The growing need for healthcare providers due to the Affordable Care Act and the aging US population is expected to increase the workload of adult primary care practitioners by 29% from 2005-2025.1 In fact, by 2020, the United States may be facing a shortage of 45,000 primary care physicians and 46,100 medical specialists and surgeons, as estimated by the Association of American Medical Colleges (AAMC).2 In particular, specialties that care for older adults and their age-related concerns will experience shortages. Atul Grover, MD, PhD, chief advocacy officer for the AAMC, says, “The biggest concern is that over the next 10 years, as 10,000 baby boomers turn 65 every day, things will get much worse.”3
Limited research suggests that if physicians report greater practice satisfaction, their patients then report significantly improved satisfaction with their care and physician interaction.4 With the increasing demand on healthcare providers, attention to provider contentment is important to ensuring patient satisfaction.
A provider shortage is expected in orthopedics because of a 17-fold projected increase in the demand for total knee arthroplasty and six-fold increase in the demand for total hip arthroplasty by 2030.2 A shortage of 7,800 orthopedic surgeons is expected by 2050.5 The need for orthopedic care draws attention to the healthcare professionals who can provide this specialty service. Despite the increasing need for healthcare providers, little research has compared the satisfaction of providers in various roles. In particular, scant research has compared the satisfaction of physicians versus physician assistants (PAs), which is intriguing given how closely they work together. Although the two professions have many similarities, their significant differences may lead to differences in career contentment.
This study used an online survey to compare the lifestyle satisfaction of physicians and PAs in orthopedics. This is one of the highest paid specialties for physicians, which could improve career satisfaction and personal lifestyle. Many PAs work in this specialty, making orthopedics a prime population to study. The aim of this study was to determine if physicians in orthopedics experienced a better lifestyle and career satisfaction than PAs in orthopedics. The hypothesis was that within this specialty, PAs would experience a higher level of lifestyle and professional contentment than physicians in orthopedics. If this is true, although physicians are better reimbursed, perhaps people choose the PA profession for other, nonfinancial motives such as lifestyle.
The survey link was distributed from December 2014 to March 2015 after approval from the Georgetown University institutional review board. Through convenience sampling, the link was e-mailed using contact information retrieved from Internet searches for orthopedic practices across the United States, most of which advertised having physicians and PAs in the practice. Offices contacted were recorded in a word processing document. A follow-up e-mail was sent 1 week after initial contact. Surveys were conducted using the online service Survey Monkey. Each participant was kept anonymous with no identifying information collected. Surveys were sent through a primary contact to keep physician and PA e-mail addresses confidential. A response rate was not available.
The demographics portion of the survey asked the professionals their age, sex, race and ethnicity, and if they were a physician or PA. The professional's years in practice, annual income, days of vacation, region and type of practice, hours on call per week, and current specialty also were surveyed. Physicians were asked if they worked with one or more PAs, and if not, had they ever worked with a PA before.
To assess perspective on career and lifestyle satisfaction, participants were given seven questions with responses on a Likert scale (1, strongly agree; 5, neutral; 10, strongly disagree). The survey questions attempted to gain a broad perspective on the professional's career and lifestyle satisfaction.
Data were exported from Survey Monkey to an electronic spreadsheet and the mean values of the Likert rankings were calculated. The means were then compared using a two means t-test for independent variables to find the confidence intervals and P values.
Table 1 depicts the demographic information of the 79 completed surveys. Two surveys were disregarded because the respondents were no longer working in orthopedics. Data analyzed were from 50 physicians and 27 PAs; however, respondents were not required to complete every demographic question, so the sample size varies for some of these responses. The average age of the physicians was 49.8 years; PAs, 35.5 years. Forty-three physicians were male, 6 were female, and one did not respond to the question; 7 of the PAs were male and 20 were female.
Table 2 depicts data from the career and lifestyle satisfaction portion of the survey. No differences between PAs and physicians were found for responses to three out of the seven questions. However, the other four questions had statistically significant differences in their results.
Demand is increasing for healthcare professionals to care for more patients with fewer resources, and need is increasing specifically for orthopedic professionals. This small-scale study found that PAs in orthopedics reported a higher satisfaction with their career and lifestyle compared with physicians in the same field. Because few studies compare lifestyle and career satisfaction of physicians versus PAs, this research may be informative for practicing professionals, employers, and those considering health-related professions.
