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Highlights: The Supply of Physician Assistants in Texas - 2006


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Highlights: The Supply of Physician Assistants in Texas - 2006

  1. 1. Center for Health Statistics Health Professions Resource Center Statewide Health Coordinating Council Highlights: The Supply of Physician Assistants in Texas - 2006 March 2007 Publication No. 25-12556 E-Publication No. E25-12556 Texas has a dynamic health care workforce incorporating a diverse set of providers to meet the growing needs of the state’s population. A strong mandate exists to improve the health care of Texas residents, many of whom go without any form of health insurance. Texas faces both a shortage and a maldistribution of physicians in Texas, which is partially addressed by increasing the use of Physician Assistants (PAs). While their numbers are modest, PAs are providing physician-supervised health care throughout the state, yet more may be needed in the years ahead, if physician shortages continue in some areas of the state. Background During the 1960’s, physicians and educators recognized the existence of a shortage and uneven distribution of primary care physicians. To address the shortage in the delivery of quality medical care, Doctor Eugene Stead of Duke University Medical Center in North Carolina put together the first class of Physician Assistants (PAs) in 1965. Doctor Stead selected Navy Corpsmen who received medical training during their military and Vietnam War service who had no comparable civilian employment. He based his curriculum for the PA program in part on his knowledge of the fast track training of doctors for World War II.1 PAs are now recognized as part of a team of health care professionals who are licensed to practice medicine under the direction and responsible supervision of a doctor of medicine or osteopathy.2 The physician-PA team relationship enhances the delivery of high quality and timely health care. PAs make clinical decisions within the physician-PA relationship. The clinical role of PAs includes primary and specialty care in surgical practice and medical settings, and they provide a broad range of diagnostic, therapeutic, preventive, and health maintenance services. A PA’s practice may include educational, research, and administrative activities, but is usually centered on patient care. 1 Length of Training The typical PA program is 24-27 months long3 and requires at least two years of college and some health care experience prior to admission.4 PA programs in Texas are highly competitive and most programs accept students with a Bachelor’s (BA) or a Master’s (MA) degree. Education consists of classroom and laboratory instruction in basic medical and behavioral sciences that is followed with rotations in clinical settings; students are taught to diagnose and treat medical problems.1 All fifty states and the District of Columbia govern the qualifications and practice of PAs, requiring that they complete an accredited formal education program and pass a National exam to obtain a license. The majority of PA programs can be found in schools 1
  2. 2. of allied health, academic health centers, medical schools, or 4-year colleges, with the remainder in community colleges, hospitals, and the military. Many accredited PA programs have clinical teaching affiliations with medical schools. 4 According to the American Academy of Physician Assistants (AAPA), approximately 4,400 students graduated each year from PA programs in the U.S. during 2003, 2004, and 2005, and approximately 5,400 students enrolled in PA programs in 2005. The average PA class in the U.S. contains approximately 45 students, and the average program duration is about 26 months. There are typically about 90 students enrolled in each program at any given time. However, class size varies considerably, with some programs enrolling only about 10 students per year while others are enrolling over 100 per year. In 2005, more than 135 education programs for PAs were accredited or provisionally accredited by the AAPA in the U.S.4 Licensure/Certification Including the Military Interservice Program, there were eight PA programs in Texas in 2006.5 Currently, PAs licensed under the Physician Assistant Licensing Act must register annually with the Texas Board of Medicine and pay a licensing fee. The requirements for licensure include the completion of a program that is approved by the Texas Physician Assistant Board and the national accreditation organizations.6 From 2003 through 2005, a total of 572 degrees were awarded to PAs in Texas. Sixty-two percent