Physician Assistant Collaborative Roles Roderick S. Hooker, PhD, PA October 2009 Department of Veterans Affairs Dallas, Texas

Physician Assistants: A Workforce Policy Success? Over 4 decades observation: the PA concept has been shown to be a workforce policy success because…. Patients acceptance; 66% of citizens recognize the PA role and 1/3 have been treated by a PA High levels of job satisfaction: –salary, –retention, –Work environment PAs complement physician practices and do not threaten physician roles/authority Global movement: the Netherlands, Canada, England, Australia, South Africa, Sub-Saharan Africa PA clinical mobility: across medical specialties and settings

PAs in Practice 73,000 Source: AAPA ,500 11,500 16,000 24,000 31,000 49, ,000 20,000 30,000 40,000 50,000 60,000 70,

Distribution Physician Assistants: 2009

2009 Canada England The Netherlands Scotland Taiwan Australia South Africa Ghana

CANADA The Canadian Forces converted their medical assistant program to an accredited PA program. >100 PAs in uniform 25 PAs in Manitoba 40 Ontario New Brunswick (2010) Programs 2009: –Canadian Forces Borden –University of Manitoba –McMaster University –University Toronto (2010) –Other

Canadian Forces Physician Assistants Somalia Honduras Israel Persian Gulf Afghanistan Bosnia Kosovo Haiti

Two-year program –Phase One Didactic 51 weeks four semesters –Phase Two Clinical rotations 49 weeks 15 rotations PA Program Base Borden

New PA Graduates* by Specialty, * PAs graduating in year immediately preceding the census reference year are considered New Graduates Sources: AAPA Membership Census Survey, ; AAPA Physician Assistant Census Survey,

PA Specialization PAs have been shown to emulate the practice patterns of physicians The current job demand for PAs is mainly from physicians in specialties and hospitals Lifestyle plays a role in specialty selection

Source: Morgan PA, Hooker RS, Health Affairs, 2009 (in press). Correlation of PA Salary with Doctor : PA Ratios

Specialty Change: A Unique Feature Among the Health Professions Virtually all doctors are postgraduate trained for a specialty (and remain in that specialty) NPs and other APNs are specialty trained PAs are capable of changing specialties (jobs) over the course of their working careers

Clinical Flexibility The capability of PAs to change specialties over the course of their career. This capability is based on the premise that PAs work closely with their employing physician and that the practice content of the PA is closely linked to the employing physician. This may be a desirable aspect of the PA profession for recruits and members. Provides extensive opportunities for lateral mobility and professional growth. Permits PAs to fill emerging niches in the medical workforce.

Mean Number of Years in Current Specialty, 2008 Source: AAPA 2008

How Many Types of Specialty Class Changes in a PA Career? Source: American Academy of Physician Assistants, Annual Census Data, 2008.

Where Do Family Medicine PAs Depart For? Source: American Academy of Physician Assistants, Annual Census Data, 2008.

Specialty Changes: No Change, Within a Class or Interclass Percentages (Select Year Dyads) Source: American Academy of Physician Assistants, Annual Census Data, 2008.

Workforce Implications PAs appear to be responding to medical marketplace demands. PAs appear to be remarkably versatile clinicians capable of practicing in a wide range of medical settings and specialties PAs likely change specialty areas in part due to evolving medical marketplace demands (the availability of jobs) as well as career and lifestyle factors (personal considerations)

Number of PAs in the Workforce per Million Residents for the Highest and Lowest States, 2008 Source: Department of Labor Statistics: 2009

Summary PAs will remain in high demand for the foreseeable future: –Population growth –Aging population –Doctor shortages –Technology –Other PAs will be drivers of improved care and standards of care Specialization of PAs will be in tension with the primary care basic education model –Reductionism leans towards a specialist model –Medical Home advocates will advocate for primary care models PA legislation will continue to improve Women will dominate the PA profession Issues about physician dependency will arise from time to time The PA model will undergo some changes internationally Evidence based medicine will drive PA utilization

Canada: Facing its future “New models of care and new technologies will require specific training for rural settings. International experience must be used to mutual benefit in developing services of appropriate standard, which comply with local needs.” D Godden Director, Centre for Rural Health, Inverness