Rising health care costs is a hot topic that impacts your clients in very real ways. How are we going to care and pay for patient services in the coming decades? That is a question facing the health care industry as demand grows, while the physician shortage worsens and the possibility of further reform at the federal level remains uncertain.

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

At the dawn of the profession, PAs practiced almost entirely in local primary care offices. Today, more than 70 percent of PAs now practice in non-primary care areas, such as emergency and hospital medicine, surgical specialties, psychiatry and other high-impact areas.

Gaining insight into the expanding role of PAs can help benefit leaders and managers know how PAs are expanding access to high-quality care, controlling costs and working collaboratively with physicians to help improve health outcomes.

A brief history

The first class of PAs graduated from Duke University 50 years ago. The profession was started by physicians who recognized the need for more providers to care for an increasing number of patients, including those covered by the recently passed Medicare legislation. Military medics returning from the Vietnam War were prime candidates to be educated in the medical model and work side by side with physicians.

Increasing demand

The demand for skilled medical providers continues today, and is expected to increase over time. While the nation continues to debate health care policy, aging baby boomers and an escalation in chronic illnesses fuel the need for health care services.

This demand coincides with the aging of the physician population. Surveys report that many physicians plan to retire earlier. As a result, analysts are predicting a significant shortage of providers by the early 2020s.

PA profession today

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

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

A continuing trend toward specialization. Over 70 percent of PAs work in specialties outside of primary care, including in highly technical surgical specialties.
Healthy workforce gains. Almost 6,900 new PAs entered the workforce last year indicating the profession continues to be an attractive option for those seeking a medical career with stability, professional fulfillment and flexibility to move across specialties.
Two new medical specialties captured. As America’s population lives longer with chronic diseases, pain management and hospice and palliative medicine are growing areas, captured for the first time in this report.
A capacity for growth. Most of the 69 unique medical and surgical specialties experienced growth, with significant growth found in family medicine, emergency medicine and orthopaedic surgery.
PAs meet patients where they live. PAs are filling care gaps in rural states such as Alaska, Idaho, and Montana where PA-to-patient ratios are higher than most states.

Certified PAs work in every clinical setting, including almost 40 percent in hospitals. More than 18 percent work in surgical subspecialties, including cardiothoracic and vascular surgery, and orthopaedic surgery. Another 13 percent work in emergency medicine. Certified PAs also provide care in virtually all specialty areas, including oncology, gynecology, gastroenterology, psychiatry and neurology.

Proven and prepared

PAs today are also doing more than ever before. Beyond taking a history and performing a physical exam, PAs are diagnosing, treating and managing acute illnesses. We order and interpret lab tests, X-rays, EKGs and other diagnostic studies. We counsel and educate patients and families and fulfill a critical role in care coordination, helping to ensure smooth transitions and reduce hospital readmissions.

Our rigorous education helps to prepare us with the knowledge and 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. This intensive educational process is based on the medical model. In fact, we often take the same Continuing Medical Education (CME) courses as physicians.

Upon graduation, PAs must pass a rigorous certification exam before receiving our license from any state medical board. These exams are created by peer PA groups and physicians and are continuously updated to ensure they reflect current practice patterns.

Certified PAs maintain the highest levels of certification in health care. That includes earning 100 CME credits every two years and passing a recertification exam every decade.

Many PAs choose to further document experience and skills by obtaining an additional credential — the Certificate of Added Qualifications (CAQ). To gain the CAQ, PAs must have experience in the specialty, 150 CME credits focused in the specialty and, and acquire a physician attestation of their knowledge and skills. Then the PA must pass a national exam focused solely in that specialty. CAQs are available for seven specialty areas: cardiovascular and thoracic surgery, emergency medicine; hospital medicine; nephrology; orthopedic surgery; pediatrics and psychiatry.

What this means for benefits industry leaders

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. For example, a recent peer reviewed article reported that over an 18-month period, there was no significant difference in patient mortality, hospital readmissions, lengths of stay and consults with specialists such as cardiologists when care was led by PAs compared with doctors.

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

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

Instant Insights /

How physician assistants are helping control health care costs, expand access

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