were awarded a master’s degree; 23.2 percent were awarded a bachelor’s degree, and 14.9 percent were unknown (Table 1).7 Table 1. Degrees Awarded in Texas, 2003-2005 Major Total % Degree Awarded Master’s 354 61.9 Bachelor’s 133 23.3 Unknown 85 14.9 Source: Texas Higher Education Coordinating Board All applicants who wish to become nationally certified must be graduates of a program accredited by the Commission on Certification of Allied Health Education Programs (CAAHEP) and pass a certifying examination given by the National Commission on Certification of Physician Assistants (NCCPA).3 Only those applicants who successfully complete the examination may use the credential “Physician Assistant-Certified (PA-C).4 To remain certified, CAAHEP requires PAs to complete 100 hours of continuing medical education every 2 years.1 In addition, every 6 years, they must either pass a recertification examination or complete an alternative program combining learning experiences and a take-home examination.4 PAs in Texas have to renew their licenses annually and obtain at least 40 hours of continuing medical education (CME) annually.6 Currently, all states, including the District of Columbia, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands, have enacted laws that authorize PAs to prescribe medication.8 Change in Profession/Retention A report published on May 5, 2006 by the Journal of the American Academy of Physician Assistants (JAAPA) described a definite trend over the past few years toward new PA graduates entering specialty practice, suggesting that PAs were possibly choosing these specialties for the 2
  3. 3. same reasons as their physician colleagues who are also moving away from the primary care specialties: more control over their lifestyle.9 The September 2005 issue of the Academic Medicine defined controllable lifestyle specialties as those that allow practitioners more personal time for family, leisure, and vocational pursuits free of practice requirements, and more control of total weekly hours spent on professional responsibilities.10 The JAAPA reported that in 2004, only 38 percent of the new PA graduates in the U.S. took jobs in primary care (considered an uncontrollable lifestyle specialty), down from a peak of 62 percent in 1996.9 According to the American Academy of Physician Assistants, seventy-eight percent of Texas- trained PAs currently reside in Texas; however, some of them may not be in practice.5 Enrollment/Declared Majors According to Texas Higher Education Coordination Board, there were a total of 1,964 students enrolled in PA programs in 2003 through 2005. There was a 3.2% decrease in enrollment between 2003 and 2005 (Table 2). Table 2. PA Enrollment/Declared Majors in Texas, 2003-2005 Year Total Enrollment 2003 666 2004 653 2005 645 Source: Texas Higher Education Coordinating Board PA Supply The data analyzed for this report indicates that the overall supply of PAs per capita in the state was growing throughout the 1990s. There were 1,052 PAs practicing in the state in 1995 and 3,630 in 2006, with an average annual increase of 12.1%. The supply of PAs per 100,000 population was higher in the U.S than in Texas over the past decade, and both ratios have been rising (Table 3). Table 3. PA Supply Ratios*: Texas and U.S., 1991-2006 Year # of PAs in TX Texas Ratio U.S. Ratio 1991 622 3.6 8.1 1995 1,052 5.6 10.1 2000 2,106 10.6 14.1 2003 2,880 13.2 17.2 2005 3,375 14.7 19.8 2006 3,630 15.5 21.0 *The number of PAs per 100,000 population Source: Texas Medical Board’s PA licensing database PAs in Border Counties The 32-county border area, which is predominately Hispanic, has a higher poverty rate than the rest of Texas and other high-needs indicators that suggest this area has a shortage of health care 3
  4. 4. services and requires special attention. The population of those 65 years of age or older in the border counties is increasing more rapidly than the overall border population: between 1999 and 2006, the senior population in the border counties increased by 21.4 percent, while the overall border population increased by 17.3 percent; however, in 2006, the border counties’ senior population was proportional to that of Texas as a whole. The ratio of PAs in the border counties is similar to the ratio statewide (Table 4); this is an unusual characteristic, in that PAs are one of the few professions in which this is the case. Table 4. Demographics of Border Counties in 2006 Texas Border Counties Rural Border Counties PAs per 100,000 Population 15.5 13.6 15.4 Hispanic Population 36.1% 86.2% 81.7% Hispanic PAs 13.4% 54.2% 46.6% Poverty Rate* 15.4% 29.2% 28.8% Average