As increasing proportions of the population now have coverage under the Affordable Care Act, the primary care physician shortage has become increasingly concerning. Concepts such as team-based care and value-based performance require comprehensive services and management of patient outcomes. Physician assistants (PAs) are suggested as one of many solutions to the shortages. The authors of a recent paper exposed the differences in demand and supply for primary care versus specialty positions for PAs.
With 18% of PA job postings for primary care positions and 27% of currently occupied positions for primary care, the market is arguably not responding to the concern. The authors cite salary differential, lack of experience, and geography as reasons that newly graduated PAs are unable to find positions. They discuss the concept of scope of practice and cost as well. Specialists place a great distance between the physicians and PA based on the needs within the practice. Additionally, the employment costs of PAs is more favorable to the business model of specialists than that of primary care physicians.
Additional areas for concern include training and oversight of physician assistants within a medical practice. As the scope of practice within the specialties allow PAs to become oriented to very specific conditions and procedures, primary care is defined by providing management for a broader number of conditions. With the need for additional on-the-job training for newly graduated PAs given their general training model, primary care practices often cannot afford to commit resources to orienting these new graduates to such a large scope of practice. Even with experience in primary care, the oversight required for this larger scope of practice could arguably take away from the physicians productivity. By comparison, for surgical specialties, the limited outpatient management and the hands-on capacity of the operating room allows for easier orientation and oversight.
As in physician education, the training model for physician assistants should adjust to expand primary care training within their formal education. Though the profit margin issue will not be addressed by this approach, altering the educational model to address the needs of the population should not be ignored by either professional – the physician or the physician assistant.
commentary by Kameron Matthews
BACKGROUND: Physician assistants (PAs) are often suggested as a partial solution to predicted primary care workforce shortages, but a declining proportion of PAs are entering primary care practice. Policy efforts have focused on increasing primary care PA supply, but low labor market demand might be constricting the primary care PA pipeline.
METHOD: In this descriptive, cross-sectional study, we compare primary care and specialty job postings to each other and to occupied PA positions. Job posting data for 2014 are from a leading labor analytics firm.
RESULTS: Only 18% of job postings were in primary care, compared with 27% of occupied PA positions. The proportion of postings that were for primary care varied widely by state (9% to 40%) and were highest in the West.
DISCUSSION: Job availability is a potential barrier to PAs practicing in primary care, especially in some locations. Other job factors are examined and policy solutions are suggested.
Morgan, P, et al. Med Care Res Rev. 2016 Feb 4 Epub. PMID: 26846844