272389 Increasing health workforce capacity by utilizing physician assistants in clinical areas that exhibit a high degree of PA autonomy

Wednesday, October 31, 2012 : 11:00 AM - 11:15 AM

Raymond Fang, MSC MASC , American Academy of Physician Assistants, Alexandria, VA
Joshua Umar , American Academy of Physician Assistants, Alexandria, VA
Ann Davis , American Academy of Physician Assistants, Alexandria, VA
Michael Powe , American Academy of Physician Assistants, Alexandria, VA
Objective: Physician Assistants (PAs) are health professionals licensed to practice medicine as members of physician-directed teams. PAs provide disease prevention services, diagnose, and treat illness, manage chronic medical conditions, and provide a broad range of health care services traditionally performed by physicians. In many instances, especially rural and underserved areas, PAs are the primary health care professionals in the community. This study examines PAs' practice autonomy by clinical setting. Its conclusions inform policies addressing physician shortages through using team-based approaches that optimize the utilization of all available providers.

Method: Clinical settings were examined with data from the American Academy of Physician Assistants 2010 PA Annual Census. Based on frequency of consultation with supervising physicians during patient visits, level of autonomy was grouped as high (≤20%), medium high (21%-50%), medium-low (51%-80%) and low (>80%). Complex survey analyses were performed to survey samples with post-stratified weights assigned according to demographic, professional and clinical characteristics to ensure good representation of the entire profession.

Results: The proportions of PAs with a high degree of autonomy are 86.2% (95% confidence interval (95%CI): 81.7%-90.6%) in health centers, 66.9% (95%CI: 64.7%-69.1%) in physician offices, 54.1% (49.0%-59.3%) in hospital outpatient care settings, 44.6% (39.7%-49.6%) in hospital emergency rooms; and 25.6% (21.9%-29.2%) in hospital inpatient care settings. Higher proportion of PAs with high autonomy was seen in rural areas than metro centers (71.4% (95% confidence interval (CI): 68.0%-74.7%) versus 57.1% (95%CI: 55.6%-58.7%)). Other factors that influence the level of PA autonomy are specialty, region, and years as a PA and in current specialty.

Conclusions: Evidence is mounting that the U.S. is facing a growing shortage of physicians. Population growth and the increasing prevalence of chronic illness from aging, unhealthy behaviors, and disparities in health care are expected to have an unprecedented impact on provider demand. Thus, changes that reconfigure the way the providers are teamed, services are delivered, and physicians' time is utilized are necessary. This study is the first nation-wide look at the level of autonomy in health care delivery for PAs. Its findings suggest PAs' roles in high-autonomy areas should be further strengthened. We must design optimal medical teams and remove existing barriers to optimal utilization to address physician shortages and increase the availability of cost-effective medical services. During the implementation of health care reform, changes that reconfigure the way the providers are teamed and services are delivered will be necessary.

Learning Areas:
Chronic disease management and prevention
Other professions or practice related to public health
Provision of health care to the public
Public health or related research

Learning Objectives:
Identify clinical locations where physician assistants can function as primary or important health services providers especially in health centers where many vulnerable and underserved Americans usually receive care

Keywords: Workforce, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Vice President for Research and senior scientist at American Academy of Physician Assistants with 20 years of health care research experience. I have presented dozens of studies at conferences such APHA, AcademyHealth, AAMC, Society for Epidemiological Research and etc. and published dozens of articles at peer-reviewed journals including Lancet. My publications are mainly around public health, social determinants of health, health disparities, workforce, cancer epidemiology.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.