physician assistant collaborative roles roderick s. hooker, phd, pa october 2009 department of...
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PhysicianPhysicianAssistantAssistant
CollaborativeCollaborativeRolesRoles
Roderick S. Hooker, PhD, PAOctober 2009
Department of Veterans Affairs
Dallas, Texas
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Physician Assistants: A Workforce Policy Success?
• Over 4 decades observation: the PA concept has been shown to be a workforce policy success because….
• Patients acceptance; 66% of citizens recognize the PA role and 1/3 have been treated by a PA
• High levels of job satisfaction: – salary, – retention, – Work environment
• PAs complement physician practices and do not threaten physician roles/authority
• Global movement: the Netherlands, Canada, England, Australia, South Africa, Sub-Saharan Africa
• PA clinical mobility: across medical specialties and settings
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PAs in Practice73,000
Source: AAPA 2009
2504,500
11,500
16,000
24,000
31,000
49,500
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
1970 1975 1980 1985 1990 1995 2000 2009
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Distribution Physician Assistants: 2009
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2009
• Canada• England• The Netherlands• Scotland• Taiwan• Australia• South Africa• Ghana
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CANADA• The Canadian Forces converted their
medical assistant program to an accredited PA program.
• >100 PAs in uniform• 25 PAs in Manitoba• 40 Ontario 2009• 6 New Brunswick (2010)• Programs 2009:
– Canadian Forces Borden– University of Manitoba– McMaster University– University Toronto (2010)– Other
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Canadian Forces Physician Assistants
• Somalia• Honduras• Israel• Persian Gulf
• Afghanistan• Bosnia• Kosovo• Haiti
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Two-year program– Phase One Didactic
• 51 weeks • four semesters
– Phase Two Clinical rotations
• 49 weeks • 15 rotations
PA Program Base Borden
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New PA Graduates* by Specialty, 1991-2007
0%
10%
20%
30%
40%
50%
60%
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Surgical Subspecialties
Family Practice
Other
Internal MedicineSubspecialtiesEmergency Medicine
General Internal Medicine
General Surgery
General Pediatrics
Pediatric Subspecialties
* PAs graduating in year immediately preceding the census reference year are considered New Graduates
Sources: AAPA Membership Census Survey, 1991-1995; AAPA Physician Assistant Census Survey, 1996-2007
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PA Specialization• PAs have been shown to emulate the practice patterns of physicians• The current job demand for PAs is mainly from physicians in specialties and hospitals • Lifestyle plays a role in specialty selection
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Source: Morgan PA, Hooker RS, Health Affairs, 2009 (in press).Source: Morgan PA, Hooker RS, Health Affairs, 2009 (in press).
Correlation of PA Salary with Doctor : PA Ratios
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Specialty Change: A Unique Feature Among the Health Professions
• Virtually all doctors are postgraduate trained for a specialty (and remain in that specialty)
• NPs and other APNs are specialty trained
• PAs are capable of changing specialties (jobs) over the course of their working careers
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Clinical Flexibility• The capability of PAs to change specialties over the
course of their career.• This capability is based on the premise that PAs work
closely with their employing physician and that the practice content of the PA is closely linked to the employing physician.
• This may be a desirable aspect of the PA profession for recruits and members.
• Provides extensive opportunities for lateral mobility and professional growth.
• Permits PAs to fill emerging niches in the medical workforce.
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Mean Number of Years in Current Specialty, 2008
Source: AAPA 2008Source: AAPA 2008
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How Many Types of Specialty Class Changes in a PA Career?
Source: American Academy of Physician Assistants, Annual Census Data, 2008. Source: American Academy of Physician Assistants, Annual Census Data, 2008.
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Where Do Family Medicine
PAs Depart For?
Source: American Academy of Physician Assistants, Annual Census Data, 2008.Source: American Academy of Physician Assistants, Annual Census Data, 2008.
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Specialty Changes: No Change, Within a Class or InterclassPercentages (Select Year Dyads)
Specialty Changes: No Change, Within a Class or InterclassPercentages (Select Year Dyads)
Source: American Academy of Physician Assistants, Annual Census Data, 2008.Source: American Academy of Physician Assistants, Annual Census Data, 2008.
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Workforce Implications
• PAs appear to be responding to medical marketplace demands.
• PAs appear to be remarkably versatile clinicians capable of practicing in a wide range of medical settings and specialties
• PAs likely change specialty areas in part due to evolving medical marketplace demands (the availability of jobs) as well as career and lifestyle factors (personal considerations)
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Number of PAs in the Workforce per Million Residents for the Highest and Lowest States, 2008
Source: Department of Labor Statistics: 2009Source: Department of Labor Statistics: 2009
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Summary• PAs will remain in high demand for
the foreseeable future:– Population growth– Aging population– Doctor shortages– Technology– Other
• PAs will be drivers of improved care and standards of care
• Specialization of PAs will be in tension with the primary care basic education model
– Reductionism leans towards a specialist model
– Medical Home advocates will advocate for primary care models
• PA legislation will continue to improve
• Women will dominate the PA profession
• Issues about physician dependency will arise from time to time
• The PA model will undergo some changes internationally
• Evidence based medicine will drive PA utilization
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Canada: Facing its future
“New models of care and new technologies will require specific training for rural settings. International experience must be used to mutual benefit in developing services of appropriate standard, which comply with local needs.”
D Godden
Director, Centre for Rural Health, Inverness
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