Shortage of primary care PAs likely to worsen with time

LAS VEGAS – In the United States, recent PA graduates continue to select primary care careers less often than specialty careers; a trend that is likely to worsen with changes in health care delivery and population demographics, according to research presented at the 39th Annual American Academy of Physician Assistants (AAPA) Annual Meeting.

Historically, PAs have played a strong role in shaping and providing primary care, but data from recent studies have shown that fewer and fewer graduates are choosing primary care specializations.

The most recent AAPA census data found that one-third of PAs choose to practice in primary care fields such as family/general practice medicine, general internal medicine and general pediatrics. However, few studies have focused on identifying factors that influence PA career choice.

Karen A. Wright, PhD, PA-C, and Venetia L. Orcutt, PhD, PA-C, both assistant professors in the health care sciences department at George Washington University attempted to describe recent PA graduates' career choices by identifying modifiable factors related to career decision making.

They distributed Web-based questionnaires to 12,128 certified PAs that graduated from the university from 2007 to 2009 to gauge PA perceptions and influences when determining a career specialty.

Nineteen of the survey questions focused on the PA's perception of primary care compared with other specialties they had chosen or considered. The remaining 21 items focused on the factors that had influenced their decision to enter primary care. In all, survey results from 871 participants were available for factor analysis.

The researchers identified five factors that influenced 52.6% of the participants' decisions. These were: personal satisfaction, intellectual challenge, commitment to patient care, image of primary care and professional satisfaction.

Another five factors influenced 45.2% of participants' career choices: practice environment, nature of patient care, lifestyle, employment opportunities and risk aversion.

These results closely paralleled previous study findings from Hauer et el, which also identified five perception factors as well as three influencing factors that explained PA career choice in internal medicine.

“Identification of factors, whether perceptual or influential, that affect this career choice should provide an enhanced understanding to educational and professional organizations as they explore strategies to increase the recruitment and expansion of the primary care workforce in an effort to reverse this trend,” the researchers concluded.

Wright K, Orcutt V. "Physician assistant career choice: a factor analysis." Presented at: American Academy of Physician Assistants' 39th Annual PA Conference. 2011: Las Vegas, Nevada. 

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