Physician assistants: 5 predictions in the era of health reform

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1. Physician assistant (PA) growth will remain unprecedented. Demand is driving growth and PA program expansion.  The educational programs are charging students higher tuition costs for these coveted PA positions. PA students now acquire unparalleled debt, according to a recent Robert Graham Center report; one in four PA students owed more than $100,000. Although high student debt may impact PA graduates ability to go into fields like primary care, it will only fuel continued program expansion.  Forbes listed PAs as the no. 1 best master’s degree for jobs and projected employment increases of 30% with mid-career median pay of $97,000.

2. The profession will remain predominately white and female. Contrary to the image of the returning military male medic from the 1960s, like many similar post graduate programs, the gender demographic has flipped from predominately male to predominately female.  While some research suggests the increasing number of women applying to medical school may be flattening, the number of female applicants to PA school will keep rising.

3. PAs are no longer “more than a nurse less than a doctor.” With a bright and highly motivated workforce PAs can handle the increasingly complex medical environment. Everyone in health care, including nurses, PAs and doctors, are taking on more responsibility. Physicians can no longer do everything so the well-trained and highly functioning PAs are now key members of the interdisciplinary health care teams.  Each team member is critical to the safety and positive outcome of the patient. A crucial component to the success of the Affordable Care Act (ACA) is a safety-centered health care environment.  These interdisciplinary health care teams have been shown to increase patient satisfaction, reduce error and increase quality of care.

4. The end of sexism in medicine. Arguably the most hierarchical and stereotypical of all professions women health care providers are poised to take on leadership roles. We now see female presidents of the American Medical Association (AMA) such as Nancy Dickey, MD, a family practitioner and first female president of the AMA.  Karen Bass, a physician assistant, serves in U.S. House of Representatives California 37th district since 2013 and started in the California State Assembly.

5. Health care in the era of the ACA will be increasingly cost conscious. The largest employer of PAs in this country is the Veterans Administration (VA). The entire country will see a surge of a health care system more like the VA with its commiserate problems and solutions.  The employment of PAs will be a part of that cost saving equation because of their ability to fill voids by going into any subspecialty area as well as being able to go into smaller communities that cannot support a physician.

Jennifer Coombs is an assistant professor, division of physician assistant studies, University of Utah School of Medicine, Salt Lake City, UT.

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