Rising health care costs is a hot topic that impactsyour clients in very real ways. How are we going to care and payfor patient services in the coming decades? That is a questionfacing the health care industry as demand grows, while thephysician shortage worsens and the possibility of further reform atthe federal level remains uncertain.

Amid the uncertainty, one thing has become increasingly clear:cost-effective, qualified providers are a critical component of theequation, and highly educated certified physician assistants(PA-Cs), are prepared to perform many of the same duties ordinarilyprovided by physicians.

At the dawn of the profession, PAs practiced almost entirely inlocal primary care offices. Today, more than 70 percent of PAs nowpractice in non-primary care areas, such as emergency and hospitalmedicine, surgical specialties, psychiatry and other high-impactareas.

Gaining insight into the expanding role of PAs can help benefitleaders and managers know how PAs are expanding access tohigh-quality care, controlling costs and working collaborativelywith physicians to help improve healthoutcomes.

A brief history

The first class of PAs graduated from Duke University 50 yearsago. The profession was started by physicians who recognized theneed for more providers to care for an increasing number ofpatients, including those covered by the recently passed Medicarelegislation. Military medics returning from the Vietnam War wereprime candidates to be educated in the medical model and work sideby side with physicians.

Increasing demand

The demand for skilled medical providers continues today, and isexpected to increase over time. While the nation continues todebate health care policy, aging baby boomers and an escalation inchronic illnesses fuel the need for health care services.

This demand coincides with the aging of the physicianpopulation. Surveys report that many physicians plan to retireearlier. As a result, analysts are predicting a significant shortageof providers by the early 2020s.

PA profession today

Here’s where the PA profession is helping to meet the growingdemands for health services. The number of certified PAs isincreasing more quickly than the number of physicians — almost 45percent in the last six years. We are a younger profession. Theaverage age of PAs is 40 versus an average age of 40 among physicians. Additionally, mostPAs are highly satisfied with their jobs and report they plan tostay in the profession. According to PA practice profile data fromthe National Commission on Certification of Physician Assistants(NCCPA), less than 1 percent of PAs plan to retire within the nextyear.

The NCCPA has been providing certification programs for PAs formore than 40 years. We have profile information on 94 percent ofthe nation’s 115,500 Certified PAs. Per the latest data, CertifiedPAs are increasingly moving into areas where there is strongpatient need. Here’s a quick summary of findings from our 2016 Statistical Report of Certified PhysicianAssistants by Specialty, released earlier thissummer.

• A continuing trend toward specialization. Over70 percent of PAs work in specialties outside of primary care,including in highly technical surgical specialties.

• Healthy workforce gains. Almost 6,900 new PAsentered the workforce last year indicating the profession continuesto be an attractive option for those seeking a medical career withstability, professional fulfillment and flexibility to move acrossspecialties.

• Two new medical specialties captured. AsAmerica’s population lives longer with chronic diseases, painmanagement and hospice and palliative medicine are growing areas,captured for the first time in this report.

• A capacity for growth. Most ofthe 69 unique medical and surgical specialties experienced growth,with significant growth found in family medicine, emergencymedicine and orthopaedic surgery.

• PAs meet patients where they live. PAs arefilling care gaps in rural states such as Alaska, Idaho, andMontana where PA-to-patient ratios are higher than moststates.

Certified PAs work in every clinical setting, including almost40 percent in hospitals. More than 18 percent work in surgicalsubspecialties, including cardiothoracic and vascular surgery, andorthopaedic surgery. Another 13 percent work in emergency medicine.Certified PAs also provide care in virtually all specialty areas,including oncology, gynecology, gastroenterology, psychiatry andneurology.

Proven and prepared

PAs today are also doing more than ever before. Beyond taking ahistory and performing a physical exam, PAs are diagnosing,treating and managing acute illnesses. We order and interpret labtests, X-rays, EKGs and other diagnostic studies. We counsel andeducate patients and families and fulfill a critical role in carecoordination, helping to ensure smooth transitions and reducehospital readmissions.

Our rigorous education helps to prepare us with the knowledgeand skills we need to move into these different specialty areas.The majority of PAs earn a master’s level degree (72.7 percent),averaging 1,000 didactic hours and 2,000 clinical hours. Thisintensive educational process is based on the medical model. Infact, we often take the same Continuing Medical Education (CME)courses as physicians.

Upon graduation, PAs must pass a rigorous certification exambefore receiving our license from any state medical board. Theseexams are created by peer PA groups and physicians and arecontinuously updated to ensure they reflect current practicepatterns.

Certified PAs maintain the highest levels of certification inhealth care. That includes earning 100 CME credits every two yearsand passing a recertification exam every decade.

Many PAs choose to further document experience and skills byobtaining an additional credential — the Certificate of AddedQualifications (CAQ). To gain the CAQ, PAs must have experience inthe specialty, 150 CME credits focused in the specialty and, andacquire a physician attestation of their knowledge and skills. Thenthe PA must pass a national exam focused solely in that specialty.CAQs are available for seven specialty areas: cardiovascular andthoracic surgery, emergency medicine; hospital medicine;nephrology; orthopedic surgery; pediatrics andpsychiatry.

What this means for benefits industryleaders

As much as our profession has grown and changed over the years,there remains some stubborn misperceptions that must be addressed.Certified PAs provide exceptionally high levels of care. Forexample, a recent peer reviewed article reported that overan 18-month period, there was no significant difference in patientmortality, hospital readmissions, lengths of stay and consults withspecialists such as cardiologists when care was led by PAs comparedwith doctors.

Additionally, while we perform many of the same services andprocedures, PAs are often billed at 85 percent of the physician feeschedule, except when we provide care incident to the physician.PAs are also much more cost-effective for hospitals and medicalgroups to employ.

With proven outcomes and a profession that emphasizes education,certification, communication and care coordination, the message forconsumers and patients is clear. PAs are key members of the healthcare team. Patients who see certified PAs can be assured that thoseproviders are caring and committed, as well as proven and prepared,to provide the highest standards of care. Their willingness toembrace PA services ultimately will help improve health care andlower overall costs.