PA Education Worldwide

Transcription

1 Physician Assistants: Past and Future Roderick S. Hooker, PhD, MBA, PA October 205 Oregon Society of Physician Assistants PA Education Worldwide Health Workforce North America 204 US Canada Population Percent 65 and older Percent Rural (% very rural) Number of Physicians (20) 36 Million 34 Million 3% 3% 20% (2%) 20% (2%) 720,000 65,800 Percent FP 30% 50% Number PAs 88, Number NPs 27,000 3,000 Physician interest in family medicine is declining Workforce policy experts believe that PAs and NPs are an important asset for primary care service delivery PA/NPs not only augment primary care services but provide roles in hospital inpatient services and teaching centers

2 U.S. PAs at a Glance 203 Growing the PA Profession : PAs Entering Workforce Gender / Age Distribution Female Male N = 29 Age = 29 years

3 970-79: PAs Entering Workforce Gender / Age Distribution Female Male : PAs Entering Workforce Gender / Age Distribution Female Male : PAs Entering Workforce Gender / Age Distribution Female Male

4 : PAs Entering Workforce Gender / Age Distribution Female Male PAs Entering Workforce Gender Percentage by Year Percent % Female % Male US Licensed PA Population: 205 (N = 90,859) Source: Hooker & Muchow204 4

5 US PA and NP Graduates Per Year ( ) 7000 Number of Graduates PA NP Hooker et al 205; PAEA, ARCPA, AACN data 205 Geographic Distribution of PA Programs: 205 US programs by state: New York Pennsylvania California Texas Florida Program size is expanding Graduation rates are increasing Approximately half are private institutions Geographical Distribution of Physician Assistants 5

6 Physician Assistant Scope of Laws Few states have the full complement of 6 criteria to meet model legislation (Federal policies excepted) Mean Annual Salary (MGMA 204) Compensation for Primary Care Providers 6

7 203 Annual Wages for 5 Major Employers of Physician Assistants Outpatient Care Centers General Medical and Surgical Hospitals Offices of Physicians Colleges, Universities, and Professional Schools Federal Executive Branch $30, $50, $70, $90, $0, $30, Quella, Brock, Hooker 205 PA Wage Comparison by State: 203 Quella, Brock, Hooker 205 Quella, Brock, Hooker 205 7

8 204 PA Specialty Distribution General Surgery 3% Obstetrics & Gynecology 2% Emergency Medicine % Pediatric Subspecialties % Other 9% Occupational Medicine % Primary Care 3% Internal Medicine Subspecialties 8% Surgical Subspecialties 24% Growth of Invasive Procedures: PAs & NPs Association Between Prevalence & Salaries Ratio of MD to PA Median Salaries, Neurosurg Ortho Surg 6 Derm CV/Thor Surg 5 Urol Surg EM GI Fam/Gen Med Geriatrics y = -0.03x R² = 0.38 Gen Peds Ratio of Number of Active MD/DOs to PAs, 203 Morgan, Everett, Valentin 205 8

9 00 Primary Care in America: Percentage of Providers Identified in Primary Care NPs MD/DOs PAs Trends in Emergency Medicine The role of NP/PAs in emergency medicine is varied but spans the same degree of care as doctors Many PA/NPs staff fast-track (urgent care) In US EDs, there is one PA/NP for every five doctors ED: fast growth for PAs since 2000 Team based care studies are needed to understand the dynamics and interaction of the players Outcomes studies are needed NCHS ED Visits (non-federal) Hooker, Cipher, Cawley 2008 NPs and PAs on Inpatient Services NP/PA utilization on inpatient services has gained increasing attention since 2003 as hospitals adjust to GME work hour limitations Several reports have documented hospital services experiences in using PA/NPs as resident substitutes Time-motion studies are needed to document the work flow and role Duffy, K., Physician Assistants: Filling the Gap in Patient Care in Academic Hospitals. Perspective on Physician Assistant Education 2003;4:

10 US PA & NP Population in 203: Active Licenses (PA = 84,059) (NP = 27,857) Predominantly female On average women clinicians are younger than men A younger cohort suggests they may remain in the workforce longer Forecasting the Supply of PAs Important to establish the correct base number Limitations of existing data sources on the number of PAs: AAPA Census (decreasing participation rate) NCCPA certificates (renewal every 6 years) New Source: Provider 360 Database Uses number of PAs with active state licenses 84,059 in 202 May be the most reliable and accurate database available Stock & Flow Model US PA Population: 203 (N = 84,059) Source: Hooker, Sen, and Williams, The Lewin Group,

