Today I read this interesting article from the Annals of Family Medicine. It is titled: Physician Assistants in Primary Care: Trends and Characteristics
It proved the point of a recent conversation I was having with my cousin - an orthopedic PA at Kaiser.
My theory was that family practice PAs would soon see the same trend toward specialty practice that we have seen among medical doctors.
The pay would continue to increase among those in specialty while pa school tuition and student loans would become more of a burden. In order to both pay back student loans and in chase of higher wages, more PAs would gravitate towards specialty. The gap between primary care pay and specialty pay would grow and we will continue to have an increasing shortage of primary care PAs and MDs.
I guess we will eventually need physician assistant, "assistants", of course probably even they would trend toward specialty at some point in time.
Here is a quote from the article:
PAs working in primary care have demographic characteristics similar to those of medical students who choose general primary care specialties. A systematic review determined that six factors are associated with a medical student’s commitment to primary care practice:
- Female sex
- Older age
- Latino ethnicity
- Lower socioeconomic status
- Receipt of a National Health Service Corps scholarship
- Intention to practice in primary care at the time of medical school matriculation
We found that PA practice in primary care is also more likely among those who are female, older, and Hispanic. The only other recent study of the relationship between demographics and PA practice setting also found that minority and older PAs are more likely to work in primary care. Furthermore, similar to the findings for medical students, the data on PAs identified a positive association between primary care practice and lower economic status.
I was both the recipient of an NHSC scholarship and I had the intention to practice in primary care at the time of PA school matriculation. So I guess I am part of this trend.
The Family Practice PA of the Future
I love family practice and I personally feel that those who choose specialty practice are missing out.
But then again, I am biased. I certainly miss out on some benefits: Like those nice Christmas bonus' I hear about, CME pay, or raises for that matter (we have been put on an indefinite hold for the last 2 years at my practice). But I do love my job and I make more than enough to support my family.
But, as those of us in primary care continue to hear our PA colleagues brag about their perks we may also start to crave the grass on the other side of the proverbial PA fence.
The only thing I see saving this trend is another new trend I predict, and that is a trend towards more PA's opening up their own businesses. We are finally at the point where technology and the growing demand for cost-effective health care are crossing paths. PA's will have a place here, and we will be hiring doctors on the side to act as "virtual" preceptors.
Need, Not Greed
One of the worst parts of the increasing cost of education is that student loans change the focus of an individual. When you are saddled with tens of thousands of dollars of interest laden student debt, it is hard to fulfill your innermost desire to provide family practice medicine.
It seems to me that at least part of the six factors listed above has to do with money. Although, I think there are some other reasons as well. Here are my thoughts:
- Female sex: I know this is not true for many advanced practice practitioners, but women are more likely to provide a second income for a family, are more nurturing by nature, if children are part of the equation family practice schedules tend to work better as a parent, women are more apt to work part-time and there is often more need in primary care for women's health providers.
- Older age: Again schedule may be a factor here, including lack of call and a slower paced lifestyle. Finances may also play a part as older students tend to be more financially established.
- Latino ethnicity, Lower socioeconomic status: Latino culture as a whole is much more family oriented and it may be that this is a factor. Lower socioeconomic status is not a surprise as far as I am concerned. Coming from a humble background tends to result in those with a desire to the serve within the community.
- Receipt of a National Health Service Corps scholarship: The NHSC's goal is to place providers in under-served rural/inner city communities. So this goes without saying. Why do we stay? It's not that hard when you love your job.
- Intention to practice in primary care at the time of medical school matriculation: Well this comes as no surprise. If you fell in love with Doc Hollywood as a kid, it is hard to give up that dream!
Goodbye to Primary Care?
For now, I guess I will have to just sit on the sidelines and wait. I will continue to practice the primary care I love and watch more of my colleagues and acquaintances move into specialty.
Who knows, maybe my days are numbered as well.