Physician Assistant Workforce Research Articles

Black and Hispanic Representation Declined After Increased Degree Requirements for Physician Assistants.

The physician assistant (PA) profession is one of the least racially and ethnically diverse health professions requiring advanced education. New PA graduates are even less diverse than the current PA workforce and less diverse than professions requiring doctoral degrees. Between 1995 and 2020, the percent of all PA graduates that were Black individuals fell from 7% to 3.1%, while Hispanic representation increased from 4.5% to 7.9%. Using the federal Integrated Postsecondary Education Data System, we examine the impact of transitions to master's degrees for PAs on Black and Hispanic representation between 1995 and 2020, using individual universities as the unit of analysis. After adjusting for state and year effects, PA programs that transitioned from bachelor's to master's degrees experienced a 5.3% point decline in Black representation and a 3.8% point decline in Hispanic representation. Relative to the already low proportions of Black and Hispanic graduates in PA programs, these declines are significant. Steps should be taken to ensure that underrepresented populations have greater access to PA education.

The influence of government policies on the nurse practitioner and physician assistant workforce in the Netherlands, 2000–2022: a multimethod approach study

BackgroundMany countries are looking for ways to increase nurse practitioner (NP) and physician assistant/associate (PA) deployment. Countries are seeking to tackle the pressing issues of increasing healthcare demand, healthcare costs, and medical doctor shortages. This article provides insights into the potential impact of various policy measures on NP/PA workforce development in the Netherlands.MethodsWe applied a multimethod approach study using three methods: 1) a review of government policies, 2) surveys on NP/PA workforce characteristics, and 3) surveys on intake in NP/PA training programs.ResultsUntil 2012, the annual intake into NP and PA training programs was comparable to the number of subsidized training places. In 2012, a 131% increase in intake coincided with extending the legal scope of practice of NPs and PAs and substantially increasing subsidized NP/PA training places. However, in 2013, the intake of NP and PA trainees decreased by 23% and 24%, respectively. The intake decreased in hospitals, (nursing) home care, and mental healthcare, coinciding with fiscal austerity in these sectors. We found that other policies, such as legal acknowledgment, reimbursement, and funding platforms and research, do not consistently coincide with NP/PA training and employment trends. The ratios of NPs and PAs to medical doctors increased substantially in all healthcare sectors from 3.5 and 1.0 per 100 full-time equivalents in medical doctors in 2012 to 11.0 and 3.9 in 2022, respectively. For NPs, the ratios vary between 2.5 per 100 full-time equivalents in medical doctors in primary care and 41.9 in mental healthcare. PA-medical doctor ratios range from 1.6 per 100 full-time equivalents in medical doctors in primary care to 5.8 in hospital care.ConclusionsThis study reveals that specific policies coincided with NP and PA workforce growth. Sudden and severe fiscal austerity coincided with declining NP/PA training intake. Furthermore, governmental training subsidies coincided and were likely associated with NP/PA workforce growth. Other policy measures did not consistently coincide with trends in intake in NP/PA training or employment. The role of extending the scope of practice remains to be determined. The skill mix is shifting toward an increasing share of medical care provided by NPs and PAs in all healthcare sectors.

Cultural competence of dutch physician assistants: an observational cohort study

BackgroundCurrent cultural competence training needs were assessed as baseline measurement in Dutch physician assistant (PA) students and PA alumni that were not specifically trained in cultural competence. In particular, differences in cultural competency between PA students and PA alumni were assessed.MethodsIn this cross-sectional, observational cohort study knowledge, attitude, and skills and self-perceived overall cultural competence were assessed in Dutch PA students and alumni. Demographics, education and learning needs were collected. Total cultural competence domain scores as well as percentage of maximum scores were calculated.ResultsA total of 40 PA students and 96 alumni (female:75%; Dutch origin:97%) consented to participate. Cultural competence behavior was moderate in both groups. In contrast, general knowledge and exploration of patients’ social context were insufficient, i.e., 53% and 34%, respectively. Self-perceived cultural competence was significantly higher in PA alumni (6.5 ± 1.3, mean ± SD) than in students (6.0 ± 1.3; P < 0.05). Low heterogeneity among PA students and educator exists. Seventy percent of the respondents considers cultural competence important and the majority expressed a need for cultural competence training.ConclusionsDutch PA students and alumni have moderate overall cultural competence, but insufficient knowledge and exploring social context. Based on these outcomes the curriculum of the master of science program for physician assistant will be adapted.Emphasis should be made to increase the diversity of PA students to stimulate cross-cultural learning and developing a diverse PA workforce.

