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Education: Higher Education

The Physician Assistant Profession: Reflections on Its Past, Present, and Future

Class 3: Contributions of Physician Assistants to Primary Health Care and Non-Primary Health Care Fields


As the physician assistant (PA) profession grew, its original focus on primary health care and underserved areas diminished somewhat during a period of spectacular growth in specialty care in the 1980s and 1990s. PAs moved increasingly into non-primary healthcare specialties and into hospital settings, where they met other emerging needs. In the late 1990s, the American Council of Graduate Medical Education reduced the number of positions available for residency training of physicians and at about the same time, it reduced the number of hours that residents were allowed to work. Consequently, PAs were hired to fill an important niche that had previously been occupied by physician residents-in-training. At the same time, PA career patterns were becoming clearer, and the PA profession was seen increasingly as a satisfying and productive career for health professionals who enjoyed treating patients. The financial rewards were (and continue to be) attractive relative to the financial costs of training and the time required to complete it, particularly when compared to careers for physicians.

Suggested class outline:

  1. PAs providing primary health care in underserved areas (among the first generation of PAs, more than 50% worked in primary care specialties and over 20% were located in communities of fewer than 50,00 people)
  2. PAs providing primary health care in government programs, including the military (for example, the Veterans Administration was one of the earliest PA employers and is now the largest employer of PAs)
  3. PAs working in private practices that provide primary health care (including the delivery of primary care services by PAs who work in specialty practices) and the utilization of PAs in virtually all medical and surgical specialties (especially emergency medicine, orthopedics, cardiology, cardiothoracic surgery, and dermatology)
  4. PAs providing primary health care in organizations (including a growing role in Federally Qualified Community Health Centers, which serve uninsured populations)
  5. PAs working in non-primary care specialties (such as surgical and medical sub-specialties) and the growth of PA utilization in specialties and subspecialties
  6. PAs working in academic medical centers and referral hospitals (which increased in 2004 in part due to restrictions imposed by the American Council of Graduate Medical Education on the number of physician residency training positions as well as the number of hours worked by physician residents-in-training)
Class Resources
Core resources
  • American Academy of Physician Assistants. “Physician Assistants: A Fast-Growing Profession.” YouTube video, 7:20. Posted January 31, 2012. (accessed 10/7/2016).
  • Coplan, Bettie, James F. Cawley, and James Stoehr. “Physician Assistants in Primary Care: Trends and Characteristics.” Annals of Family Medicine 11, no. 1 (2013): 75–79. doi: 10.1370/afm.1432.
  • Detmer, D. E., and Henry Perry. “The Utilization of Surgical Physician Assistants: Policy Implications for the Future.” The Surgical Clinics of North America 62, no. 4 (1982): 669–675.
  • Heinrich, J. J., et al. “The Physician’s Assistant as Resident on Surgical Service. An Example of Creative Problem Solving in Surgical Manpower.” Archives of Surgery 115, no. 3 (1980): 310–314. doi:10.1001/archsurg.1980.01380030056012.
  • Hooker, R. S. “The Military Physician Assistant.” Military Medicine 156, no. 12 (1991): 657–660.
  • Morgan, Perri A., and Roderick S. Hooker. “Choice of Specialties Among Physician Assistants in the United States.” Health Affairs 29, no. 5 (2010): 887–892. doi: 10.1377/hlthaff.2008.0835.
Supplemental resources
  • Doescher, M. P., et al. “The Contribution of Physicians, Physician Assistants, and Nurse Practitioners Toward Rural Primary Care: Findings From a 13-state Survey.” Medical Care 52, no. 6 (2014): 549–556. doi:10.1097/MLR.0000000000000135.
  • Henry, L. R., and R. S. Hooker. “Autonomous Physician Assistants in Remote Locations: Perspectives from the Communities They Serve.” The Journal of Physician Assistant Education 19, no. 1 (2008): 34–37. (accessed 10/7/2016).
  • ———. “Caring for the Disadvantaged: The Role of Physician Assistants.” Journal of the American Academy of Physician Assistants 27, no. 1 (January 2014): 36–42. doi:10.1097/01.JAA.0000438532.92138.53.
  • Hooker, R. S., James F. Cawley, and D. P. Asprey. Physician Assistants: Policy and Practice (4th edition). Philadelphia, PA: F.A. Davis, 2016.
Discussion Questions
  1. How do PAs fit into the medical problem-solving process (gathering data, carrying out procedures, interacting with other providers, and so forth), whether it is working in a primary health care setting or in a non-primary health care setting?
  2. What drew PAs to work in non-primary health care specialties?
  3. What are the demographic characteristics of PAs working in primary health care?
  4. How were PAs affected by the growing trend to provide health care in organizations and institutions, rather than in private physician practices?
  5. How have PAs contributed to meeting society’s needs for primary health care, and how could their contribution be stronger in the future?
  6. Why have academic health centers become major employers of PAs?
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