More jobs are available for physician assistants (PAs) in specialty practice than in primary care, according to Duke-UCSF research published this month in the journalMedical Care Research and Review.
The study, “Scarcity of Primary Care Positions May Divert Physician Assistants Into Specialty Practice”was conducted by a team of researchers at Duke University and the University of California, San Francisco, led by Perri Morgan, Ph.D., PA-C, professor of community and family medicine and director of research at the Duke Physician Assistant Program, and Christine Everett, Ph.D., MPH, PA-C, assistant professor of community and family medicine, also at Duke. The research was funded by a grant from the Physician Assistant Education Association.
PAs are often suggested as a partial solution to a predicted primary care workforce shortage, Morgan says, but a declining portion of PAs are entering primary care practice.
The study shows that in 2014, 82 percent of PA job postings were for positions in specialties, while only 18 percent were for primary care. Of approximately 100,000 PA positions occupied in 2014, 73 percent were in specialty care while 27 percent were in primary care.
“Even though there are already more PAs working in specialties than in primary care, there are proportionately even more ads seeking PAs for specialty care jobs,” Morgan says. “For years we have encountered students who came to PA school wanting to work in primary care, but when they graduated they had difficulty finding primary care jobs.”
Morgan says she observed that the PA graduates accepted specialty positions, which were easier to find, and never made their way back to primary care.
“This struck us as a shame, especially given the need for more primary care providers and the resources that are being invested, primarily by the federal government, to bolster the primary care pipeline,” Morgan says. “So we decided to see if our impressions would be validated by job opening data.”
The study uses an emerging source of data — real-time labor market information from online job postings — as an indicator of market demand for PAs. National data on 2014 job postings for PAs were purchased from Burning Glass Technologies, which uses an Internet “spider” to continuously crawl over 38,000 websites in search of job postings.
Duke’s study team determined that technical advances, especially in de-duplication procedures, have improved the quality of this data so that it is now suitable for use in workforce research.
The study is the first to evaluate the national job market for PAs by specialty, and possibly the first to engage the question of whether comparatively low demand for primary care PAs might contribute to growing PA specialization.
“We have known for some time that salaries are usually higher for PAs in specialty practice than for those in primary care, but we now know that there are also proportionately a larger number of jobs in the specialties,” Morgan says.
If the job market is exerting, through number of job opportunities, a stronger pull toward specialty care than primary care, there might be policy approaches to address the bottleneck in the primary care pipeline, Morgan says.
“For example, two very different approaches that might increase the demand for PAs in primary care are outreach to primary care practices with resources to help them successfully incorporate PAs and/or advantageous insurance payment structures for primary care PAs,” Morgan says.
Maps of job openings for PAs in each state as well as the entire United States are available on theDuke Physician Assistant Program website.
Researchers interested in investigating the PA job postings data further for state-specific or specialty-specific analyses, or who wish to analyze similar nurse practitioner job opening data, are encouraged to contact the investigators. The study team is working on several more publications based on this data and will present its findings at the Association of American Medical Colleges Health Workforce Conference in May.
The research team also includes: Kristine A. Himmerick, Ph.D., MPAS, PA-C, post-doctoral fellow, Center for the Health Professions University of California, San Francisco; Brandi Leach, MS, research analyst, Duke Physician Assistant Program; and Patricia M. Dieter, MPA, PA-C, professor of community and family medicine and division chief of the Duke Physician Assistant Program.