Federal support through Title VII, Section 747 has played an important role in promoting the use of physician assistants (PAs) in primary care and in the growth and institutionalization of PA educational programs in the United States. Federal workforce policy approaches include PAs in strategies to (1) increase the supply of generalist providers, (2) better balance the distribution of providers to rural and medically underserved areas, and (3) improve the diversity of the health workforce. Evidence from several decades shows that, likely because of Title VII program incentives, PAs have met expectations in terms of practicing in primary care specialties and serving in rural and medically underserved areas. Yet, increasingly, market forces and decreasing federal support for Title VII are affecting these trends, with PAs, like physicians, being drawn to specialty practices.
There is considerable use of PAs in all practice settings in U.S. medicine. For several decades, PA training programs have demonstrated that they are efficient means of preparing clinicians who provide considerable benefit to society in return for a modest public investment. At the present time, when the climate seems not to favor public subsidy of health professions education, it may be wise for policy makers to consider strategies that address the long-term needs of the health care workforce and the public for primary care clinicians.
This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.
Mr. Cawley is professor and director, PA/MPH Program, Department of Prevention and Community Health, School of Public Health and Health Services; and Professor of Health Care Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, DC.
Correspondence should be addressed to Mr. Cawley, School of Medicine and Health Sciences, The George Washington University, 2175 K St. NW, Washington, DC 20037; e-mail: (firstname.lastname@example.org).