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

THE GROWTH OF PA TRAINING PROGRAMS: 1967-2000

Number of Programs

The two periods of rapid increase in the number of PA graduates were mirrored by two periods of rapid increase in the number of active PA training programs in the United States. As shown in Figure 5, there were just six active PA training programs in the United States that had graduated PAs by 1969. A sharp increase between 1970 and 1974 (due in part to increased federal support of PA programs2) provided the training slots necessary for the rapid mid-1970s growth in the number of graduates shown in Figure 2.

After the first period of expansion, the number of active training programs remained fairly steady from 1975 to 1994. Between 1994 and 2000, the number of active programs almost doubled, to 116 open programs by 2000. Although the net number of programs remained steady throughout the late 1970s and 1980s, many programs closed during this period and were replaced by new programs. In some years, program closures exceeded the number of new programs opening, as seen in Figure 6.

By 2000, PAs were being trained in programs spread across 41 states and the District of Columbia. About 51.5% of PAs practicing in 2000 were practicing in the states in which they were trained. In 1991, only 46.2% of the PAs had been trained in the state where they were practicing (data not shown). While more than 70% of the PAs practicing in some large states like Texas, California, and New York were trained in those states, Figure 7 shows that the majority of PAs practicing in 31 out of 50 states did not receive their training locally.

Trends in PA Credentialing

A typical PA training program takes 26 months to complete. To practice as a PA, a graduate of an accredited PA training program must pass a certification examination (to stay certified, the PA must complete continuing medical education training and take a recertification examination every 6 yrs). Prerequisites and degree requirements to enter a PA program, however, vary widely. Consequently, the degree or certificate that a graduate receives from their program also varies widely. However, a trend toward PA programs offering higher degrees has emerged over the past 20 yrs. Table 3 shows that in 1986, none of the 49 accredited active PA training programs in the country offered a master's degree.15-19 Most offered baccalaureate degrees, and 28% offered either an associate's degree or certificate only. By 2000, 42.9% of programs offered master's degrees and only 14.3% offered associate's or certificate-level degrees as their highest degree.

Discussion

The demography, practice characteristics, and geographic distribution of the PA population changed rapidly over its first 33 yrs. One of the early changes that occurred in the profession was a transformation from an almost exclusively male profession to one that is now well more than 50% female (62% of the PAs who graduated in 2000 were women). This change began very early in the history of the profession; by 1983, women made up more than 50% of PA students. Another major transformation occurred in the specialty profile of the PA population. While primary care specialties (taken together) have remained the largest single specialty of PAs, more than half of PAs worked in subspecialties of internal medicine and surgery by 2000. Specialty roles appear to be attractive to PAs with experience in primary care as well as to newer graduates whose training may be more oriented toward the wide variety of specialist roles that have emerged as the profession has evolved. In terms of geographic distribution, PAs now practice in all 50 states and the District of Columbia, with their distribution roughly mirroring that of the population, both at the regional level and across the rural/urban spectrum (Figure 1). The rural/urban distribution is much closer to the distribution of the U.S. population than for primary care physicians, who remain much more concentrated in metropolitan counties.