Unbiased Analysis of Today's Healthcare Issues

More Physician Assistants prefer working in specialty fields over the primary care setting

Written By: Jason Shafrin - Oct• 08•07

What has happened to physician assistant (PA) education in recent years? An article by P. Eugene Jones (Academic Medicine 2007) enlightens readers with the latest information.

The states with the most PA programs are: New York (19), Pennsylvania (15) California (10), Texas (8) and Florida (6). Alaska, Delaware, Hawaii, Mississippi, Vermont and Wyoming all have zero PA programs. Unsurprisingly, PA concentrations are highest in the states with the highest population.

For the 2002-2003 academic year, one year of PA education costs $36,000 for residents and $44,000 for non-residents. These figures include tuition costs and student fees plus expenses for books and equipment.

The most surprising finding of the article is that there is a trend for PAs to choose jobs outside the primary care fields. I once thought that PAs could be a replacement for primary care doctors when: 1) a patient was healthy or had a disease which was relatively simple to diagnose and treat, and/or 2) when patients wished to spend more time with their medical provider. In fact, Dr. Jones cites an article which claims that PA productivity is 84% of that of a FTE family medicine physician.

Nevertheless, Dr. Jones finds “…the distribution of PAs in the primary care settings of family medicine, general internal medicine, and general pediatrics was 50.8% in 1996. By 2006, only 36.1% were reportedly practicing in theses settings.”

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  1. jay says:

    The reasons for this are probably the same as the reasons for physicians abandoning primary care. Over time the pay differential between specialty work and primary care work has expanded to the point where those for whom pay is a key element in career choice-as it usually is for heavily indebted MD or PA graduates-specialty work is the obvious choice. In clinical work, the vendors have no pricing power. Scarcity in primary care does not readily translate into a scarcity value in money terms. Insurers and especially medicare present a take-it-or-leave-it fee scale. Specialty work is more highly paid on a $/time spent basis. Surgeons and radiologists now earn triple what a pediatrician or family practice doc earns and so can pay their PAs far better than the primary care doc can. This is a no brainer for any PA.