Are we facing a PA surplus?

[LKPAC]

Seeing this headline in the November 2016 issue of JAAPA.

 

I have long feared this.  Too many new PA programs churning out too many new grads.  I would also add that IMO, these new grads are of lower quality since prior HCE is often not required, or of lower quality.  Also, because there are more PA student slots to fill, it generally lowers the quality of pre-PA students that are accepted.  (before anyone hollers, I'm not suggesting that ALL new grads are inferior)  This has an overall effect of diluting our profession and lowering salaries.

 

 

[mgriffiths]

Being a PA student who graduates in a month and recently completed my job search, I can unequivocally say that there are plenty of jobs out there.  As others have mentioned on here, you have three choices and get to choose two: specialty, location, salary.

 

So, I would say that currently there is not a surplus, but that can quickly change if the need for PAs doesn't increase at the same rate as new programs.  One of the biggest questions is what happens with healthcare with our new president?  Assuming Trump follows through with his promise to repeal or at least significantly change the ACA - what will be the result?  If we can continue to increase the number of people who are insured (with decent health insurance) and work to increase awareness that UC/ED isn't primary care then we still have quite a bit of growth - especially as physicians seem to be running away from a lot of primary care jobs.  But, if the number of people insured decreases then we might hit that tipping point quite quickly.

[BruceBanner]

Myself and others have been predicting a surplus for a couple of years now.

 

I think it will be realized slowly, and will manifest in lower paying jobs for new grads, more demand for experienced PAs, and a lot more 1099 work.

 

For those of us who have been PAs for 5 or more years, I think we are 'grandfathered' in, but for new grads looking for work in certain areas, it's not going to get any easier.

[EMEDPA]

fewer folks with insurance doesn't mean less jobs, it means more jobs in places that folks go who don't have insurance; ERs, homeless clinics, etc.

[Katera]

It's a good question, and I think the answer is yes, but only because of the rapid rise of NP's doing "Online" training, getting out and competing for the same jobs and very willing to take less money to do it.  That has narrowed the job market substantially.

[treejay]

fewer folks with insurance doesn't mean less jobs, it means more jobs in places that folks go who don't have insurance; ERs, homeless clinics, etc.

Disagree.  Sure there will be a shift to those places, but the number of patient visits overall will decline with a decline in the # insured.  

[EMEDPA]

Disagree.  Sure there will be a shift to those places, but the number of patient visits overall will decline with a decline in the # insured.  

doubt it. people need care and will go where they need to get it. remember when GW Bush said "we already have a safety net system for health care in this country, it's called the ER".

[polarbebe]

No. As mentioned above more insurance means more visits by people.

 

Also bear in mind "we" as a profession are on occasion in direct competition with NPs for the same positions (depending on the state you reside in). NPs have 350 programs and last checked more than double the number of practicing NPs than PAs (per ARC-PA there are 218 PA programs, not sure all of them are up and running yet).

 

In my mind, it is possible some areas are saturated with PAs but overall there is significant demand for providers and if they are not filled by PAs then NPs will gladly take it... making it harder for PAs to get a foothold in that facility later (due to nursing administration typically preferring NPs over PAs).

 

As an aside... NYU is beginning the process of starting a PA program (expected to start in about 5 years or so). In one respect, NYC is saturated with PA programs with more programs than any other state by far. On the other side of the argument, NYU has been rated in the top ten hospitals in the country (per a recent report) and a NP stronghold; this can definitely help PAs obtain more exposure and increase the number of PAs at the facility (versus NPs), NYU medical school is rated in the top 20 of the country and potentially help produce some excellently trained PAs.

[treejay]

doubt it. people need care and will go where they need to get it. remember when GW Bush said "we already have a safety net system for health care in this country, it's called the ER".

nah.   The type of care that is delivered at a primary clinic and ER differ.  The most obvious example being annual preventative visits.  Those account for a lot of daily visits in a primary care clinic.  Those will go away as those patients become uninsured and they will present to the ER only for their acute complaints.   ER doesn't provivide "preventative care" in the sense of pap smears, routine screening labs, bone density scans, other routine screenings and immunizations on a general level.  of course there are specific exceptions but we're not discussing exceptions.

 

The ER is there to put out fires and a primary care clinic is in part there to prevent fires.  Sure with lack of primary care, there will be more fires to put out, but I don't think the number of visits is directly proportional.  Of course this is just all instinct, there is no data to support either of our claims to my knowledge

 

Ask any primary care clinic in my area, and you will find that # of visits and increased substantially and dramatically with the implementation of ACA and the increase in # of insured.  I guarantee you these people weren't all going to the ER for every one of these visits before they got insurance.  Now that they have it, they are just more likely to seek care in general, not just shift the venue they obtain that care. 

