Physician Assistants Employed by the Federal Government

Characteristics of physician associates/assistants in dermatology

The dermatology workforce includes physicians, nurse practitioners (NPs), and physician associates/assistants (PAs). The number of dermatologists is growing slowly while the growth of PAs working in dermatology is rapid and accelerating. To understand their characteristics, a descriptive study of PAs practicing in dermatology utilizing the National Commission on Certification of Physician Assistants (NCCPA) workforce dataset on PA practices was undertaken. NCCPA certifies PAs who practice in the United States and queries them about their role, employment, salary, and job satisfaction. Analyses consisted of descriptive statistics, Chi-Square, and Mann-Whitney tests for comparisons between PAs practicing in dermatology versus the total of all other PA specialties. As of 2021, 4,580 certified PAs reported practicing in dermatology-a nearly twofold increase since 2013, when 2323 worked in the specialty. This cohort's median age was 39 years, and 82% were female. Almost all (91.5%) are office based, and 81% work more than 31 h per week. The median salary was $125,000 (2020 dollars). Dermatology PAs work fewer hours and see more patients than their counterparts compared to all 69 PA specialties. At the same time, dermatology PAs are more satisfied and less burnt out when compared to all PAs. The increased number of PAs selecting dermatology as their discipline can help lessen the projected physician shortage in this field.

Physician Associates/Assistants in Primary Care: Policy and Value

Since the new century, primary care physician supply has worsened. Analysts predict that health service demand in the United States will grow faster than physician supply. One strategy is the utilization of physician assistants/associates (PAs). Most PAs work full-time, and approximately one quarter are employed in family medicine/general medicine. PAs deliver primary care services in a team-oriented fashion in a wide variety of settings, including private health systems and community health centers. One fifth work in rural and medically underserved areas. Together PAs and nurse practitioners provide approximately one third of the medical services in family medicine, urgent care, and emergency medicine.

PAs in the National Guard and Reserves: Army, Navy, Air Force, Coast Guard

ABSTRACT

The role of physician assistants (PAs) in the United States extends to the Army National Guard; Air National Guard; and reserves of the Army, Navy, Air Force, and Coast Guard (collectively known as reserve components). To understand the duality of civilian-military PA roles, a census of the armed forces was undertaken, drawing on knowledgeable senior PA medical officers in each of the services. The survey was supplemented with data from the National Commission on Certification of Physician Assistants. In 2020, there were 1,944 PAs in the five military reserve components with the majority (1,597) in the Army. Most National Guard, Air National Guard, and Reserve PAs fill medical officer roles, drill with units, and are subject to active duty. As soldiers, sailors, and airmen, military PAs are trained in health, safety, warfare readiness, casualty, trauma, and crisis response. The tenure of a reserve component PA in the military ranged between 10.2 and 17.8 years. In their civilian roles, most PAs are licensed and clinically active-the majority report they work in family/general medicine, emergency medicine, general surgery, or orthopedic medicine and surgery. This dual-career role and responsibility suggests the utility and flexibility of the PA is broader than previously reported. The findings set the stage for additional research on healthcare professionals during times of domestic and international emergencies.

The history and role of PAs in the US Coast Guard

The US Coast Guard is a military service in the Department of Homeland Security charged with broad domestic and international missions. In 1971, the Coast Guard began recruiting physician assistants (PAs) in an effort to supplement physician staffing support. When first introduced, PAs were in the enlisted ranks. However, consistent with the other armed services, their entry ranks changed from enlisted to commissioned warrant officer and later to a commissioned officer status. As their numbers grew, PAs began augmenting and later replacing general medical officers assigned to treatment facilities and aboard ships. Their role is to keep the 43,000 men and women of the Coast Guard and their dependents healthy by providing medical care at 40 bases and stations. As of 2020, the Coast Guard has 47 commissioned PAs who work on shore postings, on polar-bound ice breakers, training ships, as faculty in the Interservice Physician Assistant Program, or as senior administrative officers. About one-third are female.

Physician assistants in geriatric medical care

BACKGROUND

The US population is maturing. As of 2020, over 52 million (16%) people are age 65 or older. With a citizenry that is increasingly "gray," the nation is short of medical providers who specialize in geriatric medical care. For example, the number of geriatrician physicians per 10,000 adults 65 years and older has decreased since 2000, with approximately 5300 in 2018. Nurse practitioners in geriatric medical care numbered 598 in 2018. Considering that the projected needs by 2030 will be over 30,000, the trajectory of geriatricians is becoming increasingly inadequate for the aging population. Physician assistants (PA) are another class of providers that are filling this geriatric medical care role, although little has been published. To address this role of PAs a study was undertaken.

METHODS

The National Commission on Certification of Physician Assistants databank provided the number and characteristics of PAs in geriatric medicine and compared them to all other certified PAs. Analyses included descriptive statistics, Chi-Square, and Wilcoxon Rank Sum tests for comparisons between PAs practicing in geriatric medical care vs. all other PA specialties. Where a comparison between PAs in geriatrics and other specialties was made, a P value of .05 or less was considered statistically significant.

RESULTS

As of 2018, there were 794 certified PAs, or 0.8% of the certified PA workforce, in geriatric medical care. This cadre has grown significantly since 2013, both in total number (increasing over 373%) and as a percentage of the PA workforce. The median age of certified PAs in geriatrics is 45 years, and 79% are female. Almost half (46%) of PAs in geriatric medicine work in extended care facilities or nursing homes, which differs from PAs in non-geriatric care. Another 8% work in government facilities and 8% in rehabilitation facilities. In 2018, the mean annual income for this PA group was $106,680.

CONCLUSIONS

As the American population continues to age, the relative growth of PAs in geriatric medicine makes them a natural part of the solution to the projected physician geriatrician deficit. The role of PAs in geriatric medical care remains to be explored.

Public policies that shaped the american physician assistant

Introduction

The American physician assistant (PA) was created through a series of federal policies and legislative acts. Each was intended to improve society through advancements in the delivery of healthcare. The theory why this public policy developed has been unexplored.

Method

A search of reports was undertaken to identify national legislation that enabled the PA to be included in the American medical workforce. The effect was a chronology of federal acts and policies.

Results

In the early 1960s editorials, conference proceedings, and reports signaled that more access to physician services was needed for a growing American society. Beginning in 1965 with a series of congressional acts such as Medicare and Medicaid, a call was made for a physician analog. Envisioned was a type of assistant who could undertake many of the routine responsibilities of the doctor. Half a century later the number of clinically active PAs exceeds 120,000 and 260 PA programs are operational. What policies gave impetus to this novel health workforce innovation? All the acts and policies produced by Congress or federal agencies that involved PAs were analyzed, summarized, and placed in chronological order. The result reveals an evolution of healthcare reform that continues well into the 21st century.

Conclusion

From 1966 to 2024 (58 years) there were 18 significant federal acts, policies, and improvements that enabled PAs to provide medical services in American society. With each enactment drawing on the success of preceding ones, more expansion of the PA took place and their utilization grew.

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American public health policy is an evolutionary process building on the success or effect of previous ones.

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Federalism is the sharing of power between government and states as to how should be shared.

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The physician assistant is the result of national polices to promote primary care and the care of vulnerable populations.

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The COVID-19 Crisis of 2020 propelled PAs into national spotlight as an adaptable and flexible medical workforce.