Growth and Change in the Physician Assistant Workforce in the United States, 1967-2000

Journal of Allied Health, Fall 2007 by Larson, Eric H, Hart, L Gary

DEMOGRAPHY, LOCATION, SPECIALTY, AND ATTRITION: 1967-2000

Demography

Between 1967 and 2000, 49,641 persons graduated from PA training programs. As Figure 2 shows, there were two periods of fairly explosive growth in the number of graduates per year. The first period of rapid increase came in the mid1970s. The number of graduates increased from 282 in 1972 to 1,610 in 1976. This was followed by some decrease in the number of yearly graduates, with an average of 1,200 per year between 1980 and 1990. Beginning in the early 1990s, the number of PA graduates increased substantially each year until 2000, when more than 4,000 students graduated from training. In that year, the number of PAs graduating and entering practice made up 10% of the total active PA workforce in the United States.

Figure 2 also shows the transformation in the gender profile of PA classes over the study period. During the late 1960s and early 1970s, PA graduates were almost entirely male, because most programs were aimed at retraining military corpsmen for roles in the civilian health care workforce. By the end of the 1970s, women were entering training in increasing numbers, making up half of the yearly population of new graduates. Sixty-two percent of the PAs who graduated in 2000 were women.

Location

A goal of most of the early PA training programs was to train PAs for careers in rural settings.2�4 Analysis of the location of PA practices across time shows that between 1980 and 2000, PAs were fairly evenly distributed across rural and urban settings in terms of PA/population ratios (Figure 3), with urban ratios being slightly higher. Graduates from the 1970s practiced in rural settings at a slightly higher rate than those from later cohorts (22% compared with 18%; not shown in table). At the census division level, the regional distribution of PAs was close to that of the distribution of the U.S. population in 1980 and 2000 (not shown in table).

Specialty

Another emphasis of early PA programs was the training of PAs for careers in primary care. The emergence of roles for PAs in subspecialty practice and surgical assisting, especially during the 1980s, created substantial employment opportunities for PAs.14 It also led to a decline in the proportion of PAs practicing in primary care (although the number of primary care PAs increased because of the explosive growth of the profession). Hooker and Cawley estimate that in 1974, 68.8% of all PAs were practicing in the primary care specialties of family medicine, general internal medicine, and general pediatrics. As shown in Table 1, this had declined to 47.8% by 2000. (Hooker and Cawley4 estimate that it had reached 43% in 2002.) PAs from early graduate cohorts appeared to be only slightly more likely to be working in primary care in 2000 than later graduates, as shown in Figure 4.

Attrition

Currently, many PAs train for roles in specialty care while others leave primary care for specialist positions. This can be seen clearly in Table 2, which compares the specialty of PAs known to be in primary care in 1991 with their specialties in 2000. Seventy-five percent of the PAs who were in primary care in 1991 were practicing in primary care specialties in 2000. Twenty-five percent had changed to other specialties (PAs who had left practice or whose specialties in 2000 were unknown were excluded from this analysis). The most common specialties that primary care PAs changed to were the internal medicine subspecialties (5.7%), emergency medicine (5.1%), and the surgical subspecialties (3.7%).