'Make more of them' isn't the only solution to America's worsening physician shortage
In spite of the tremendous amount of time and money it will require to produce enough physicians to offer access to care for all Americans, federal and California state officials continue debating how to "make more of them" ("Salute efforts to educate new doctors," Nov. 14).
In reality, the aging population, the limited access in rural and underserved communities and the promise of universal health care warrant the inclusion of all levels of providers in the medical workforce. Fortunately, a team-based approach, including all providers, such as physician assistants (PAs) and nurse practitioners (NPs), can help to bridge the gap while we await the genesis of more doctors.
PAs are amassing in the medical work force faster than physicians and are already playing a role in offsetting the physician shortage. This is in part because PAs are produced in about one-third the time of physicians. The PA profession has doubled in the past decade and tripled in the last 15 years. Currently in the U.S., there is approximately one PA in practice for every 10 physicians. In 2008, the American Academy of Physician Assistants reports that there were 73,893 PAs in clinical practice and more than 257 million visits to PAs.
The potential for continued growth in the profession remains high, with 88 percent of programs reporting an increase in applicants in 2008. The quality of PA students is also increasing as programs become more competitive. For instance, the New York Institute of Technology's PA program has 1,500 applicants for 52 seats. That's roughly a 3 percent acceptance rate -- the equivalent of Harvard Medical School's 2008 acceptance rate.
So are we turning out PAs in vain? Absolutely not; for now there is no such thing as too many PAs. The profession's affordable salaries (averaging about $89,000 per year across all specialties) make it an attractive choice for increasing the volume of providers within the medical system at a fraction of the cost. Many planners are especially concerned about the future supply of primary care providers. PAs may offer the most savings when placed in specialties. In family practice, PAs make a little more than half of the physician's $150,000 salary, while in orthopedics, PAs may make about $90,000 compared to physicians who make from $350,000 to $500,000. We also know that many PAs deliver or supplement primary and preventative care through their work in specialties. For example, PAs in oncology see survivors for years after their cancer has been treated and the diligent monitoring of the patients' health often uncovers other issues.
We're continuing to learn more about how PAs actually deliver care. Recently, Perri Morgan, Ph.D, PA-C, director of Physician Assistant Research at the Duke University Medical Center, examined the cost-efficiency of PAs using national data to study office visit resource use when PAs are in the provider mix. She and her colleagues asked whether PAs increase the availability of the services offered by physicians or whether they instead provide additional care that actually increases the number of visits that a patient uses. They concluded that, on average, PAs are replacing care that would be provided by physicians rather than offering additional or redundant services to patients. The research showed that when PAs provided 30 percent or more of a patient's office visits in a year, there was no increase in the total number of office visits per year.
In my experience, patients not only accept, but also rely on the care they get from providers such as PAs and NPs. Numerous studies conducted in the last decade have found little or no difference in the patients' perception of quality of care delivered by PAs, NPs or physicians. So, while PAs may not be the entire answer to a growing shortage of physicians, they clearly are a part of the solution. I believe a large part.
Stephen Hanson of Bakersfield is the president of the American Academy of PAs (AAPA), representing nearly 75,000 practicing PAs. He work as a physician assistant at the Grossman Burn Center at San Joaquin Community Hospital.
