The physician assistant (PA) profession has long sought to establish a comprehensive, reliable, source of longitudinal data on the PA workforce. In today's rapidly changing healthcare landscape, the profession must supply quality data to the policy makers and workforce planners charged with developing and implementing new models of healthcare delivery. These delivery models seek to address the triple aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of healthcare.”1
In March 2012, the nccPA Health Foundation, a supporting organization to the National Commission on Certification of Physician Assistants (NCCPA), worked with the NCCPA to create a new online data collection tool, the PA Professional Profile, that would efficiently collect and refresh data from certified PAs every 2 years as they log CME. Based on the perceived value of this dataset, the National Center for Health Workforce Analysis selected the nccPA Health Foundation as its designated partner in the federal Health Resources and Services Administration's Minimum Data Set project, which seeks to establish comparable data for the purpose of workforce research, policy, and planning across 13 health professions.
This brief report shares preliminary information from the initial PA Profile dataset, collected through December 31, 2012, and supplemented by data from the NCCPA master datafile. A more complete report, including 2013 data, is planned for 2014.
The PA Professional Profile was based on similar surveys of other health professions and complements demographic data in the existing master datafile of the NCCPA. Built with custom branching strategies, the profile can be completed in 10 or fewer minutes by certified PAs. The profile consists of three modules: About Me, My Practice, and a Recently Certified/New Graduate section piloted beginning in December 2012. A dynamic backend database supports secure storage and information retrieval that allows for longitudinal information tracking. In May 2012, all certified PAs were invited to complete the profile by logging in to their secure PA record. PAs are further encouraged to complete the profile when they log required CME.
As of December 31, 2012, a total of 54,982 certified PAs had completed the profile, yielding a 61% response rate in the tool's first 6 months. When compared with the larger NCCPA database, the respondents were found to be representative of the entire population of certified PAs with respect to sex, age, and geographic distribution.
Demographics Demographic data largely confirm current beliefs about the PA profession. PAs tend to be young; 59% are 40 years old or younger and only 4.8% are over age 60 years. They are predominantly female (exactly two-thirds of responding PAs were female), white (82.4%), and non-Hispanic (90%). More than 20% of PAs communicate with their patients in languages other than English, most commonly Spanish.
More than half of responding PAs (56.2%) received a master's degree on completion of their PA education program, and an additional 9.4% earned master's degrees after graduation, bringing the total percentage to 65.6%.
The supply of PAs varies across states, with the highest numbers found in New York, California, Texas, Pennsylvania, and Florida, and the lowest in Delaware, Hawaii, Arkansas, Wyoming, and Mississippi (Figure 1). Relative to the overall population, the highest proportions of PAs are found in Alaska, South Dakota, Maine, Montana, and New York, and the lowest in Indiana, Missouri, Alabama, Arkansas, and Mississippi (Figure 2).
The large majority of PAs work in urban areas. The principal position for nearly 80% of respondents was in an urban area and just 14.4% are in rural areas, based on the Rural-Urban Commuting Area (RUCA) Codes.
Practice patterns Reflecting the recent rapid growth of the profession, most PAs (61.4%) have been in the workforce 10 years or less and 79.4% for 15 years or less. More than 98% of responding PAs have spent less than 5 years out of the workforce since first working as a PA, and less than 1% have been out of the workforce more than 10 years.
PAs work an average of 40.6 hours per week at their principal clinical positions, with men reporting working slightly more average hours per week (43.4) than women (39.1). Few PAs work part-time; 86.6% work more than 30 hours per week. More than a third of PAs (36.5%) take call, with 14.2% of all respondents reporting taking call more than 10 hours per week.
Nearly 95% of respondents work in at least one clinical PA position. For those not clinically practicing as PAs, the most common reason given, by 33.5% of these 2,754 respondents, was the need to tend to family responsibilities. Other factors were employment as something other than a PA in other health settings (15.6%), working in education (11.9%), and retirement (8%).
Nearly 9,000 PAs (17.5% of respondents) work in two or more positions—14.3% in two or more clinical positions and 3.2% in a principal clinical position and one in which no direct patient care is provided. PAs who work in more than one clinical position did so primarily to supplement their income (44.3% of respondents) as well as because they enjoy working in a variety of clinical settings (25.7%) or to gain experience in a different aspect of clinical care (17.7%). Most PAs (64.7%) with secondary clinical positions reported working 10 hours or fewer in their secondary clinical positions. Responding PAs saw an average of 70.5 patients per week in their principal clinical position and 21.4 per week in their secondary clinical position.
PAs practice in virtually every area of medicine and surgery. The most common areas of practice are family medicine/general practice (24.7%), surgical subspecialties (19.5%), emergency medicine (15.2%), general internal medicine (8.2%), and internal medicine subspecialties (7.9%).
Many PAs, however, practice in more than one area of medicine. Nearly 36% practice in two or three different areas and about 4% in four or more different areas. Thirty-three percent reported working in practice defined as primary care (general internal medicine, family medicine, general pediatrics, and geriatric medicine).
Income for clinically practicing PAs ranges from less than $40,000 to more than $140,000 per year, from all clinical positions combined. A little over half (53.6%) of PAs earn between $70,000 and $110,000 per year with 33.6% earning more than $100,000 per year.
With a high response rate (61%) by the first cut-off date of December 31, 2012, and the likelihood of higher response rates in the future as more PAs complete their certification maintenance requirements and are encouraged to complete their profile, this new data source offers the potential to provide the first true census-level data on the PA profession. Future efforts will be directed toward cross-validating this information with other national datasets.
Initial results provide demographic data that are in line with data produced from other sources. PAs tend to be young, female, and predominantly white and non-Hispanic. Most work in urban areas. About one-third work in primary care.
The data also illustrate a number of key features of the PA profession. Relatively few PAs work part-time, and significant numbers of PAs work in more than one clinical position and in more than one area of medicine. This flexibility and commitment may provide PAs with opportunities to fill gaps in a changing workforce faced with shortages in other health professions.
This initial cut of the NCCPA data from the PA Professional Profile provides a baseline for tracking future trends in the profession. The capacity to prepopulate the existing data fields with previous responses allows for the addition of new questions, as they emerge, to inform future workforce and policy discussions. This comprehensive new data source lets the profession chart its own future by contributing important information to workforce planning and policy decisions at the national, state, and local levels.
© 2014 American Academy of Physician Assistants.
1. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood)