Healthcare workforce policy discussions typically are top-heavy with supply data and short on specific indicators of demand. This has long been the case for the physician workforce and is certainly true of the physician assistant (PA) profession. The reasons for the imprecision on the demand side of the supply-and-demand equation are obvious: it is difficult to directly estimate the current and future extent of healthcare provider demand in the medical marketplace.
Enter Morgan and colleagues, who bring a new implement to the toolbox of healthcare workforce estimation that applies to the demand side (“Job openings for PAs by specialty,” page 45). Using new labor analytics, they were able to identify national data on job postings for PAs—a proxy measure that provides a more precise assessment of PA demand than included in previous examinations of the workforce. This technology identified more than 34,000 PA-specific job postings that were then coded to practice specialty and analyzed descriptively.
In a large sense, their results confirm commonly held perceptions of PA demand in the workforce. Overall demand for PAs in the medical marketplace was strong in 2014, with one job posting for every three certified PAs and about five jobs available per PA graduate during that year. The highest proportion (51%) of posted PA job ads were in the surgical and medical subspecialties; only 18% of posted ads were for primary care positions.
This latter figure is of particular interest in that it sheds some light on the trend of the falling proportion of PAs who work in primary care. According to the American Academy of PAs (AAPA) census and salary survey data, the percentage of PAs working in the primary care specialties of family medicine, general internal medicine, and general pediatrics has declined from more than 50% in the late 1990s to the present 24%.1,2 Various explanations of this decline have been put forth, including the rising demand and salaries for PAs in specialties and subspecialties, relatively low availability of jobs in primary care, and possibly a saturation of PAs and NPs in primary care practices. At least 50% of family medicine practices indicate that they employ a PA or NP or both.3 The findings of Morgan and colleagues suggest a low availability of positions in primary care relative to specialty positions. In particular, this makes it more difficult for a primary care–motivated PA graduate to find a position in these areas of practice.
The trend of increasing employment in medical and surgical specialties and subspecialties also is elucidated. What began as a healthcare profession with a strong primary care orientation has been transformed, largely by market forces, to one with a specialty profile distribution roughly parallel with that of physicians. Specialty practice is dominant in the entrepreneurial US healthcare system and physician practices and hospitals have been quick to pick up on the significant economic advantages of using PAs. The fact that most jobs for PAs were in the specialties should not be a surprise even to casual observers of the PA marketplace.
The question going forward is how long the robust medical market demand observed by Morgan and colleagues will continue. Anecdotal evidence suggests that demand for PA services remains strong, with little to no voluntary PA unemployment, new graduates quickly finding positions, and no reports of PA saturation in specialty practices. We also know that healthcare workforce supply and demand equations sometimes experience cycles of oversupply and shortage. Healthcare workforce experts debate whether the tea leaves indicate a surplus of PAs by a distant year (arbitrarily selected, typically 2025).4,5 They lose sight of the well-established fact that such long-range predictions usually are wrong and call for more granular research. Data products like the one delivered by Morgan and colleagues represent a solid effort in that direction.
1. American Academy of PAs. Annual census, 1998. Alexandria, VA, 1998.
2. American Academy of PAs. 2017 AAPA salary survey. Alexandria, VA, 2017.
3. Peterson LE, Phillips RL, Puffer JC, et al. Most family physicians work routinely with nurse practitioners, physician assistants, or certified nurse midwives. J Am Board Fam Med
4. Salsberg E, Quigley L. Are we facing a physician assistant surplus. JAAPA
5. Hooker RS. When will physician assistant supply exceed demand. JAAPA