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

By 2000, PA training took place in more than 116 programs in 41 states that produced more than 4,000 graduates per year. (In 2005, there were 134 programs training PAs.) There were two periods of rapid growth in the number of PA programs. The first came in the late 1970s and the second in the late 1990s (see Figure 6). In between, numerous programs closed as the market for PAs temporarily stagnated during the 1980s. One of the most dramatic changes in PA training that has occurred is the increase in the number and percentage of PA programs offering a master's degree as a terminal degree. In 1986, none of the PA training programs in the country offered a master's degree. In 2000, 42% of the programs offered a master's degree. This is a profound change in a profession that was founded with the intention of transforming and enhancing the skills of military medics and, later, other health providers such as paramedics, technicians, and nurses so that they could function at a higher level within the health care system. It is a change that, in the long run, may make PA training a less attractive and less viable option for those from other allied health professions whose training regimens do not include baccalaureate-level training.

LIMITATIONS

Although the data presented in this report are helpful in forming a picture of the transformation of the demography of the PA population and historical trends in PA training, the data are subject to a number of limitations that dictate caution in interpretation of the results. Perhaps the most important limitation is that the AAPA data used in this study did not contain information on work setting; this prevents us from knowing much about how clinical practice for PAs actually has changed over the years, particularly as specialty care roles for PAs developed. We do know from other data that in 1994, most PAs practiced in either solo/group practice settings (29.5%) or hospitals (25.7%).4,20

The lack of age, race/ethnicity, and temporal data frustrate efforts to understand how those demographic dimensions may influence practice specialty, location, and chances of being in practice. To some extent, graduation year serves as a proxy for age, but because a PA career is frequently a second career, it is a very rough proxy that cannot be relied on strongly for purposes of predicting retirement or observing location or specialty trends. Finally, practice status, location, and specialty data were only available at the individual level for 1991-2000 and were in some cases imputed from data collected in other years. Some comparisons with earlier periods, such as the PA/population ratios for 1980, are based on aggregate county data from the Area Resource File (data that originated from the AAPA) and should be treated with appropriate caution.

Conclusions

The information presented in this report augments a fairly rich literature on the PA profession by providing a numeric and geographic portrait of the early growth and maturation of a new health profession. Hooker and Cawley4 have suggested that the PA profession entered a period of consolidation in the 1990s in which barriers to PA practice continue to fall and acceptance of PAs widens, but where there is less expansion of the clinical scope of PA practice than occurred in earlier years. In many important respects, this appears to be the case. While some substantial interstate regulatory differences remain,9 many key issues of scope of PA practice, prescriptive authority, integration into the health care system, and patient acceptance appear to have been largely settled in most states.4,8 In addition, the effectiveness and productivity of PAs have been well documented.5,20-23 The results of this study, however, suggest that other important questions and issues remain to be resolved. These issues include the number of PAs and PA programs that can be sustained in the workforce, specialty roles for PAs, long-term effects of the "feminization" of the profession, and the effects of changing academic requirements for PA students.