Future excess of PAs? Anyone worried?

[RHC81]

Obviously, PAs are getting a lot of press about being in a "recession-proof job" and having a great future and great potential for growth. PA programs seem to be popping up all over the place, even in schools that have previously had no healthcare programs whatsoever. Application rates for PA programs keep shooting up, and it seems that many programs are requiring little to no HCE to actually matriculate.

 

Do any of you worry that this increased attention will eventually be a problem? As in, with more PAs than jobs? It seems like this is already becoming reality in some areas, but do you foresee it spreading nationwide? Or do you think that the number of new PAs and new PA programs will naturally balance with attrition?

 

ETA: I tried to think of a decent number of alternatives for the poll, but it's late. So my apologies if the poll options seem too limited.

[RHC81]

I know the ACA is expected to flood healthcare with new patients, which is part of the driving force of the media calling this profession "recession-proof." But I also know that there are other areas of healthcare that have become oversaturated, depending on the market.

 

Incidentally, "recession-proof" is not my term; it's the one I see over and over in the print and broadcast media. Personally, I think it's slightly a misnomer.

 

Many factors are in play here: number of PA programs starting, number of PAs graduating, number of actual patients being seen that have not been seen prior to ACA, number of MDs/DOs in given fields, choice of PAs to go primary care or into a specialty, post-graduate residencies (if any) for PAs, etc. And this isn't even counting the NPs and their numbers.

 

Actually, this question was born of several discussions I read on allnurses. The nurses there were saying that many markets are oversaturated with new RN grads, and, in order to find an actual job, new RNs either had to leave the area or do per diem work or cobble together part-time jobs. A few places were even offering "residencies" to new RNs so they could get a few years' experience under the belt. With PAs being touted (accurately or not) as a "quick route" to healthcare provider, I started wondering if we might eventually see the PA profession experiencing the same problem - new grads unable to find work, markets saturated, etc. Furthermore, staffing usually does not require as many midlevel providers as staff nurses, so it seemed that the problem has the potential to even be more pronounced in the midlevel provider arena.

 

Part of this is also based on the perception put forth in the public mind. For a person with a non-science baccalaureate, it's two years' graduate school to PA. It's at least two years of nursing school to RN (or BSN), then another two or three to APN. So, for many college grads, PA may be the faster route to midlevel provider; this often translates in the public mind to "easier." Most people usually choose the path of least resistance. Could this be part of what is driving the significant increase in applications to PA programs? That, and the perception that one will walk out of PA school into the market and specialty of one's choosing and demand six figures?

 

Mathematically, at some point, even with millions of patients entering the healthcare scene, you must meet or exceed the demand for midlevel providers if the provider numbers continue to increase. The provider numbers cannot increase indefinitely without saturation of the field. Where that point is, I do not know - thus, my question. We may be far from that point, even with the increase in NPs and PAs.

[EMEDPA]

the number of patients, especially older pts, is increasing more rapidly than the number of medical providers. If I am remembering correctly there is forcast to be a shortage of medical providers for at least the next 60 years.

[LT_Oneal_PAC]

I'm not worried in the least. Here's why in no particular order:

 

The more of us there are, the better our lobby efforts, the more autonomy we have, the more jobs will open up.

 

Since we can go into almost any medical field, there will always be jobs. Will you get that favorite of yours? Maybe not, but neither do docs. May have to spend time in primary care before you get it. This is a good thing for patients.

 

Residencies will become required and will control numbers.

 

Nursing (RN) is irrelevant because it's not nearly as hard as becoming a PA. People love nursing because you can go from a high school degree to an associate in nursing from your local uncompetitive CC and double your income. Plus all the things PAMAC said are true. As an RN I can tell you it's totally different situation.

 

Even without ACA, we are very short on providers and will be in the foreseeable future.

 

Lastly, I'll already have a job by the time it happens ;) jk

[primadonna22274]

I am absolutely NOT worried about the future of PAs in American medicine. As E said, the aging masses and explosion of lifestyle diseases will keep us all employed throughout our careers, at the very least. I might be concerned that salaries will remain stagnant and very well might fall, as they are projected to do for physicians. If anything I should perhaps be worried about becoming a primary care physician myself, but I'm a born romantic and FM is my first love, so....

Anyone else care to gaze into the crystal ball and predict our future?

:)

[Gordon, PA-C]

Over the next 20 years or so we'll be OK, but after the baby boomers start dying off, there will be a surplus of medical providers. There are 40 new med schools in the works, half a dozen PA programs will open in that time, and the number of NP programs is skyrocketing every year.

[Joelseff]

I am absolutely NOT worried about the future of PAs in American medicine. As E said, the aging masses and explosion of lifestyle diseases will keep us all employed throughout our careers, at the very least. I might be concerned that salaries will remain stagnant and very well might fall, as they are projected to do for physicians. If anything I should perhaps be worried about becoming a primary care physician myself, but I'm a born romantic and FM is my first love, so....

