Where Does the Role of Physician Assistant Fit in Today's Health Care Picture?

Analysis of physician assistant career patterns

In 1999 and 2000, an Arizona State University investigator, Eugene Schneller, conducted a follow-up survey of a group of physician assistants (PAs) whose experience as PAs has been tracked since 1975.

Duke University developed the PA occupation in 1965 to increase patient access to medical care by relieving physicians of routine tasks that could be handled by non-physicians.

Background

The US Department of Health, Education, and Welfare (HEW) funded the first Physician Assistant Career Study to understand PA roles and careers, and changes in the occupation. This study first surveyed all 1,312 students who enrolled in PA programs in 1975. It then re-surveyed the same group of people two times: in 1976 after one year of school and in 1978 after one year on the job.

The results provided the basis for a longitudinal study of this entire group of PAs. Schneller's book based on the study, Physician Assistant: Innovation in the Medical Division of Labor, has been cited as a milestone in the development of the PA occupation and has helped build public policy in favor of PAs.

Since the first round of surveys, health care management and delivery have changed significantly, including the emergence of the nurse practitioner and other occupations aimed at broadening access to medical care.

RWJF Strategy

To better understand the effect of these changes on the PA occupation, in 1989 the Robert Wood Johnson Foundation (RWJF) funded ASU (ID# 014800) to survey the original group of PAs regarding how the realities of their work compared with their original expectations, the adequacy of PA training programs, and overall career satisfaction.

From the original group of 1,312, 536 responded. The survey found that:

  1. 29 percent had left the profession and another 7 percent were practicing in non-clinical roles.
  2. PAs had gained significant autonomy from supervision by physicians, but were frustrated that their levels of autonomy did not keep pace with their increasing levels of competence over time.
  3. PAs were increasingly employed as specialists rather than in primary care settings.
  4. Only 19 percent were working in underserved areas and only 38 percent had ever worked in an underserved area.

Key Findings

The original survey was redesigned and sent to the PAs who had participated in the previous surveys. The new survey included questions about work history, practice settings, supervision and autonomy, job satisfaction, and future plans including retirement. Of the 323 individuals who responded to this survey, 236 were still practicing as PAs.

Initial comparisons of the PA's responses in 1978 with those in 2000 as reported by the investigator include the following:

  • There is a trend toward employment in hospitals (17.2 percent in 1978 vs. 26.1 percent in 2000).
  • PAs are less likely to work in rural areas (41 percent vs. 32 percent).
  • PAs are less likely to work in primary care than in specialty care (80 percent vs. 50 percent).
  • PA attitudes towards managed care were frequently negative, but were not influenced by the extent to which managed care penetrated their practice.
  • PA expectations regarding autonomy have turned out to be realistic. In general, respondents reported that they expected to be given autonomy and were given it.

Funding

RWJF provided $49,940 in funding from August 1999 to December 2000 to support the project.