Comparing urban and rural Physician Assistants in hospital outpatient departments, 2005-2009

Physician Assistants (PA) play an integral role in the healthcare system. According to the 2009 American Academy of Physician Assistants (AAPA) Census, there are 72,433 individuals eligible to practice as a PA in the United States. Currently, it is estimated that there is one PA for every ten physicians in clinical practice. Although the original intended goal of the PA was to care for the underserved and rural communities, there is limited data on the PA's role in rural community health. The purpose of this study is to investigate differences in patient characteristics and provider services between urban and rural PAs in the National Hospital Ambulatory Medical Care Survey (NHAMCS) Outpatient Department 2005-2009. This is a cross-sectional study including only visits from the NHAMCS outpatient department who saw a provider. From 2005 to 2009, subjects were 3.46 times (95% CI, 2.22-5.41) more likely to seen by a PA than a physician in a rural location when compared to an urban location. There were 9,847 visits seen by PAs in hospital outpatient departments representing 32,029,901 visits nationally. The only predictor variables that were associated with being seen by rural PAs were ordering of medications and being in a general medicine outpatient department. Taken together these results indicate there are differences between PAs practicing in urban and rural areas, therefore more studies are needed to further elucidate these differences.