Anyone else care to gaze into the crystal ball and predict our future?

:)

 

I'm with you Lisa. I love IM/FP! (With a HIV sub, certification in progress :p )

I deliberately went into this profession knowing I would be in PC. I have been in PC a total of 16 years including pre-pa and though I tried some specialty jobs (physiatry/pain, and GI/Hep) I treated those jobs like residency rotations FOR Family Med. Yah the money sucks but who wants to be rich :rolleyes:

 

 

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[burnpac]

There is no end in sight for continued robust demand for PAs in any analysis.

 

Markets will always vary geographically. PAs in the major metropolitan areas of California make MUCH less than PAs in the rural and medically underserved areas. This is the price that PAs pay to live in "desirable" areas.

 

The big problem into the foreseeable future is how to train adequate numbers of PAs as rapidly as possible.

 

As I tell all my rotating students, this is a great time to be a PA.

[Guest hubbardtim48]

Also, I think past medical experience counts (RN, RT, paramedic, chiro, med. tech. etc..). My goal is to practice in rural health, but as an asthma educator and having years of experience in this specific area, I think I favor better in a allergy/asthma clinic than most people that have experience as a PA. Also, having years of critical care experience, I would hope that my past knowledge on vents, trauma, resp., etc would really help getting a job in a small critical access hospital. I would hope this would be true, but I think it depends on a million things on each specific job that one is applying too. I am saying this because a lot of people in my class are doing the same thing. Some of the ATs are only applying to ortho. jobs because they have years of experience in being a physician extender as an AT. If I applied for the position I would get laughed at, so that is why I am going to apply to more pulm/cardio jobs because my past HCE is in those two areas.

[KMD16]

IM/FP provides the basic foundation/tools prior to transitioning to pulmonary/cardio subspecialty. I don't care what your experience where prior to PA school. Just my 0.02c

[Guest hubbardtim48]

I am not saying my RT/asthma educator experience over rules other PAs, I was just stating that if I applied to an ortho position and a AT applied that had ortho experience, who do you think they would pick. Also, the AE-C is (in my book) a big deal and is a very hard test to master. The guidelines are used in primary care settings which are the same thing I do on a daily basis through a physician/therapist driven protocol. I will go into IM/FP and would love to work there my entire life, but if a pulm/allergy/asthma job opens up then I am there and would hope that my past experience would out way LOTS of people. Also, the AE-C can make the clinic/hospital money due to reimbursement of the credentialed provider.

[Mainer]

I agree that the future of the PA profession has never been brighter.

There are predicted shortages of primary care providers and recent reports suggest that analysis likely underestimated the extent of the shortage.

This is the opportunity for the profession to grow.. And the growth of the profession only makes it stronger and more relevant in the face of such demands.

With increased numbers, there is more organizational money and more political clout. As I understand it, the organization is very deliberate in opening additional programs after careful market analysis. The larger the segment of the current and forecasted market we fill, the brighter and more powerful the profession becomes.

If the profession were to sit back failing to graduate more students, the markets for providers would simply allow others to fill the demands. I think that capping growth based on the thought process it would make the PA profession "more exclusive" is the result of common everyday skepticism driven by small talk among students and practicing clinicians in the trenches. Failing to grow would be destructive to the profession.

Competition for PA school has never been so competitive.

The profession has never been stronger.

The Pay for PA's has likely never been better.

The forecast for the profession has never looked so promising.

The challenge is opening enough PA schools to give the profession the marketing advantage it deserves.

 

 

At least, the aforementioned is how I have come to understand it.

[KitKat85]

I have been thinking that lately. There are a LOT of people interested in becoming PA's. Its crazy that some programs require little or no HCE. That doesnt make sense at all. It kind of reminds me of nursing where everyone and their grandma wants to be a nurse. I hope the PA field doesnt become saturated. Oh and Im tired of hearing about "recession proof" jobs because there is no such thing.

[mjl1717]

the number of patients, especially older pts, is increasing more rapidly than the number of medical providers. If I am remembering correctly there is forcast to be a shortage of medical providers for at least the next 60 years.

 

Yes, this is what it looks like to me! At first I thought they opened too many PA programs in a short period of time in the congested New York City area.

But after speaking to a fairly reliable source in the Bronx..They say PAs are still in demand..

In addition I always see jobs for Ortho, E.R. and the Derm specialty often pops up...And hands on experience means a lot!