Age of PAs (years) 41.7 40.6 43.7 Population 65 and over 9.7% 9.7% 12.0% Source: Texas Medical Board’s PA licensing database *Poverty data from the Bureau of the Census, 2002 In 2006, 88.6 percent of the PAs in Texas practiced in urban counties and 11.4 percent practiced in rural counties. The ratios for the rural areas have been higher than those for the urban areas since 1994, until 2003, when the urban ratios surpassed the rural ratios (Table 5). Nonetheless, this is one of the few professions where both the ratios for the rural and urban areas are similar to those of the state overall. Table 5. PAs per 100,000 Population, Rural and Urban Counties, Texas, 1991–2006 Year Rural Urban 1991 2.8 3.7 1994 6.2 5.3 1997 11.2 6.5 2000 13.4 9.8 2003 13.0 13.2 2005 13.2 14.9 2006 13.6 15.8 Source: Texas Medical Board’s PA licensing database Source for rural and urban definition: Office of Management and Budget In 2006, the counties with the highest supply ratios were in West Texas and the Panhandle; however, most of the 58 counties that did not have PAs were also located in those areas. Of the 4
  5. 5. 58 counties with no PAs, 53 of them were rural counties and 10 of them were border counties. Over the past decade, most of the counties with the greatest increase in supply ratios have been in East and Central Texas, with a few counties showing increases in South Texas and the Panhandle. From 1998 to 2006, the supply ratios decreased for 77 counties. Demographics of PAs In 2006, 75.2% of the PAs in Texas were White, followed by Hispanic PAs at 13.4 percent (Table 6). Historically, the PA profession has been predominately male. However, in 2002, the number of females surpassed the number of males, and since then the percentage of female PAs has continued to increase, an observation described as “feminization.”* An age and gender gap exists among PAs based upon whether they practice in urban or rural areas; in urban counties 57.2 percent of the PAs were female in 2006; however, in rural counties, only 46 percent were female. According to Texas Tech University Health Sciences Center PA program, the number of female PAs has been increasing consistently over the past 20 years. For the last three years, 70 percent of the students enrolled in PA programs were female. An interview of 150 female students found that they chose this profession because of their desire to provide care and treatment to patients, and they did not want to invest a lot of time going to medical school; also, the PA profession allows them a more flexible lifestyle.11 In Texas, the median age of females in this profession was 36 years, compared to 45 years for males. The median age of PAs in the state was 40 years in 2006, down from 41 years in 2000. In 2006, the median age of PAs in rural counties (47 years) was several years older than the median age of PAs in urban counties (40 years). The median age of PAs in non-border counties was 41 years, and the median age in the border counties was 38 years. Table 6. Distribution of PAs by Gender and Race-Ethnicity, Texas, 2006 Characteristic Category Percent Gender Male 44.1 Female 55.9 Race-Ethnicity White 75.2 African-American 5.3 Hispanic 13.4 Asian-Pacific Islander 5.5 American Indian–Alaskan 0.6 Native Source: Texas Medical Board’s PA licensing database *More information on the feminization of the health care workforce in Texas can be found in the HPRC report The Feminization of the Health Care Workforce: Implications for Texas, available on the HPRC website at This report also includes more information on controllable and uncontrollable lifestyle specialties. 5
  6. 6. Haworth Press recently published a report regarding 21 qualitative interviews of male and female PAs, the purpose of which was to determine why there was an influx of women into this profession. Female PAs said they were entering the profession because it allowed them time to practice in the medical model without having the high expense and the demanding schedule of medical school.12 Hispanic PAs in Texas The overall supply of Hispanic PAs per capita in the state increased throughout the 1990s. In 1998, 145 PAs (3.1 percent of the overall PA supply) in Texas were Hispanic, compared to 479 (13.4 percent) in 2006. Over nine percent of Hispanic PAs practiced in rural counties, compared to 90.6 percent practicing in urban counties; 37.6 percent practiced in border counties, and 62.4 percent practiced in non-border counties. From 2000 to 2006, the number of female PAs increased by 94.4 percent, while the number of Hispanic female PAs increased by 188 percent, due to low numbers at baseline. The gender gap in 2006 