Meeting the Accreditation Standard for Diversity.

While increasing diversity has been an ongoing concern in physician assistant (PA) education, there is now a concentrated focus on diversity, equity, inclusion, and social justice, elevating these to top priorities. To achieve the goal of diversifying the PA workforce, PA programs, with their institution's support, must systematically inculcate strategies for overcoming and dismantling barriers against students of color and students underrepresented in medicine (URiM). These strategies should disrupt the status quo and expand structural processes that ensure successful diversification of students, especially URiM students, LGBTQ students, students from medically underserved areas, and first-generation college students.

A survey of the current nurse practitioner and physician assistant workforce in Dutch ambulance care.

Dutch ambulance service faces future challenges due to acute care development, patient changes, demographics, increased ambulance runs and regional differences. Ambulance Care Netherlands published a framework titled "Pilot physician assistant and nurse practitioner ambulance care". Within this framework, a role is proposed so that their qualifications can provide solutions to future challenges. Despite the introduction of nurse practitioners and physician assistants into Dutch ambulance care, little is known about the effects of this introduction or the tasks these professionals perform. Nevertheless, they are being called upon, even though it is not known whether their potential contribution to the desired outcome described in the framework. This study aims to provide an overview of all nurse practitioners and physician assistants working in Dutch ambulance care and the tasks they perform. We used a cross-sectional exploratory study design. The nurse practitioners and physician assistants participated in a structured telephone survey. Emergency ambulance services in the Netherlands. A total of 56 respondents participated in a telephone survey. We found 53 nurse practitioners and 20 physician assistants working in Dutch ambulance care, 56 participated in the survey. Their performance of both direct care and indirect care tasks differed considerably. While some nurse practitioners and physician assistants were fully autonomous in-patient care, others were bound by regulations and restrictions. We found large variations between respondents in direct and indirect care task, number of working hours, and the different positions within the different Emergency ambulance services in the Netherlands. As a result, the established framework cannot presently function but can provide sound guidance to different ambulance services in positioning their nurse practitioners or physician assistants.

An assessment of physician assistant student diversity in the United States: a snapshot for the healthcare workforce

BackgroundThe Physician Assistant (PA) workforce falls short of mirroring national demographics mainly due to a lack of diversity in student enrollment. Few studies have systematically examined diversity across PA programs at the national level, and little is known about best practices for consistently graduating a diverse group of students. We descriptively characterized the extent to which PA programs are graduating a diverse group of students and identified top performing PA programs.MethodsData from the Integrated Postsecondary Education Data System (IPEDS) were used to calculate the number and proportion of racial or ethnically diverse graduates. The study sample included 139 accredited PA programs that had graduated a minimum of five cohorts from 2014–2018. Within each of the United States Census Divisions, programs were ranked according to the number and proportion of graduates who were underrepresented minority (URM) race, Hispanic ethnicity, and of non-white (URM race, Hispanic, and Asian).ResultsAmongst PA programs in the United States, a large disparity in the number and proportion of racial and ethnic graduates was observed. Of 34,625 PA graduates, only 2,207 (6.4%) were Hispanic ethnicity and 1,220 (3.5%) were URM race. Furthermore, a large number of diverse graduates came from a small number of top performing programs.ConclusionDespite the abundance of evidence for the need to diversify the healthcare workforce, PA programs have had difficulty recruiting and graduating a diverse group of students. This study provides empirical evidence that PA programs have not been able to attain the level of diversity necessary to shift the lack of diversity in the PA workforce. Based upon this study's findings, the top performing PA programs can be used as role models to establish benchmarks for other programs. The results of this descriptive study are currently being used to guide a qualitative study to identify the top performers’ strategies for success.

Understanding Early Admission Processes: Implications for Physician Assistant Workforce Diversity and Healthcare Equity.

