Physician Assistant Spots Grow as Profession Reaches 40-year Mark

There are now over 100,000 PAs in U.S. healthcare. The PA role, and acceptance of the position, has evolved over the years.

At the 40-year mark of the first certification of physician assistants (PAs), demand for the position in hospitals, healthcare systems, and physician groups continues to grow.

In one of the most comprehensive studies on PAs, the National Commission on Certification of Physician Assistants (NCCPA), which began administering PA certification exams in 1975, reports there are now 102,000 certified PAs in the U.S. That's a 36% increase from 2009, a trend that is expected to continue.

"The employment rates across settings has skyrocketed," says NCCPA CEO Dawn Morton-Rias, EdD, PA-C. "People often think of PAs working in primary care, family medicine, and internal medicine, but 70% of PAs work in specialty areas doing high-tech and high-risk procedures."

Surgical subspecialties (19.5%) and emergency medicine (13.8%) are the two specialties where the greatest number of PAs work, according to NCCPA's report. Others include dermatology, hospital medicine, surgery, pediatrics, and internal medicine subspecialties.

Thomas Bat, MD, CEO and founder of North Atlanta Primary Care, says PAs are an invaluable part of the practice. At seven primary care locations, 15 PAs work alongside 20 doctors.

"PAs are the ones who call patients, share cell phone numbers," says Bat. "They work more hours than physicians."

Bat first used a PA in 1989 to help out during a particularly busy flu season. He thought the person would be useful for the overflow patients, temporarily.

"Initially, I oversaw every single case. There was a ton of paper, I was typing notes, and how it changed was interesting," says Bat. "This PA started doing more complicated cases, and I started realizing what a wealth of energy they brought to practice."

Morton-Rias has seen an evolution in acceptance of PAs over many years, she says. Although she no longer sees patients herself, she cared for patients for decades as a PA in several settings, including family practices and urban centers.

"Early in my career, I had to explain everything I could do for physicians because the profession was still new," she says. "They [PAs] don't have to do that anymore. They're being educated and trained by physicians who have grown up with them professionally."

One factor leading physicians to accept PAs in the exam room and operating room is that they are educated much like physicians, Morton-Rias says. Many PAs set out to be MDs but couldn't afford the expense, she says.

The profession is projected for 38% growth through 2022, according to the U.S. Department of Labor's Bureau of Labor Statistics. That's a faster growth rate than for most other occupations.

While the medical community has largely accepted PAs, payers are lagging in recognizing their value, says Morton-Rias. For example, electronic medical records may be able to track the cost-effectiveness or quality metrics of PA activities, but Medicare and commercial payers do not recognize PAs as a reimbursable entity.

"I hate the thought of being invisible," she says. "On a practice and system level, they can capture the impact of PAs, but we're challenged by the macro level."

Nonetheless, the effectiveness of PAs is well-documented. Last year, Medical Group Management Association (MGMA) issued a report on NPP Utilization in the Future of U.S. Healthcare. NPPs (non-physician providers) includes PAs, nurse practitioners, and other midlevel providers. The report found that using this group of healthcare workers can give upwards of 80% of services a lower cost without sacrificing patient satisfaction.

The Patient Protection and Affordable Care Act does give PAs some visibility and recognition. For example, it provides funding to train 600 new PAs as well as allowing PAs to be an eligible care partner who can share in some primary care incentives.

Morton-Rias says she expects the PPACA changes will leverage PAs in a more noticeable way.

"There are some changes afoot, and that's created a stage. … We won't be the best kept secret anymore."

PAs who work in specialty areas can earn additional recognition beyond certification (PA-C). PAs can earn a specialty certificate of added qualifications, a CAQ, by completing additional specialty experience, 150 hours of specialty-focused CME credits, a physician attestation, and passing a rigorous, national exam in that specialty. PAs have to already be certified and have a valid state license before attempting to earn a CAQ. This added designation is available for cardiovascular and thoracic surgery, emergency medicine, hospital medicine, nephrology, orthopedic surgery, pediatrics, and psychiatry.