The PA profession has success-fully maintained a workforce database, and recent studies have detailed the distribution and expansion of the profession.1–5 From 1974 to 2007, the profession changed from an estimated 68.8% in primary care to 37%.1 Previous studies have examined factors impacting specialty selection, including a recent study of new graduates 2007-2009 where five factors explained more than 50% of the variance in specialty selection.4 This study examined the extent to which financial considerations (student debt, pay, and benefits) influence the current migration to specialties.
Methods This was a descriptive, correlational, cross-sectional survey study. The Minnesota Academy of Physician Assistants and the NCCPA assisted with participant sampling. Primary care was defined as Family Medicine, General Internal Medicine, and Pediatrics. Using a set of Likert questions, participants were asked their current specialty and factors that might impact their choice to practice primary care. The electronic survey and cover letter were distributed via e-mail by the NCCPA to a randomized sample of 30,000 of the 79,000 PAs in its database. Data collection window was July 29 through August 30, 2011, with one reminder sent at 21 days.
IBM SPSS Statistics Version 19 was utilized for analysis. Chi square was used to examine differences between primary care and specialty PAs. Breslow Day analysis was used to test whether differences in attitude changed over time. Alpha was set at P < .05, two tailed, with no correction for multiple comparisons.
Results A total of 2,020 PAs (RR = 6.7%) submitted completed surveys (Tables 1 and 2). A greater percentage of specialty PAs reported that salary (P < .001) and bonuses (P < .001) contributed to their decision (Table 3). In comparison, primary care PAs placed a greater importance on “opportunity to make a difference” (P < .001) and “long term relationships” (P < .001). Both groups noted that geography and work-life balance were important factors, although primary care PAs rated these higher than specialty PAs (P = .001, P < .001). A greater percentage of primary care PAs (89.8%) than specialty PAs (81.2%) noted pay disparity, a factor associated with reduced primary care selection (P < .001). Specialty PAs had a negative impression of primary care and were less likely to rate primary care as fun and/or complex (P < .001). Table 4 summarizes attitudes about factors that may attract PAs to primary care. A greater number of primary care PAs indicated that increasing reimbursements would increase primary care selection (45.8%) compared to specialty PAs (34.2%, P< .001). A greater percentage of primary care PAs indicated that increasing federal student loan repayment (P< .001) and Title VII funding (P< .001) would increase primary care selection. A subsequent Breslow-Day analysis indicated no significant difference between the two groups over time.
Discussion The results of this study show that primary care and specialty PAs value different factors. Primary care PAs were more influenced by nonfinancial factors and stated a greater interest in serving underserved populations, while specialty PAs were more influenced by salaries and bonuses. This implies that increasing reimbursements may increase primary care selection. However, specialty PAs did not indicate that increased financial factors would make them more likely to choose primary care, implying that factors influencing practice choice may go beyond financial remuneration.
Limitations The survey had a low response rate, although the sample was similar to the NCCPA database except for slight overrepresentation of subjects older than 50 years and more than 10 years in practice. Self-reported data may produce recall bias. Because the study focused on primary care choices, the questions were specific to primary care.
Conclusions This study suggests differences between PAs who choose primary care and those who choose specialty care. Financial factors alone may not have a substantial effect on specialty selection.
To view the references and tables, please see the online version of this article at www.jaapa.com.
The authors thank the NCCPA for assistance with this project. Approval was obtained from the ATSU and Mayo Clinic Institutional Review Boards.
1. Morgan PA, Hooker RS. Choice of specialties among physician assistants in the United States. Health Aff.
2. Hooker RS, Berlin LE. Trends in the supply of physician assistants and nurse practitioners in the United States. Health Aff.
4. Wright KA, Orcutt, VL. Physician assistant specialty choice: a factor analysis. Journal of the Physician Assistant Education Association.
© 2012 American Academy of Physician Assistants.
5. Singer AM, Hooker RS. Determinants of specialty choice of physician assistants. Acad Med.
[Research Support, Non-U.S. Gov't]. 1996 Aug;71(8):917-919.