A first-of-its-kind practice specialty report compiled by the National Commission on Certification of Physician Assistants (NCCPA) reveals that the majority of physician assistants (PAs) â€“ 70% â€“ now work in non-primary care specialties.
A first-of-its-kind practice specialty report compiled by the National Commission on Certification of Physician Assistants (NCCPA) reveals that the majority of physician assistants (PAs) — 70% – now work in non-primary care specialties.
That’s significant, says Dawn Morton-Rias, EdD, PA-C, president and CEO of NCCPA.
“When this profession was born almost 50 years ago the purpose and intent was to fill primary care gaps in rural and urban settings,” Morton-Rias says. “And that’s where the profession … stayed for quite some time.”
But over the past five years in particular there has been a significant shift away from the primary care disciplines and into specialty practice. PAs are now currently working in every discipline where physicians are working, and in every setting: in-patient, outpatient, urgent care, and hospitals.
“Those changes in terms of the distribution are significant for this profession when we look at its history and what it was intended to do initially,” she adds.
And significant in terms of the clinical and financial benefits PAs bring to the table.
Morton-Rias says the migration of Pas into non-primary care specialties demonstrates the nimbleness, the flexibility, and the responsiveness of the profession to the shifting needs in the healthcare landscape.
“Fifty years ago PAs were needed in primary care rural settings,” she explains. “I think there’s still a need for care in those disciplines, but as the healthcare industry has continued to expand and welcome other providers, PAs have been able to fill that gap providing high quality, cost effective care in all of these specialty disciplines.”
Anil Ranawat, MD, is an orthopedic surgeon at Hospital for Special Surgery (HSS) in New York. He’s also the medical director of the physician assistant department at HSS, and has seen significant change over the last 10 years.
“We went from a department of five PAs to 87,” Ranawat says. “That’s just the hospital PAs. There are also around 60 private PAs.”
There are, Ranawat explains, several reasons for the growth. Pas are less expensive to hire than physicians, yet they enable hospital or medical practice staff to operate more efficiently. That translates into increased revenue, because the services a PA provides are billed through private and public insurance at the same reimbursement rate as a physician.
Pas also excel in sub-specialty care.
“I’m a knee and hip surgeon, and that’s all I do,” Ranawat says. “So if I train somebody to do just those things with me, they get very good at it.”
And that’s where PAs come in. Residents and fellows, he explains, move on through their rotations. PAs don’t change rotations every three months.
“They stay with you for years and years,” he says, “and they become excellent in providing care. I actually think sub-specialty care is probably the best avenue for PAs.”
Training and Dedication
Morton-Rias says one of the reasons PAs work well with physicians is that they receive similar training. PAs are educated, trained, and practice in the medical model. And a key part of that training focuses on good communication skills.
“We spend a lot of time obtaining a good patient history, understanding the patient’s perspective, performing a complete and accurate physical examination, ordering and interpreting laboratory studies, and then explaining to the patient what they’re experiencing,” she says. “That’s the value and the beauty of our profession. We mirror physicians in almost every possible way with the additional added value of a little more emphasis and time for good communication and what we call good assessment skills.”
The growth of PAs in sub-specialty areas, Morton-Rias says, is also a testament to their dedication to their craft. Not only have they made the decision to pursue continued education in highly specialized areas, they also continue to maintain a generalist base of knowledge and skills that is reinforced through the certification and re-certification process.
“That enables us to move from discipline to discipline should we choose to over the course of our careers,” she says.
Environment of Acceptance
Morton-Rias says that while there are still pockets of physicians who are unsure how to integrate PAs into their practice, that’s a rare exception. The norm today is that physicians, for the most part, have trained as medical students and in their residency programs working with PAs.
“The physician community is so very well accepting of PAs because they understand and know what this profession is,” she says.
What about those who believe that old habits die hard? Ranawat acknowledges that there are always going to be those who adapt more slowly to change.
“I always say, you never want to be first and you never want to be last for a new trend,” he says. “But those people (who have not yet begun working with physician assistants) are now becoming last into a new trend.”