Increasing diversity in the physician assistant (PA) workforce has been identified as a key priority by national PA organizations and PA programs alike. This study aimed to understand why certain applicants did not progress in PA program admissions by exploring common reasons for nonprogression and identifying any demographic trends. We conducted a retrospective review of applicants over the last 5 consecutive admission cycles at the University of California Davis Physician Assistant program. The most common reasons for denial, starting with the most prevalent, were low application score, bachelor's GPA <3.0, missing prerequisite(s), late application, and science GPA <2.7. Several associations between demographic groups and reasons for nonprogression were identified. The findings from a multicohort study might help programs consider these issues in their own programs and identify interventions to support underrepresented applicants.

Evaluation of the Dermatology Physician Assistant Workforce in the US

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Cross-sectional analysis of US scope of practice laws and employed physician assistants

ObjectiveThis study examined if the variation in physician assistant (PA) state scope of practice (SOP) laws across states are associated with number of employed PAs, PA demographics and PA/population ratio...

The impact of nurse practitioner and physician assistant workforce supply on Medicaid-related emergency department visits and hospitalizations.

New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions. To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries. A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition-related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis. As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p = .007; β = -2.218; 95% confidence interval [CI]: -3.79 to -0.644 and p = .04; β = -2.698; 95% CI: -5.268 to -0.127, respectively). Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries.

The workforce trends of physician assistants in Iowa (1995-2015).

BackgroundPhysician assistants are expected to have an important role in providing both primary and specialty care. Iowa has a large rural (and aging) population and faces challenges to provide equitable access to care. This study examined changes in the Iowa physician assistant workforce (1995–2015) focusing on practice setting (primary v. subspecialty care) and geographic location (rural/urban, Health Professional Shortage Area). Documenting their current locations and service in HPSAs for primary care will help health planners track future changes.MethodsData from 1995–2015 from the Iowa Health Professions Inventory (Office of Statewide Clinical Education Programs, Carver College of Medicine, University of Iowa) were combined with US census data on rural location and HPSA status. SPSS was used to compare Iowa and national data. Growth trends were analyzed using joinpoint regression.ResultsThe overall Iowa physician assistant workforce increased 161% between 1995 and 2015. In 2015, more than two-thirds (71%) were female and more than 30% practiced in rural counties. The average annual growth rate of primary care PAs (per 100,000 population) was significantly higher in the periods from 1995–1997 and 1997–2001 (22.4% and 7.4% respectively) than in period from 2001–2015 (3.8%). By 2015, 56% of Iowa’s physician assistants practiced in primary care (versus 29.6% nationally). Of these, 44% of primary care physician assistants in Iowa practiced in counties, geographic locations or worksites designated as Health Professional Shortage Areas for primary care.ConclusionsA high proportion of Iowa’s physician assistant workforce practiced in primary care and many served patients in Health Professional Shortage Areas. The number of physician assistants in Iowa will continue to grow and serve an important role in providing access to health care, particularly to rural Iowans.

Commentaries on health services research

Commentaries on health services research

Exploring physician assistant data sources.

To assess four physician assistant (PA) proprietary datasets and inform researchers about data quality for addressing healthcare policy and workforce questions. The quality of datasets was assessed by experienced researchers. Descriptive analysis included overview, collection methodology, variables, and availability. Assessment included each dataset's strengths and limitations. Datasets from the American Academy of Physician Assistants, National Commission on Certification of Physician Assistants, Physician Assistant Education Association, and Optum Provider360 Database include overlap in variables reflecting organizational mission and/or design. Attributes include variables for validation; limitations were lack of public use files, requirements for specific data requests or data purchase. The datasets do not have unique identifiers and cannot easily be linked. The PA datasets contain variables of interest but are limited in scope. Better data collection and shared platforms could further the understanding of PA workforce characteristics and contributions to American healthcare. Researchers await more comprehensive, longitudinal, linked, and publicly available datasets.

Understanding the motivations of the multigenerational physician assistant workforce

Physician assistants (PAs) are more frequently finding themselves in positions where they are responsible for staff recruitment and retention. Staff turnover is associated with significant financial costs for organizations. Motivational theories focusing on job design indicate that paying attention to a combination of factors related to the work itself, in addition to the environment where the work is performed, increases satisfaction. This study asked a convenience sample of practicing PAs to rate the importance of a number of work-related factors known to influence job satisfaction. The results may be used as a basis for designing an environment to increase job satisfaction and improve recruitment and retention of highly qualified staff.