[LT_Oneal_PAC]

Agreed. 

 

While I'm not exactly ecstatic about the number of programs, if we don't fill empty positions the NPs will. Plus they have 250k graduate to our 100k, which combined with the sad percentage of us that give to the AAPA and PAC puts us way behind on lobbying efforts.

 

No. As mentioned above more insurance means more visits by people.

Also bear in mind "we" as a profession are on occasion in direct competition with NPs for the same positions (depending on the state you reside in). NPs have 350 programs and last checked more than double the number of practicing NPs than PAs (per ARC-PA there are 218 PA programs, not sure all of them are up and running yet).

In my mind, it is possible some areas are saturated with PAs but overall there is significant demand for providers and if they are not filled by PAs then NPs will gladly take it... making it harder for PAs to get a foothold in that facility later (due to nursing administration typically preferring NPs over PAs).

As an aside... NYU is beginning the process of starting a PA program (expected to start in about 5 years or so). In one respect, NYC is saturated with PA programs with more programs than any other state by far. On the other side of the argument, NYU has been rated in the top ten hospitals in the country (per a recent report) and a NP stronghold; this can definitely help PAs obtain more exposure and increase the number of PAs at the facility (versus NPs), NYU medical school is rated in the top 20 of the country and potentially help produce some excellently trained PAs.

[sillycibin]

Yes, we are heading for a surplus.  Especially when you look at the number of NPs being churned out.  I'm trying to remember the numbers off the top of my head, but basically since 2001 the number of NPs graduating every year has tripled from 6,000 to 18,000 and the number of PAs has doubled from 6,000 to 12,000.  And the projections for 2020 for PAs is 16,000 a year and I can only imagine NPs will be north of 20,000.  So we are looking at 36,000+ advanced practitioners being milled out ever year.  That's 2 PA/NPs for every 1 doctor graduating each year.  Just doesn't seem tenable.  You can look at recent history as to what happened to Pharmacy which was hot in the early 2000s and then Lawyers where there profession collapsed for new grads.  And you can also look to Europe where you have newly minted residency trained general surgeons who can't get jobs.  Initially it will be the new grads who get screwed.  I'm already seeing the majority of job postings demanding experience, 1 sometimes 2 years experience and recently I've even seen demands for 3 years experience.  I just hope PAs get independent practice soon so I can at least hang my own shingle and compete fair and square and not have to rely on being somebodies employee to make a living.

[sillycibin]

nah.   The type of care that is delivered at a primary clinic and ER differ.  The most obvious example being annual preventative visits.  Those account for a lot of daily visits in a primary care clinic.  Those will go away as those patients become uninsured and they will present to the ER only for their acute complaints.   ER doesn't provivide "preventative care" in the sense of pap smears, routine screening labs, bone density scans, other routine screenings and immunizations on a general level.  of course there are specific exceptions but we're not discussing exceptions.

 

The ER is there to put out fires and a primary care clinic is in part there to prevent fires.  Sure with lack of primary care, there will be more fires to put out, but I don't think the number of visits is directly proportional.  Of course this is just all instinct, there is no data to support either of our claims to my knowledge

 

Ask any primary care clinic in my area, and you will find that # of visits and increased substantially and dramatically with the implementation of ACA and the increase in # of insured.  I guarantee you these people weren't all going to the ER for every one of these visits before they got insurance.  Now that they have it, they are just more likely to seek care in general, not just shift the venue they obtain that care. 

I think studies have shown that even after giving people insurance the number of ER visits don't go down.  In some states they've been shown to go up.

[BruceBanner]

Yes, we are heading for a surplus.  Especially when you look at the number of NPs being churned out.  I'm trying to remember the numbers off the top of my head, but basically since 2001 the number of NPs graduating every year has tripled from 6,000 to 18,000 and the number of PAs has doubled from 6,000 to 12,000.  And the projections for 2020 for PAs is 16,000 a year and I can only imagine NPs will be north of 20,000.  So we are looking at 36,000+ advanced practitioners being milled out ever year.  That's 2 PA/NPs for every 1 doctor graduating each year.  Just doesn't seem tenable.  You can look at recent history as to what happened to Pharmacy which was hot in the early 2000s and then Lawyers where there profession collapsed for new grads.  And you can also look to Europe where you have newly minted residency trained general surgeons who can't get jobs.  Initially it will be the new grads who get screwed.  I'm already seeing the majority of job postings demanding experience, 1 sometimes 2 years experience and recently I've even seen demands for 3 years experience.  I just hope PAs get independent practice soon so I can at least hang my own shingle and compete fair and square and not have to rely on being somebodies employee to make a living.

