Jennifer M. Coombs, PhD, PA-C
In 2014, I wrote a
Kevin MD article,
“5 predictions for physician assistants in the era of healthcare reform.” What a difference 2.5 years makes. We now have healthcare reform whiplash, as the Republicans will surely repeal the Affordable Care Act as we know it, replacing it
with an as-of-yet undetermined plan. What can this end of the year bring in terms of predictions for PAs? The PA profession is turning 50. Born out of a time of great change (the Vietnam War) in the 1960s, the profession was nurtured by visionaries, leaders, and great reformers in medicine. What will the next 50 years bring? I’ll be 100 years old then, so for purposes of prediction, I’ll stick to 5 years in the future.
PAs will experience continued unprecedented growth, based on the number of new programs, now 218. Looking ahead, there are potentially 32 additional new programs in the works. It does appear that new programs will continue to be accredited or that many, if any, established programs will shut down. The resources to negotiate new program expansion are, if not unlimited, adequate to help these programs sustain themselves. Certainly charging a substantial tuition does not hurt, and the students and their graduate school debt appear for now to be vast.1
PAs will eventually oversupply the profession, but not soon, and not enormously.2,3 Demand for healthcare workers is hard to estimate. Supply is an easier target to predict, although healthcare researchers have made erroneous predictions in the past. Making predictions about the number of clinicians necessary in the workforce is clouded by the fact that the variables are constantly changing. Certainly healthcare reform is one variable that has been completely unpredictable, but there are other variables as well. Technology has been nearly impossible to factor into productivity. Ten to 15 years ago, the prediction was that electronic medical records (EMRs) would make physicians, PAs, and NPs immensely productive. Instead, we spent years as highly paid typists filling in colossally ill-designed records. This will change, but how to factor productivity into supply models is yet unreliable. One thing that is sure is that the population is in need of healthcare, and the country has pockets of gross undersupply, such as rural areas and inner cities. This may be job security for PAs interested in filling these gaps.
PA practices will expand in practice authority but will never give up their relationship with physicians. The names may change—supervision, collaboration—but the basic unassailable fact is that PAs work with physicians, day in, day out, for the good of the patient, the good of the practice, and the good of the profession.
• Sexism in medicine will end with changes in value and in the hierarchical educational structure. Teams are the safest way to take care of patients, and PAs, NPs, and physicians will work more efficiently and collaboratively in the future. The mothers and grandmothers who are now housestaff in large enough numbers mean that the demeaning and sexist training is a thing of the past. Have female PAs largely skipped over the horrors of the belittlement, shaming, and outright sexual harassment of the past? Being pregnant during training and raising children while practicing full-time will never be easy. There is still a huge pay gap to overcome. There are self-doubts and outright lack of family and society support for women who decide to focus on careers. There is still a sexist and bullying culture to hold the line against; young women will still be doubted for being full-time workers and not full-time mothers, but things are slowly changing. The “on ramps” and “off ramps” for women to work part-time or work at home for periods of time will need to be expanded. Childcare and elder care solutions need to be available for everyone. Fair and adequate maternity and paternity leave policies are needed to support new parents.
The PA profession will not become more diverse, but will continue the trend toward well-educated white women in the workplace. Efforts must be made to reach out to qualified diverse potential PAs. This is a tremendous opportunity to look like we as a profession should look, given our mission for social good. Social justice, the good that we can do as PAs, should be the pride of our professional identity. A diverse and inclusive profession will benefit society, and is our
raison d'être. However, with the cost of undergraduate education, out of reach for many, this many not change quickly.
The American Academy of PAs and the National Commission on the Certification of PAs will continue to fight about absolutely nothing. Like siblings, these two important organizations will vie for our attention. Like little children, they will fight over who is loved most, who matters most, and who can get our money. The siblings only grow up to be able to hurt each other more and get into bigger arguments. The irony is, just like grown children, we love them both for what they bring to the table, and their own unique talents. But somehow the setup for fighting is too much for them to resist. The leadership can’t contain the odd feelings of jealousy, and the only question is who will play the role of Cain and who will be Abel.
I hope to look back at my predications again, in a few years and see where I was too bold or not bold enough in my future predictions. As our profession turns 50, and healthcare providers collectively look forward, I do feel the future is bright.
1. Snyder J, Nehrenz G, Danielsen R, Pedersen D. Educational debt: does it have an influence on initial job location and specialty choice?
J Physician Assist Educ. 2014;25(4):39-42.
2. Salsberg E, Quigley L. Are we facing a physician assistant surplus?
3. Hooker RS. When will physician assistant supply exceed demand?
Jennifer M. Coombs is an assistant professor in the Division of Physician Assistant Studies, Department of Family and Preventive Medicine at the University of Utah School of Medicine in Salt Lake City. The views expressed in this blog post are those of the author and may not reflect AAPA policies.