Unlike other health professionals, physician assistants have the unique capability to change specialties over the course of their careers (usually without additional formal training), a characteristic that provides advantages both to them and to employers. Such clinical flexibility permits PAs to adapt relatively quickly to changing workforce needs and emerging medical practice niches. The bedrock for this capability is the PA's foundation of general medicine and close practice relationship with physicians.
The specific dimensions and patterns of PA career flexibility have been quantified, and their mobility is distinct. An analysis of AAPA data containing 42 annual cohorts of PA graduates documented patterns of specialty change.1 Among the findings,
- Half of clinically active PAs changed specialties sometime in their careers;
- One-quarter practiced in at least two different specialties;
- 11% have worked in three or more specialties;
- Since the late 1990s, the net number of PAs departing family medicine has exceeded the number entering it;
- Some PAs move from medical and surgical specialties to family medicine.
That PAs exercise their option to change specialties over the course of their careers is important on several levels. On an individual level, clinical flexibility is a distinct advantage in the modern medical marketplace, permitting movement vertically as well as horizontally within medical practices as well as to pursue opportunities in emerging fields. PAs display considerable movement among the various clinical specialties, and presumably, they use flexibility in advancing their professional careers or make adjustments to accommodate social dynamics. Analysis of market trends suggests that PAs respond to opportunities where they can optimize their income and that this often means employment changes within and across specialties.2 The PA sees an abundant job reservoir and makes choices based on factors such as location, salary, specialty of interest, and others. Along the career path, the PA may shift focus based on availability and income: popular choices today for PAs include emergency medicine, dermatology, orthopedics, cardiovascular medicine, and interventional radiology.
On a policy level, clinical flexibility holds potential for PAs to address critical health workforce needs in a timely manner. Health workforce policy experts are seeking ways to recruit providers to primary care, and PAs who can change specialties offer the potential for a near-term boost to the supply of primary care providers. In addition, hospitals, large managed care organizations, the Department of Defense, the Veterans Health Administration, and other institutions have utilized the career flexibility characteristics of PAs for decades. One hospital in Baltimore employs more than 60 PAs for many interspecialty roles within the institution, as they are sometimes called to work in emergency medicine, on the wards, or in the theater when shortages emerge. This makes the PA highly utilitarian. The underpinning of general medicine that PAs are grounded in permits them to change specialty roles without having to undergo formal retraining.
Entering PA students also highly value the ability to change specialties. While applicant or student appreciation of clinical flexibility has not been formally quantified, it is believed to be a key factor in career selection in the health professions applicant pool.
An additional implication of the finding of broad and frequent specialty change by PAs has to do with the potential threat to clinical flexibility from the emergence of PA specialty certification examinations. Should such examinations become well-established and valued by PA employers, this could pose barriers to the entry of PAs into certain clinical specialties.
One health workforce policy approach that could take advantage of PA clinical flexibility in efforts to augment America's primary care workforce is to develop incentives aimed at attracting new graduates, as well as enticing journeyman PAs, to enter (or re-enter) primary care. Such strategies could bear fruit in a shorter period of time than producing increased numbers of primary care physicians. Tax benefits, education loan repayment, and relocation expenses are tested and effective measures to produce this type of movement. Those PAs trained in the uniformed services could be transitioned to civilian roles, coupled with settlement enhancements and tax incentives. Their skills would be highly valued in rural and medically underserved areas.
The creators of what was then called the new health professional intended the American PA to be flexible and contributory in all aspects of medicine.3 For them, a dynamic, flexible clinician who differed from a doctor was a concept to be promoted. The PA of the new century seems to have lived up to that measure.
1. Hooker RS, Cawley JF, Leinweber W. Career flexibility of physician assistants and the potential for more primary care. Health Affairs
2. Morgan PA, Hooker RS. Choice of specialty among physician assistants in the United States. Health Affairs
3. Kane RL, ed. New Health Practitioners
. Bethesda, MD: US Dept of Health, Education, and Welfare; 1975. DHEW Publication No. (NIH) 75-875.