shows a very small difference between the number of male and female Hispanic PAs: 240 were male and 239 were female. In 2000, there were 3.1 Hispanic PAs per 100,000 Hispanics in Texas, compared to 5.7 Hispanic PAs per 100,000 Hispanics in 2006. Job Outlook for PAs The United States Bureau of Labor Statistics (BLS) projects that the number of PA jobs will increase by 49 percent, and the State Occupational Projections program predicts PA jobs in Texas will increase by 53 percent between 2002 and 2012.13 Employment of PAs through the year 2014 is expected to increase much faster than the average for all other occupations, ranking among the fastest growing occupations.4 This is due to anticipated expansion of the health care industry and an emphasis on cost containment, resulting in increasing utilization of PAs by physicians and health care institutions. Because PAs are cost-effective and productive members of the health care team, physicians and institutions are expected to employ more PAs to provide primary care and to assist with medical and surgical procedures. PAs also can relieve physicians of routine professional duties and procedures. Telemedicine - using technology to facilitate interactive consultations between physicians and PAs - also should expand the use of PAs. Inner city clinics and rural areas should offer good job opportunities for PAs, because these areas have difficulty attracting physicians.4 Employment/Salary The hourly mean wage for PAs in Texas was $39.44 and the annual mean wage was $82,040 (based on 69750 mail surveys of establishments in the area taken between October 1999 and June 2006).14 The national mean hourly wage was $34.17 and the mean annual wage was $71,070.15 A recent study published on April 12, 2006, by Money Magazine and ranked PAs 5th on their 10 best jobs list. This study used growth in the number of PAs, pay, stress-levels and other factors to make this determination.16 Summary • In recent years, the number of students enrolled in PA programs has decreased slightly. • Most PAs in Texas have Master’s degrees. • The supply of PAs per capita in Texas has been steadily increasing, but is still below the supply per capita of the U.S. • The supply ratios in the rural and border areas are comparable to those of statewide. 6
  7. 7. • 58 counties did not have any PAs in 2006. • The PA profession is becoming more feminized, with women comprising over 50% of the profession since 2002. • The median age of PAs has decreased slightly over the last few years. References 1 Information About PAs and the PA Profession, American Academy of Physician Assistants 2 UMG Position Paper (Adopted 1992) – A Challenge for the Physician Assistant Profession American Academy of Physician Assistants 3 Hot Jobs Allied Health Careers, Health Opportunities in Texas, A Cool Guide to Health Careers in Texas, 2nd Edition 4 U.S. Department of Labor, Bureau of Labor Statistics - Occupational Outlook Handbook - training 5 American Academy of Physician Assistants, Kevin Kraditor, Director, Data Services and Statistics, June 15, 2006 input. 6 Texas Medical Board, 7 Texas Higher Education Coordinating Board, Stacey Silverman, MA, Program Director 8 State Government Issues, American Academy of Physician Assistants 9 The shortage of physicians and the implications for PAs, Theresa Hegmann, MPAS, PA-C Journal of the American Academy of Physician Assistants, JAAPA VOL.19, NO. 5 MAY 2006 10 The Relationship between Specialty Choice and Gender of U.S. Medical Students, 1990-2003, Emily M. Lambert, MD and Eric S. Holmboe, MD Academic Medicine, Vol. 80, No. 9/September 2005 00000.htm;jsessionid=GgHM8K00y8lgZv4Hkr7yx8cx1P77G6cwV6Yq41sxWdnngLSXRpQp!869285401!- 949856145!8091!-1 11 Texas Tech University Health Sciences Center, Elvin Maxwell, MPAS, PA-C, Program Director, Physician Assistant Program 12 The Feminization of the Physician Assistant Profession, Sally Lindsay PhD, Research Fellow, Institute for Social, Cultural and Policy Research, University of Salford, The Haworth Press. Inc, Volume: 41 Issue: 4, ISSN: 0363- 0242 Pub Date: 10/26/2005 D=64554 13 State Occupational Projections, 14 Texas Workforce Commission, Tracer, 7
  8. 8. 15 Occupational Employment and Wages, May 2005, - msa; 16 Top Ten Best Job, Tara Kalwarski, Daphne Mosher, Janet Paskin and Donna Rosato, Money Magazine and, More information can be found at the Health Professions Resource Center website: This report was prepared by: Andria Orbach, Research Specialist, Health Professions Resource Center Brian King, Program Director, Health Professions Resource Center Bruce Gunn, Ph.D., Manager, Health Provider Resources Branch 8