The physician assistant workforce in Indiana: Preparing to meet future health care needs

This study identifies baseline demographic and descriptive statistics for physician assistants (PAs) in Indiana from 1978 to 2010. Data were obtained from Indiana Professional Licensing Agency applications, the Indiana State Department of Health, and PA educational programs. Descriptive statistics were used to characterize the PA workforce as well as their supervising physicians. Most PAs working in Indiana were born and educated outside the state. Of those educated in Indiana, 77% obtained an initial license in Indiana; as of May 2010, 62% were still licensed in the state. In the past 8 years, Indiana had a 97% increase in active licensed PAs. Only 24% of PAs work in primary care; 92% work in metropolitan areas. For 40 years, PAs have increasingly worked in areas that are medically underserved or experiencing a shortage of health professionals. However, the overall numbers of PAs working in those areas remain low. More PAs in Indiana are practicing in medical specialties than in primary care. As health care policy and regulatory changes evolve, future studies will be needed to understand the impact on the health care workforce of Indiana PAs. This study will serve as a baseline for those studies.

Physician Assistants—One Less Doctor(ate) in the House

IN RECENT YEARS, NUMEROUS ALLIED HEALTH PROFESsions have adopted or are planning to adopt clinical or practice doctorates. Although some have transitioned to an entry-level doctorate (eg, pharmacy and physical therapy) and others (eg, nursing) recognize the doctorate as an advanced practice degree, the professions’ goals are the same—to replace the master’s degree with a professionspecific doctoral degree. Allied health care clinicians with these degrees now practice, or will soon practice, as “doctors” alongside their physician colleagues. These clinicians function as competent and effective members of the health care team and had done so before obtaining doctoral degrees. So why make the move to a doctorate? Those in favor argue that a doctorate improves professional image, promotes more autonomous practice, and serves as an appropriate response to advancing technologies and the increasing complexity of health care. Others argue that doctorates may confuse patients, that they represent “degree creep,” and that doctoral degrees are sought largely for professional status rather than for issues related to clinical competence and market demand. The additional tuition costs associated with doctoral degrees and the perception that doctorates are prestigious and will attract students create incentives for universities to offer the degree. The added cost, however, has the potential to adversely affect recruitment of low-income and minority students. In addition, requirements for doctoral degrees lengthen the time in school, vary from program to program, and have not been proven to enhance students’ clinical abilities. At a time when the country is working to keep up with increasing demands of health care, do the perceived benefits of a doctorate justify the additional expense, time, and delay in getting clinicians into the workforce? The physician assistant (PA) profession has said “no.” In March 2009, PA organizations conducted a PA Clinical Doctorate Summit that involved clinically practicing PAs, PA educators, students, army PAs, representatives of other allied health professions, workforce experts, and allopathic and osteopathic physicians. Summit recommendations, which also reflect the views of a majority of surveyed PAs, express opposition to an entry-level PA clinical doctorate and officially endorse the master’s degree as the entrylevel and terminal degree for the profession. The recommendations include support for PAs who choose to pursue postgraduate training beyond the master’s degree but limit this support to non–PA-specific doctoral degrees. Discussions during the PA Clinical Doctorate Summit revolved around a number of issues, including the effects a PA doctorate could have on the profession’s relationship with physicians (eg, would physicians perceive a doctorate as a move toward independent practice?), the additional cost for students, and the potential for the degree to diminish the profession’s diversity. Final justifications for concluding that a PA-specific doctorate is unnecessary were “the length and cost of the current educational model has resulted in a responsive accessible PA workforce . . . and has adapted over 40 years to provide high quality, cost-effective, patientcentered care,” and that “both physicians and PAs practice in the domain of medicine therefore the entry-level doctorate for the practice of medicine is the MD or DO.” Despite the final recommendations, significant pressure for PAs to transition to a doctoral degree persists, especially as other clinicians work to expand their prestige and scope of practice. Some leaders in the PA profession have suggested that the decision not to endorse a clinical doctorate “ . . . may be tantamount to committing professional suicide.” They argue that physicians’ and the public’s perception that nonphysician clinicians with doctoral degrees are better educated, favors nurse practitioners, and will cause PAs to become marginalized, weakening the profession’s status within the health care community. Physicians practicing today may be unaware that physicians established the PA model of education in the 1960s to train individuals with prior health care experience to rapidly meet the needs of medically underserved areas. Currently, most applicants accepted to PA school have a bachelor’s degree, including required coursework in the basic and behavioral sciences, and 3 years of health care experience. PA education, which is modeled on medical education, averages 27 months in length and typically includes a didactic year of instruction in the sciences and clinical medi-