Job-related stress is believed to cause multiple health complaints, including back pain, fatigue, and headaches. Each day, an estimated 1 million workers are absent due to stress.6 In this sample population, physicians were more likely than PAs to agree with the statement that job stress impaired their health. If physicians perceive that their job has harmful effects on their health, they may indeed be in worse health. These sample data further exemplify that orthopedic surgery has a relatively high burnout rate, which has increased from 2011 to 2014, according to a survey by the Mayo Clinic Program on Physician Well-being.7
Survey analysis also indicates that physicians were more likely to agree that the professional schedule overshadows their personal life. PAs disagreed, and felt as though they had a more balanced lifestyle. This corresponds to the number of hours the professionals reported they were on call. Physician time spent on call ranged from 22 physicians spending fewer than 8 hours/week on call to 20 spending more than 12 hours/week. Twenty-one PAs spent less than 8 hours/week on call and only six spent more than 8 hours/week on call. Because PAs reported that they were not on call as often as physicians, they were able to spend more time away from the office and focus more on their private life, which also can be true of PAs in other specialties.
Physicians who felt as though their professional schedule overshadowed their private life may have higher levels of stress. Although physicians often are their own boss in many healthcare settings, the physicians responding to this survey apparently felt they had less control over stress levels and health, both direct results of work. This increased strain could cause stress-related health conditions such as hypertension, inadequate sleep, or poor diet. This analysis further suggests that PAs may be happier in the career because the professional schedule is often more flexible and less stressful than that of a physician.
Lastly, the most significant difference between the professionals was in the statement, “I would recommend my career to someone else.” PAs in orthopedics more strongly agreed with this statement than physicians. Although physicians might be thought to recommend their career due to its salary and esteem, this sample population's data show that physicians do not recommend their career as favorably as PAs recommend theirs. PAs may be more likely to recommend their career due to the freedom and flexibility in choosing a specialty. The PA profession also has a shorter educational track, yet enables the practitioners to hold major responsibilities in practice.
The expansion of this study to a larger sample may be especially important for those considering a career in the healthcare field, as it gives a glimpse into the overall satisfaction of these particular professionals in orthopedics. Employers and organizations also must recognize that the current study demonstrates that physicians in orthopedics may not be as content in their careers as the PAs. Employers should examine ways to increase physician satisfaction.
Because every healthcare environment operates differently, physicians and PAs may have varying responsibilities, influencing contentment with their career, which may not be a direct reflection of satisfaction with the profession. Limitations also include reporter bias; for instance, participants may have answered questions based on how they want the profession to be perceived and not contingent on actual experiences and opinions. Respondent bias also could play a major role. If the professionals reflected their mood that day in the Likert scale, instead of typical feelings, results could be skewed. Participants may also have answered questions strategically to idealize their profession, or to make it appear more arduous than it is.
As with any research, participation was a concern for this study. Distribution of the survey to a large enough population was difficult and a convenience sample was used. The data did not have a large enough sample for representation from regional areas or clinic types to deduce valuable information from these cohorts. Therefore, many professionals were working in similar environments. With a larger sample size, differences between physicians and PAs in various clinical settings or regions of the United States could be further developed to potentially provide valuable information. Finally, a significantly larger number of physicians than PAs responded to the survey, which may alter results. With the small sample size, it is difficult to generalize conclusions, yet the findings were very intriguing and can guide future research into the lifestyle satisfaction differences and similarities between these professions.
This research shows that in an orthopedic setting, a small sample of PAs reported a better lifestyle and are generally more satisfied with their careers than the physicians. These data tend to refute many common perceptions about the professions; most notably that PAs do not feel as respected or valued by the patients and the healthcare community. With the drastic shortage of healthcare professionals, this research highlights the advantages of the PA career in orthopedics from the perspectives of the professionals. Respondents felt that a satisfactory lifestyle can be achieved even if the PA salary is not as significant as a physician's salary. Consequently, the PAs in orthopedics who responded to this survey were more likely than physicians to recommend their career to others. Data from the survey and further research on this issue could help inform prospective medical or PA students on the careers. Employers of PAs and physicians can also be alerted to the career and lifestyle inadequacies the professionals reported.
This research can be furthered by expanding the sample size or by investigating the lifestyle differences between physicians and PAs in another specialty.