New data shows that the PA profession is growing by leaps and bounds with the number of newly certified PAs reaching a record high of 10,950 in 2021. With nearly 160,000 PAs in practice and numbers projected to increase by 31% between 2020 and 2030, it is hard to understand how the gaps in health care access remain. We spoke with American Academy of Physician Associates (AAPA) President and Chair of the Board Jennifer M. Orozco, DMSc, PA-C, DFAAPA, to better understand the PA professional landscape and what can be done to help PAs better tackle health care disparities.
Dr Orozco is also director of Advanced Practice Providers at Rush University Medical Center in Chicago and assistant professor in the Department of PA Studies at Rush University College of Health Sciences.
Q: What is underlying the marked gaps in health care access and health disparities in the US?
Dr Orozco: The reality is that patient needs are outpacing provider supply. We know that 96 million Americans lack adequate access to primary care and less than half of those with access are actually having their needs met. We have 155 million Americans without access to mental health care. We have an aging population projected to reach almost 95 million by 2060. And approximately 42% of adults over the age of 20 years are obese and many have obesity-related conditions such as heart disease, stroke, type 2 diabetes, and certain types of cancer.
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We have had a mass exodus in the health care workforce across the country and now face a projected workforce shortage of 3.2 million health care workers by 2026. In rural areas, the gaps in access may be even wider. However, findings from a JAMA study showed a 49.3% increase in the density of PAs in rural counties between 2009 and 2017 compared with a 14% increase among physicians in these areas. PAs can help improve access to care, especially given that the profession is projected to grow 31% between 2020 and 2030. However, we are not utilizing PAs as best as we should due to outdated legislation that prevents PAs from practicing to the full extent of their education and training.
Q: Can you give an example of how PAs are not used to the fullest extent of their training?
Dr Orozco: A colleague of mine practices in a rural part of Southeast Colorado, which recently experienced a large turnover among all health care providers. She’s worked as a PA there for nearly 20 years providing preventative HIV treatment, hepatitis treatment, and long-acting contraceptives among other services. Her supervising physician left and the new physician who was hired does not specialize in infectious disease or gynecologic care. Because these areas are not in the physician’s scope of practice, the PA is now no longer allowed to perform these services. She has to send her patients — whom she has been caring for for years — hours away to access care.
This is one example of how deep-seated in tradition we are in medicine; we can’t let go of things that don’t make sense anymore. At Rush, we discuss how we need to push the status quo and bring everyone along with us. I have this same philosophy at AAPA. Many people can deliver health care, whether they are a PA, a nurse, nurse practitioner (NP), or physical therapist; we have to start being innovative in health care delivery in order to meet the needs of our patients.
Q: What can clinicians do to help lobby for legislative change?
Dr Orozco: I think it is about building relationships — not just with legislators and policy makers, but with all stakeholders in a modern health care delivery system — and chipping away [at the status quo] to make a difference. Talk to people who will listen and keep pushing where you can. Always keep the discussion patient-focused because they are the ones who suffer if we can’t enact change.
Q: The recently released NCCPA survey showed a record number of PAs entering the field in 2021. What is attracting people to become PAs?
Dr Orozco: The pandemic heightened the need for more health care providers, but even prior to that, the PA profession was highly sought after. For the fifth year in a row, PA was named one of the top 2 health care jobs in the country by US News & World Report in its annual Best Jobs List. In this day and age, especially across generations, people really want to get into health care to serve patients. All of the evidence that we have gathered over the years on how PAs practice, are trained, and the high quality of care that they deliver is attracting people to become PAs.
Q: Did any data on practice patterns from the NCCPA survey surprise you?
Dr Orozco: I wasn’t surprised by many of the statistics as they align with the shifts we are seeing in health care, which is a good sign. The survey showed this continuing shift from inpatient management to ambulatory care. From a health care system perspective, we started to focus on ambulatory footprint expansion, particularly with the rise of telemedicine during the pandemic.
Q: What else would you like to tell Clinical Advisor readers?
Dr Orozco: The biggest take-home message is that PAs are a major part of the solution to improve access to care, meet the increasing demand for high-quality providers, and address issues pertaining to health care disparities in patients with chronic conditions. We will never have enough PAs, physicians, NPs, or nurses to meet patient demand. Yet, we have this untapped supply of 160,000 highly-trained PAs who have completed one of the most rigorous medical education models yet are not being optimally utilized. The continued growth in the PA profession is tremendous. At AAPA, I continue to focus on elevating awareness about how PAs go beyond for their patients every day, and why it is so important that we remove archaic and outdated barriers so that we can continue to provide all patients the care they deserve.
We have to modernize health care delivery. The old way hasn’t worked for a long time and the pandemic has heightened the need for change. PAs are highly educated and trained and able to take care of complex patients. The PA profession is continuing to grow and is here to help improve access in this country and provide high-quality care for patients.
