4 Physician Assistant Trends to Watch in 2019

This year's expected developments include a new electronic recertification process for physician assistants.

This year will feature several significant trends and developments for physician assistants, says Dawn Morton-Rias, EdD, PA-C, president and CEO of the National Commission on Certification of Physician Assistants (NCCPA).

Physician assistants (PA) are widely viewed as part of the solution to the country's physician shortage. By 2030, the physician shortage is expected to grow to as many as 120,000 doctors, according to the Association of American Medical Colleges.

Physician assistants are a dynamic segment of the healthcare sector workforce, according to NCCPA statistics released in July 2018.

• From 2015 to 2017, the number of PAs grew more than 13%.
   
• The number of PAs per physician rose 23% from 2015 to 2017, increasing to 128 PAs per 1,000 physicians. Two of the highest PA-per-physician ratios were occupational medicine at 621 PAs per 1,000 physicians and orthopedic surgery at 537 PAs per 1,000 physicians.
   
• In 2017, the average salary of PAs was nearly $108,000.
   
• The ranks of PAs are filled with relatively young professionals. In 2017, 78.5% of physician assistants were under the age of 49.
   
• The family medicine and general practice area had the highest concentration of physician assistants (19.9%), followed by surgical subspecialties (18.5%).

Morton-Rias expects four trends and developments will significantly influence the physician assistant profession this year. 

1. Easing physician shortage
 

Physician assistants will continue to play a key role in easing the country's physician shortage, Morton-Rias says.

"Given the youth of the profession, the broad-based knowledge and skills of PAs, and the ability to provide services across all disciplines, PAs can ease physician shortages and improve access to care," she says.

The relatively young age of PAs—which averages about 38—and their propensity to stay in the profession is a bright spot in the healthcare workforce.

"The attrition rate is very low, and when we compare the PA profession to some of the other healthcare professions where the average age is in the 40s or 50s, there's a concern because you have a bolus that will be retiring out," Morton-Rias says.

The relative youth of PAs helps address the physician shortage in ways beyond actuarial considerations, she says. "The youth of the PA profession will help in increasing access to care. These are young, energetic folks who are entering the profession."

2. Modernizing certification exams
 

Starting this month, NCCPA will start offering electronic administration of the 10-year recertification exam for PAs, allowing PAs to take the exam on their phone, laptop, tablet, and desktop computers.

"This assessment that we are piloting is in keeping with the emerging trends in assessment and utilizing technology. In the PA profession, we have always relied on the testing methods where you sat in a test center after memorizing a lot of information," Morton-Rias says.

The electronic platform NCCPA has developed is the first major step toward modernizing certification exams at the accrediting organization, she says.

"In this assessment method, PAs can answer questions in real time, with about a minute to respond to a question. If they get the question right, they know right away, so it reaffirms their knowledge. If they get a question wrong, they are corrected right away, and they are given resources to improve their knowledge base."

Other primary facets of the new assessment method include completing 25 questions each quarter (there are a total of 100 questions and PAs have 11 weeks to complete each 25-question set). The questions cover a broad swath of core medical knowledge, and the assessment tool has the ability to allow test takers to delay answering questions that display images by switching from their phone or tablet to a device with a larger screen.

"This assessment utilizes technology and it provides real-time information in the same way people practice medicine today. Physicians are also starting to pilot this approach," Morton-Rias says.

3. Updating state PA legislation
 

Changes in the practice of medicine are prompting state lawmakers to reform the way PAs are regulated, Morton-Rias says.

"States are modernizing their legislation as it relates to PA practice because the healthcare industry has changed from PAs working for one doctor to more providers working in health systems. As this change has occurred, some of the states still have laws that are outdated and don't reflect the new flexibility."

She says the legislative changes include reforming scope of practice, supervision, and delegation of authority.

4. Expanding specialty care roles
 

PAs are shifting away from their roots in primary care to specialty care, Morton-Rias says. "Although the profession began with primary care and general medicine mostly in underserved areas, medicine has become highly specialized and the PA profession is becoming specialized as well."

She says as many as 70% of PAs are working in specialty practice, including surgical specialties such as orthopedics, neurosurgery, and cardiothoracic surgery.

The transition to specialty care presents a challenge to PAs, she says. "PAs are carrying two responsibilities. One is to maintain expertise in their current practice discipline; the other is maintaining core medical knowledge that is useful across all disciplines."

PAs are well-prepared to rise to the challenge, Morton-Rias says. "PAs have a very solid educational process and fount of knowledge that they develop through a rigorous educational training. It's a full-time immersion type of training, so PAs enter medicine with a deep knowledge base."