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 number of PAs that can be supported in the workforce is not known, and the continuing evolution of specialty roles for PAs makes this question particularly difficult. Postgraduate specialty training for PAs has been relatively rare. In 1996, only about 5% of active PAs had participated in such programs, which were mostly oriented toward surgical practice.24 Because the distribution of PAs across specialties increasingly mirrors the distribution of physicians across specialties, the possibility of postgraduate training for PAs interested in specialty practice is an emerging theme in PA education. At the same time, there is no evidence that primary care has approached a saturation level for PAs. In addition, resolution of issues surrounding the substitutability of different provider types (including primary care physicians, nurse practitioners, and other health care providers) will come to bear strongly on the evolution of the PA profession in coming years.25 The continued growth of the use of PAs in specialty practices, hospitals,26 and primary care settings21,23 suggests that the number of training programs and the number of graduates will continue to grow.

The "feminization" of the PA workforce appears to be part of a larger trend seen in other traditionally male-dominated professions such as medicine and law.27 The current population of active physicians is approximately 30% female,28 and the present population of medical students is about 50% female.29 Among PAs, however, the trend is more strongly developed. The PA workforce was 52.4% female in 2000 and more than 70% of PA students were women. Ballweg2 noted that the trend toward the master's degree appears to be associated with the increasing number of women in PA programs. The gender transformation of the PA workforce may figure prominently in the overall future of PA roles in specialty care. In a recent report discussing the feminization of the PA profession, Lindsay30 noted that female PAs, like their physician counterparts, have tended to concentrate in primary care practice more than men but that recent evidence suggests that women are moving into specialty practices at an increasing rate. The long-term effect of this trend might be to lower the proportion of PAs in primary care even more.

Finally, the decline of the associate's degree credential and the increase in master's-level training may, by altering the PA student applicant pool, have long-term effects on the profession, possibly inhibiting the ability of rural communities and rural states to "home grow" PAs who will work in rural and underserved settings. A recent study by Evans et al.31 found that PA students with no previous academic degree before PA training were more likely to show a commitment to primary care, rural care, and care for the underserved than students entering training with a degree. The higher costs of training associated with higher-level credentialing may also affect graduate career choices.

The information presented here reminds us that the PA profession is still young, despite much change and the resolution of critical issues over the past 30 yrs. The PA profession was, in the beginning, a primary care-oriented profession whose early advocates and practitioners aimed to serve rural and underserved populations. PAs continue to make a large and effective contribution to primary care, including a substantial contribution in rural and underserved settings.20�22 Whether the PA profession can, or will, continue to contribute at a high level to primary care, especially for rural and underserved populations, is not certain. The ultimate distributions of PAs across the rural/urban and primary care/specialty care dimensions are still evolving.