Clinician demographics key to primary care career choice

By Piriya Mahendra, medwireNews Reporter

The demographics of physician assistants (PAs) who choose a career in primary care are similar to those of medical students who also choose primary care, US study findings show.

Knowledge of these characteristics may aid efforts to increase the number of primary care PAs, which dwindled from 50.8% in 1996 to 31.0% in 2010, report Bettie Coplan (Northern Arizona University, Phoenix, USA) and team.

They surveyed 18,048 PAs, who graduated from PA school between 1965 and 2008, and found that 6033 (33.4%) of them worked in primary care. Group analysis revealed a significant association between primary care practice and gender, age at time of questionnaire completion, age at time of graduation, and race.

Previous analysis has shown that the medical student demographics associated with primary care practice include female gender, older age, and Latino ethnicity.

In the current study, analysis of associations with race/ethnicity showed that Hispanic PAs were significantly more likely to choose primary care as a career compared with White PAs.

Trend analysis revealed a significant decrease in the proportion of PAs in primary care each year, from 41% in 1975 to 31% in 2008. It also showed a significant 0.5% increase each year in the proportion of primary care PAs of older age at the time of graduation (≥20 years) and age older than 40 years at questionnaire completion, at an average increase of 0.4% each year.

Trend analyses over the latest five graduating classes (2004-2008) indicated the decline has reversed in recent years, however, with a significant increase in the proportion of primary care PAs over this time period, at an average of 0.9% per year. This included a significant 1.1% increase in women practicing in primary care each year.

"PA practice trends mirror the practice trends of physicians," write Coplan et al in the Annals of Family Medicine. "Consequently actions that increase the number of primary care physicians are also likely to increase the percentage of primary care PAs."

They urge the PA profession to support workforce policy measures that successfully increase the number of primary care physicians including loan repayment and improved levels of reimbursement for primary care physicians. They also call for expansion of the Title VII, Section 747 of the Public Health Service Act, which aims to increase the quality, size, and diversity of the primary care workforce.

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