 

Yep, the same thing happened with RNs and Lawyers. It's always regional; there will be hot spots.

 

But the job outlook for newly-minted PAs will most likely decline. I'm thinking gradually over the next 5+ years. It;'s not that newer PAs wont be able to FIND jobs, they will just be of low quality, low pay, or in undesirable places. May end up increasing the need for residencies.

[Maverick87]

Yep, the same thing happened with RNs and Lawyers. It's always regional; there will be hot spots.

 

But the job outlook for newly-minted PAs will most likely decline. I'm thinking gradually over the next 5+ years. It;'s not that newer PAs wont be able to FIND jobs, they will just be of low quality, low pay, or in undesirable places. May end up increasing the need for residencies.

 

This is what has always happens with just about everything. Something becomes hot. People that get in at the right time succeed and profit. People that get in too late have more difficulty.

 

Eventually, this will happen with our profession. It's hard to say when, but, just a guess, I think it's going to happen with the vast majority of baby boomers have hit the 65+ mark and when our health care situation stabilizes. Until then, we will notice a slow creep towards saturation.

 

I agree with the 5-10 year mark, which will be fine for us because we'll have A LOT of experience under our belts (I've been practicing for 4+ years as it is).

[gbrothers98]

Contrary argument.

Still plenty of places where PAs are not utilized to fullest due to a variety of issues including decisionmakers not savvy that the ratio of PAs to physicians should be inverted significantly. Currently 800k physicians vs 100k PAs. Economically does not make sense from a payor perspective. Also, insightful organization will understand can increase access for less $ with PA vs MD.

US population increases by a million each year or more. Plenty of demand for healthcare there.

Trend towards quality of life will continue. 32 hr work week will become standard. Only way to maintain access, hire more people.

Growth of programs will come to a standstill. ARC-PA will lay out timeline that most sponsoring institutions cannot matriculate a class for 3 years due to provisional accreditation resources available. The college or university that wants a clear money maker immediately does not want to wait that long. Plus if they investigate at all, they will quickly realize that those tuition dollars will get eaten up by faculty salaries and all the infrastructure required to host the program. Final cap will be difficulty with clinical site placements. Can pack them into a lecture hall but getting them out to a clinical site is....hard. That also limits growth of cohorts for existing.

New standards are also aimed at limiting that growth. Ensuring an active learning environment along with depth and breadth of experiences takes a lot of work and $.

Easier thing to do, dangle the program in front of undergrad cohorts, use that to increase undergrad enrollment. Won't improve finances by adding 5 master degree students over 2 years but will improve when 50 new undergrads are added over 4 years.

PAs with clinical experience will encounter new opportunities, education and IT will be big both with institutions and vendors but also in house. Clinical time will shrink and be replaced by admin duties.

There will always be opportunity for the flexible whom will go to the areas no one wants to go including setting up international programs in third world countries.

My take, I think the world is our oyster.

G. Brothers

[rev ronin]

Eventually, this will happen with our profession. It's hard to say when [...]

Maybe not today, maybe not tomorrow, but soon...

[Rhizopus]

Yes, it is true that we will see a tightening of jobs, but I think pretty much everyone saw this one coming. For new providers, I think we will see the role of institution attended play a bigger part in the future. Students that attend institutions with deeply rooted clinical networks, especially alumni networks, will have a relatively easier time finding initial work. When I started, I knew I I wouldn't attend a new program for that reason unless it was tied to a larger network. 

 

Perhaps this is also best for the profession. It will ultimately raise standards. Plus, health care professions have historically followed peaks and valleys based on supply and demand. A surplus would limit interest in programs, enrollment would drop, and this would linger for a decade or so until supply is limited or demand overcomes supply. Another way to look at it is that if there are more of us, then there are more people to advocate and influence for better work conditions. There's constant chatter about the power of nursing organizations. Part of that is because they have HUGE numbers. 

 

In my opinion, the majority of good jobs in the future will be in rural areas. Prospective PAs should strongly consider where they want to live before going down this path. Other nations are also looking to the PA model. For every new country that adopts the model, it will take time for their educational infrastructure to catch up. Great opportunity for those of us looking to live abroad.