11 Age/Gender 203 Graduates N=7,00* Female: 75% Mean age: 30 years *(based on 202 CASPA matriculates) Source: PAEA CASPA 202 Attrition Attrition (not functioning as a PA/ departing clinical practice) Death Retirement Other Critical piece of predictive models High attrition Low attrition Estimating the right number is challenging because so little is known 5% is best guess for US PAs (may be changing) DoD and VA PA attrition = 9% Retention is the opposite of attrition Can be a problem with certain industries (such as pilots and professors) senior members are expensive and stand in the way of succession. Existing Information Baseline: number of PAs in active clinical practice is based on active license (excludes deceased, sanctioned and expired licenses) Graduation: The annual supply of PAs can be estimated with reasonable precision Retirement: based on patterns of expired licenses without renewal. Validated by ongoing retirement studies. J. Coombs: Intent of PAs to Retire (202) J. Coombs: Retired PAs (202) Death Registry: AAPA and National The historical career patterns of PAs are beginning to be understood

12 Attrition Patterns: US Physicians Source: 2006 Association of American Medical Colleges Survey plus CDC mortality rates Career Duration of Physician Assistants Coombs 202 PA Education (205) Number of accredited programs =98 Programs with graduates = 78 Total enrollment = 2, graduates 6,962 PAEA 205 (unpublished) 2

13 Projected Number of PA Programs in the Accreditation Pipeline Baseline number of programs as of June 205 = 90 (includes both accredited programs and provisionally accredited programs) Mean number of students per graduating class = 45 Significant expansion of the number of institutions sponsoring PA educational programs seeking to attain ARC-PA accreditation between 202 and 2020 Source: ARC-PA John McCarty, personal communication, April 204. PA Program Growth Year Total Projecting US PA Program Growth Hooker Cawley Everett 20 ARC PA 203; PAEA 203 Results Growth of the US PA supply will continue at approximately 7% annually Annual attrition will be 4%±%: aging graduation cohorts of the 970s and 980s young women are replacing older men 30 year clinical career span (range 0-40 years) 00,000 American PAs will be licensed by 206 3,000 PA Stock by Age and Sex, 203 2,500 2,000,500, Female Male Age 3

14 PA Supply Projections: : 9, : 09, : 27,428 Assumptions Variable New Graduates Attrition from PA Activity Key Assumptions Domestic students only Mean age remains stable at 30 years Percentage female remains stable at 64% Includes: retirement, illness, death, emigration, not qualified, and other reasons for leaving clinical practice. New PA programs The net number of PA programs with graduating classes by 2020: 24 After 2020, the net increase in PA program growth will average three per year (the calculation assumes some programs will close or merge). Lag time from provisional accreditation to graduation of first class: 2.5 years (but start up to full maturity takes 8 years). Existing PA Programs The mean length of a PA program remains 26 months. The number of PA programs with a graduating class at the end of 202 was 54. The mean number of graduates per program is 45 and remains at 45/year. Projected Supply of Physician Assistants and Nurse Practitioners 4

15 Results Growth : PA profession will grow approximately 7% annually NP profession will grow approximately 4% annually Annual attrition PAs will be 5%±%: NPs will be 6%±2% aging graduation cohorts of the 970s and 980s young women are replacing older men 35 year clinical career span (reasonable?) 205: 00,000 clinically active PAs 30,000 clinically active NPs Demand Growth for PA Services Source: The Lewin Group, 200 The Effect of Health Reform on Physician Assistants and Nurse Practitioners Demand: Enrollment of 6 million newly insured Aging population Sustainability of chronic diseases New technology (pharmacy, techniques, tools) Quality and cost-effectiveness imperatives Electronic health records Consolidation of small and medium size practices Hospitalization Supply Physicians: 8,000 25,000 new graduates Physician Assistants: 7,000 9,000 new graduates Nurse Practitioners: 0,000 5,000 new graduates Career span: 30 years Annual productivity: 5

16 Summary PA/NPs are a unique American phenomenon spreading globally Demand exceeds supply (for the foreseeable future) Stock of Providers PA: modest trajectory; likely to grow for 0 years NP: steep trajectory; likely to grow for 0 years PA/NPs are testing traditional models of medical education PA education is efficient and relatively inexpensive The graduate is able to assume a wide range of tasks early and tends to grow into the job quickly Postgraduate PA education; <0.% of 05,000 ever graduated PAs (and is not tested) The past predicts the future right up to the point it doesn t -George Will