A Study of Predictive Validity of Physician Assistant Students’ Reported Practice Site Intent

With the downward trend in numbers of primary care physicians, it is anticipated that mid-level providers will increasingly fill the resulting void in rural health care. Recruitment of health care providers into rural areas has been historically difficult, and West Virginia has been at the forefront of developing programs to address rural recruitment. One of these programs is the West Virginia Rural Health Education Partnership, which provides rural clinical rotation opportunities for students from multiple disciplines and schools in West Virginia. This study assessed the predictive validity of physician assistant (PA) students' prediction, after completion of rural rotations, of a rural or an urban practice site and also assessed for factors associated with subsequent rural practice. The Institutional Review Board of West Virginia University approved this study. The West Virginia Rural Health Education Partnership's electronic database, which has collected students' postrotation evaluation information since 2001, was coupled with West Virginia licensing information that included information on PA practice site(s). Data on 168 practicing West Virginia PAs who had completed rural rotation questionnaires during their clinical education were examined. Designation of a rural or an urban practice site was done using rural-urban commuting area codes. Student prediction of rural practice was significantly associated with subsequent rural practice (P < 0.04). Variables most predictive of rural practice were student reporting of high school hometown as rural and of West Virginia practice intent. This study suggests moderate predictive validity of PA student reporting on rural practice and on West Virginia practice intent; such methods may have potential in prediction of the future rural PA workforce.

Multidisciplinary Cancer Care: Development of an Infectious Diseases Physician Assistant Workforce at a Comprehensive Cancer Center

The authors outline the process through which the infectious diseases department at The M. D. Anderson Cancer Center successfully integrated physician assistants into patient care services, as judged by an overall increase in departmental productivity, broadened patient care coverage, and physician satisfaction with midlevel services.

National trends in the United States of America physician assistant workforce from 1980 to 2007.

BackgroundThe physician assistant (PA) profession is a nationally recognized medical profession in the United States of America (USA). However, relatively little is known regarding national trends of the PA workforce.MethodsWe examined the 1980-2007 USA Census data to determine the demographic distribution of the PA workforce and PA-to-population relationships. Maps were developed to provide graphical display of the data. All analyses were adjusted for the complex census design and analytical weights provided by the Census Bureau.ResultsIn 1980 there were about 29 120 PAs, 64% of which were males. By contrast, in 2007 there were approximately 97 721 PAs with more than 66% of females. In 1980, Nevada had the highest estimated rate of 40 PAs per 100 000 persons, and North Dakota had the lowest rate (three). The corresponding rates in 2007 were about 85 in New Hampshire and ten in Mississippi. The levels of PA education have increased from less than 21% of PAs with four or more years of college in 1980, to more than 65% in 2007. While less than 17% of PAs were of minority groups in 1980, this figure rose to 23% in 2007. Although nearly 70% of PAs were younger than 35 years old in 1980, this percentage fell to 38% in 2007.ConclusionThe trends of sustained increase and geographic variation in the PA workforce were identified. Educational level, percentage of minority, and age of the PA workforce have increased over time. Major causes of the changes in the PA workforce include educational factors and federal legislation or state regulation.

The productivity of PAs, APRNs, and physicians in Utah

The physician assistant workforce in Utah is experiencing remarkable growth, with a 9% net annual rate of increase since 1998. An additional 84 PAs provided patient care in Utah in the 4-year period of 1998 through 2001, an average increase of 21 per year. The Utah Medical Education Council believes that the demand for PAs will be high over the next 10 to 15 years, with several factors fueling this growth. Productivity is one of these factors. Even though Utah PAs make up only approximately 6.3% of the state's combined clinician (physician, PA, advanced practice registered nurse [APRN]) workforce; the PAs contribute approximately 7.2% of the patient care full-time equivalents (FTE) in the state. This is in contrast to the 10% FTE contribution made by the state's APRN workforce, which has nearly triple the number of clinicians providing patient care in the state. The majority (73%) of Utah PAs work at least 36 hours per week. Utah PAs also spend a greater percentage of the total hours worked in patient care, when compared to the physician workforce. The rural PA workforce reported working a greater number of total hours and patient care hours when compared to the overall PA workforce.