the US </li></ul><ul><li>What’s the “correct” ratio of phy...
Specialty practiced for primary PA employer, 2007
PAs in orthopedic practice: early results <ul><li>Employers </li></ul><ul><ul><li>58% Orthopedic group practices </li></ul...
Recent study of 400 rural hospital Emergency Depts. <ul><li>33% staffed ED with PAs part of the time </li></ul><ul><li>26%...
More research themes <ul><li>Pedagogy </li></ul><ul><li>Effects of increased PA use in teaching hospitals </li></ul><ul><l...
Three Imponderables of Health  Workforce Research or:  Why there will always be work for health workforce researchers <ul>...
Questions? [email_address]
Upcoming SlideShare
Loading in …5
×

Growth and change in the US Physician Assistant workforce

489 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
489
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Mention Gary, WWAMI CHWS/RHRC &amp; MEDEX
  • Most of this work done at Center for Health Workforce Studies with Gary Hart of Family Medicine
  • 71,000 total, 58,000 clinically active. 22,000 trained in 2000 to 2006. Assuming most are cinically active, these 22,000 mkaie up almost 40% of all clinical PAs and 30% of all PAs.
  • Now about 16 plus
  • Major transition underway with respect to degrees granted and degrees required for entry.
  • So - how did we get here from no PAs in 1965?
  • US Pop 290M, Rur pop 49M, HPSA pop 22M (1175 ctys), Perpov pop 6.6M (340cctys)
  • From AAPA survey
  • US Pop 290M, Rur pop 49M, HPSA pop 22M (1175 ctys), Perpov pop 6.6M (340cctys)
  • Watch the WWAMI states!
  • Growth and change in the US Physician Assistant workforce