[SocialMedicine]

You need to plan for the baby boomers .... but ALSO plan for what comes after that generation ..... We set up PA schools and seats for generations .... Not for ten - twenty years ....... If PAs are not HAPPY and WELL PAID this nations healthcare will suffer. I would not do this job for anything less than 80-90K a year. Far too complex and stressful a career for anything less. The more PAs on the market .... demand will get driven down .... and the talented people will become MD's, NP's or healthcare consultants. I ama BIG SUPPORTER of MORE CONTROL in the number of PA programs. Seems like anyone with a room can start a program these days. Some of the institutions with PA programs is unreal.

[KCMA79]

It seems as if PA programs have become a huge cash cow for many institutions. And as long as there are people standing in line to pay they will continue to expand. We lost control of our profession yrs ago to mult boards, commissions and such because many of us were busy just trying to survive as a profession.

[SocialMedicine]

I AGREE 100%

I hope those involved in AAPA become MORE VOCAL ABOUT THIS. I hold an AAPA leadership position and will start speaking my mind more and more.

 

It seems as if PA programs have become a huge cash cow for many institutions. And as long as there are people standing in line to pay they will continue to expand. We lost control of our profession yrs ago to mult boards, commissions and such because many of us were busy just trying to survive as a profession.

[LT_Oneal_PAC]

We don't need to become more exclusive when a) we are facing provider shortage b) our national organization (supposedly) can't find the funds for AA batteries, much less a PR campaign, a title change, or even a study for title change. That is not to say we shouldn't change entrance standards to be uniform and more stringent. The choke point should be working hard enough to get in, not finding a school at all.

[Mainer]

So, let’s say, the AAPA et al decides to limit the number of programs and graduates in the face of increasing demands for mid-level providers.

Who do you think is going to fill the market demands PA's fail to fill? ANSWER: Mostly NP's (as well as others).

Limiting the number of programs/graduates will not increase jobs nor pay for PA's. It will simply allow NP's to fill more of the jobs (and they will).

PA's will simply become less relevant in the changing healthcare climate. NP's will find themselves on more hospital and government committees, more management positions, more hiring committees, as well as more nursing organizational funds, votes, and clout......

 

We need to increase PA graduate output big time!

We need improved educational access to PA education. Somebody mentioned all you need is an empty room. Advantage goes to NP's (they simply need a computer).

We need more preceptors.

We need more new (modern) ideas on how to educate and train PA's.

 

Just my opinion.

[EMEDPA]

at the same timne we need to maintain admission standards and the quality of our educational process.....the only way we win is by putting out a superior product. flooding the market with underqualified folks just makes us look bad. it only takes 1 bad pa to sour a group on pa's and make them hire np's....

[andersenpa]

at the same timne we need to maintain admission standards and the quality of our educational process.....the only way we win is by putting out a superior product. flooding the market with underqualified folks just makes us look bad. it only takes 1 bad pa to sour a group on pa's and make them hire np's....

 

I hate to bring caq into this...but part of creating that quality product is standardizing some sort of clinical benchmark after the first few yrs of practice.

 

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[Mainer]

at the same timne we need to maintain admission standards and the quality of our educational process.....the only way we win is by putting out a superior product. flooding the market with underqualified folks just makes us look bad. it only takes 1 bad pa to sour a group on pa's and make them hire np's....

 

Agreed.

 

I would contend that admission standards have never been more competitive (more applications per seat than ever before).

PA programs can pick and choose what they want their classes to look like. Some value previous healthcare experience - others value GPA's/Stats. I graduated from a program that valued "liberal arts" backgrounds and diversity among the student body. By far the sharpest person in my class was a pianist in their previous career....next was a PhD level history professor (go figure).

However, the quality of PA education leaves something to be desired.

At least compared to other models of training healthcare providers, which are considerably more elegant.

PA education is purely vocational in nature - far from an educational masterpiece.

On the other hand, the 2+/- year model of PA education was never designed for quality.

It was designed to be pragmatic and for efficiency (train folks to be providers fast)

 

.....as I understand it, anyway.

 

Surely, PA education can't afford to compromise on quality.

[EMEDPA]

I hate to bring caq into this...but part of creating that quality product is standardizing some sort of clinical benchmark after the first few yrs of practice.

 

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Many of the residencies are( at least in em) are now gearing themselves toward taking the caq.

we can debate whether or not it's a good thing but I think residencies and caq's are coming to the pa world and we can't turn back the clock on it in the same way that docs in the 70's and 80's could not resist board certification requirements.

[andersenpa]

Many of the residencies are( at least in em) are now gearing themselves toward taking the caq.

we can debate whether or not it's a good thing but I think residencies and caq's are coming to the pa world and we can't turn back the clock on it in the same way that docs in the 70's and 80's could not resist board certification requirements.

 

Either mandatory residencies (not saying that's best) or some other documentation of competency goals (cases logged, focused CME, authorship, CAQ etc)...

 

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[EMEDPA]

I think we are headed for required residencies and caq eligibility for those who complete them