Transcript Future Direction of Physician Assistants

Physician
Assistant
Collaborative
Roles
Roderick S. Hooker, PhD, PA
October 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:
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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 Practice
73,000
70,000
60,000
49,500
50,000
40,000
31,000
24,000
30,000
16,000
20,000
10,000
11,500
250
4,500
0
1970
1975
1980
1985
1990
1995
2000
2009
Source: AAPA 2009
Distribution
Physician Assistants: 2009
2009
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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
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Somalia
Honduras
Israel
Persian Gulf
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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
Surgical Subspecialties
60%
Family Practice
50%
Other
Internal Medicine
Subspecialties
Emergency Medicine
40%
30%
General Internal Medicine
20%
General Surgery
General Pediatrics
10%
Pediatric Subspecialties
0%
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
* 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, 19962007
PA Specialization
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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
Correlation of PA Salary with
Doctor : PA Ratios
Source: Morgan PA, Hooker RS, Health Affairs, 2009 (in press).
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 2008
How Many Types of Specialty Class
Changes in a PA Career?
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.
Specialty Changes: No Change, Within a Class or Interclass
Percentages (Select Year Dyads)
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: 2009
Summary
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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
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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