    1. 1. Growth and Change in the U.S. Physician Assistant Workforce Eric H. Larson, Ph.D. MEDEX Northwest University of Washington November 11, 2008
    2. 2. Outline <ul><li>Origins of the PA profession </li></ul><ul><li>Growth of PA profession 1967-2005 </li></ul><ul><li>National PA workforce characteristics </li></ul><ul><li>Issues in PA workforce research </li></ul>
    3. 3. What’s a PA? <ul><li>A graduate of an accredited PA program authorized to practice medicine under the supervision of a licensed physician </li></ul><ul><li>Physicians may delegate to PAs medical duties within the physician’s scope of practice and the PA’s training and experience, and in accordance with law </li></ul>
    4. 4. 1967: Problems/Opportunities <ul><li>Rural Health Access </li></ul><ul><li>Physician Burn-out </li></ul><ul><li>Returning Military Medics </li></ul>
    5. 5. Founders of the PA Profession
    6. 6. Growth of the PA profession 1967 - 2005
    7. 7. PA Graduates by gender 1967-2005
    8. 8. Rural-Urban PA/Population ratios 1980-2003
    9. 9. MD/PA Population Ratios 1980-2005
    10. 10. PAs in Primary/Specialty Care: 1974-2003
    11. 11. Highest degrees granted by PA programs 1987-2006 -----134 5.2 2.2 18.7 73.9 2006 ------ 126 ------ 89 ----- 59 ----- 51 ------ 49 Number of programs 10.3 14.6 13.6 17.6 18.4 % Cert. 4.0 6.7 5.1 11.8 10.2 % Assoc. 42.9 52.8 61.0 64.7 71.4 % BA/BS 42.9 25.8 18.6 5.9 -- % Masters 2001 1998 1994 1990 1987
    12. 12. Selected Characteristics of the Current PA Workforce
    13. 13. In 2005....... <ul><li>71,216 PAs had been trained </li></ul><ul><li>58,665 PAs were in clinical practice </li></ul><ul><li>131 programs graduated 4,275 new PAs </li></ul><ul><li>72% of new students were women </li></ul><ul><li>22% of new students were non-white </li></ul><ul><li>Mean age of active PAs was 41 </li></ul><ul><li>28% practicing family practice (down from 40% in 1996) </li></ul><ul><li>25% worked in surgery </li></ul><ul><li>PAs treated 221,000,000 patients </li></ul><ul><li>(AAPA, 2005) </li></ul>
    14. 14. PA Pop. Ratios by area type, 2003
    15. 15. PA Employer Types, 2007
    16. 16. PA Primary work settings, 2007
    17. 17. Work settings of hospital-based PAs
    18. 18. Issues in PA Workforce Research “ Prediction is very difficult, especially about the future.” --Niels Bohr
    19. 19. Three Key Issues in PA Workforce Research <ul><li>Provider Supply & PA Contribution to Care </li></ul><ul><li>Geographic Distribution </li></ul><ul><li>Specialization </li></ul>
    20. 20. Provider Supply <ul><li>Who gets counted? </li></ul><ul><ul><li>Provider/population ratios </li></ul></ul><ul><li>How should we count? </li></ul><ul><ul><li>Headcounts, FTEs, visits </li></ul></ul><ul><li>How much do PAs do? </li></ul><ul><ul><li>Productivity and Contribution to care </li></ul></ul>
    21. 21. Productivity - how much do PAs do? Nationally representative sample shows: <ul><li>Overall, 61 OP visits per week (74 for physicians) </li></ul><ul><li>Specialty productivity is lower </li></ul><ul><li>PC PAs compared to PC physicians = 81 visits vs 104 (FTE equivalent ~ .78) </li></ul><ul><li>How you count providers matters (FTEs, not headcounts!) </li></ul><ul><li>(Larson, Hart, Ballweg 2001 Journal of Allied Health) </li></ul>
    22. 22. Headcount vs FTE - Washington generalist providers 1998-99 (1 FTE= 104 visits)
    23. 23. Geographic Distribution of PAs <ul><li>Rural/Urban </li></ul><ul><li>Underserved Areas </li></ul><ul><li>Regions and States </li></ul>
    24. 24. PA Pop. Ratios by area type, 2003
    25. 25. Number of active PAs - 2003
    26. 26. Number of active PAs per 100,000 - 2003
    27. 27. Number of active primary care PAs per 100,000 - 2003
    28. 28. Specialization <ul><li>The frontier of PA workforce research in the US </li></ul><ul><li>What’s the “correct” ratio of physicians and PAs/NPs? Depends on: </li></ul><ul><ul><li>Scope of practice </li></ul></ul><ul><ul><li>Degree of autonomy </li></ul></ul><ul><ul><li>Effects of PA “residency” training </li></ul></ul><ul><ul><li>Emergence of roles in hospital and specialty practice </li></ul></ul><ul><ul><li>Organization & economics of medical practice </li></ul></ul>
    29. 29. Specialty practiced for primary PA employer, 2007
    30. 30. PAs in orthopedic practice: early results <ul><li>Employers </li></ul><ul><ul><li>58% Orthopedic group practices </li></ul></ul><ul><ul><li>27% hospitals </li></ul></ul><ul><li>42% take first call </li></ul><ul><li>74% first assist regularly </li></ul><ul><li>64% close independently </li></ul><ul><li>Very strong feelings about post-grad training </li></ul>
    31. 31. Recent study of 400 rural hospital Emergency Depts. <ul><li>33% staffed ED with PAs part of the time </li></ul><ul><li>26% staffed ED with NPs part of the time </li></ul><ul><li>14% staffed ED with both NPs and PAs </li></ul><ul><li>About 59% of NP/PAs in ED employed by hospital </li></ul><ul><li>About 20% of NP/PAs in ED employed by local physician group </li></ul><ul><li>Physician was off-site in 68% of hospitals when ED staffed by NP/PA. (Casey et al, 2007) </li></ul>
    32. 32. More research themes <ul><li>Pedagogy </li></ul><ul><li>Effects of increased PA use in teaching hospitals </li></ul><ul><li>Effects of “degree creep” on the PA workforce and pipeline </li></ul><ul><li>Feminization of the PA workforce </li></ul><ul><li>PAs in the rural/underserved workforce </li></ul><ul><li>Internationalization of the PA concept </li></ul>
    33. 33. Three Imponderables of Health Workforce Research or: Why there will always be work for health workforce researchers <ul><li>New Diseases (e.g. HIV/AIDS) </li></ul><ul><li>New Technologies (e.g. laparoscopic surgery) </li></ul><ul><li>Policy and Politics (e.g. AAMC 2006, National Health Insurance, CHCs, NHSC, Medicaid/Medicare policy) </li></ul>
    34. 34. Questions? [email_address]

    ×