Are the Jobs There? Employment Opportunities for Physician Assistants in Primary versus Specialty Care in North Carolina

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1 Are the Jobs There? Employment Opportunities for Physician Assistants in Primary versus Specialty Care in North Carolina Annamarie Streilein, MHS, PA-C Eddie Alcorn, MBA, MSPH Margaret Gradison, MD, MHS-CL Nicholas Hudak, MPA, MSEd, PA-C Perri Morgan, PhD, PA-C 2013 PAEA Annual Education Forum 19 October 2013

2 Background A shortage of US primary care providers is expected The Affordable Care Act will bring about 30 million new patients into the health care system Fewer physicians are choosing to practice in primary care PAs can help fill this gap 43% of PAs in the US practice in primary care 2

3 Potential Solutions Grants for educational programs that promote primary care (Title VII grants) Scholarships for students who intend to practice primary care Many PA programs have a primary care mission (including Duke) Primary care bonus payments 3

4 Salary Location Personal interest Lifestyle Job Factors Affecting Specialty Choice Availability Eligibility/qualifications 4

5 Our experience: Students seeking their first job who desire primary care practice report difficulty finding positions 5

6 Research questions 1. What is the relative availability of primary care vs. specialty care positions for PAs in NC? 2. Are primary care positions more or less likely to be available to new PA graduates than specialty positions? 6

7 Methods In general, we modeled our study after a series of recent Allied Health Job Vacancy Tracking Reports in NC Eddie Alcorn, MBA, MSPH conducted those analyses, and this job vacancy report for PAs as his UNC Gillings School of Global Public Health Master in Health Policy project We served as advisors to his project 7

8 Methods: Data Source NC PA job vacancies from electronic sources and regional newspapers Primary source: Indeed.com Weekly collection period January 27 - April 6, 2013 (10 weeks) 8

9 Methods Primary care areas of practice included: family medicine, internal medicine, pediatrics, and Ob/Gyn Listings were complied in a Microsoft Excel spreadsheet Duplicate listings were eliminated Descriptive statistics were computed 9

10 Results 10

11 Characteristics of Job Listings (N=302) Setting Number % Hospital Long-term Care Facility 7 2 Weekly Time Experience Required Care Type Outpatient clinic 23 8 Physician Practice Retail Medical Clinic Other 6 2 Full Time Part Time 15 5 no yes unspecified Primary Specialty

12 What is the relative availability of primary care vs. specialty care positions for PAs in NC? Results Area of Practice Primary vs. Specialty Care The area of practice split in measured vacancies matches PA supply in NC 12

13 Are primary care positions available to new PA grads? Results Experience Required by Area of Practice 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 59% 53% 41% 47% Primary care Specialty care No Experience Required Experience Required Primary care positions are similarly available to specialty positions for new PA graduates A substantial portion of open positions require experience 13

14 Discussion More PAs are practicing in specialty care than in primary care The current distribution of PA jobs in NC mirrors this pattern Nearly half of the open primary care jobs require experience What is ideal distribution of primary care vs. specialty care providers? 14

15 Primary Care PA Supply vs. Demand Most policy efforts to date have focused on the supply side: creating more PAs who want to practice in primary care Our study suggests that inadequate demand for PAs might also be a barrier to increasing the proportion of primary care PAs 15

16 Strengths & Weaknesses Weaknesses Imprecise definition of primary care: Urgent care not included in primary care Internal medicine outpatient vs. inpatient not specified Did not capture job availability via word-of-mouth Short collection period may not be representative Did not address job turnover rates Strengths Begins to fill knowledge gap about the demand for PAs Establishing a methodology 16

17 Conclusions Primary care positions are less available than specialty care positions for PAs in NC Requirement of previous experience may restrict the number of new PA graduates who can practice in primary care 17

18 Recommendations Identify employers perceived barriers to recruiting new PA graduates for primary care positions Educate employers about the benefits of hiring new graduates in primary care settings Educate employers how to work with new grads Increase the number of PA primary care residencies 18

19 Future Research To determine how generalizable this is across the year, repeat the study in NC at other periods throughout the year To determine how generalizable this NC info is, repeat this study in other states Determine how long primary care positions remain unfilled How long does it take for a new grad to become an effective & efficient primary care provider? 19

20 References Agency for Healthcare Policy and Research. Primary Care Workforce Facts and Stats No 2: The Number of Nurse Practitioners and Physician Assistants Practicing Primary Care in the United States Accessed April 16, Alcorn E, Gaul, et al. Allied Health Job Vacancy Tracking Report. Chapel Hill, NC. Cecil G. Sheps Center for Health Services Research Bodenheimer T, Pham HH. Primary care: current problems and proposed solutions. Health Aff. 2010; 29(5):6. Coombs JM, Morgan P, et al. Factors associated with physician assistant practice in rural and primary care in Utah. IJFM. 2011; 6 pages. Jolly P, Erikson C, Garrison G. U.S. graduate medical education and physician specialty choice. Acad Med. Apr 2013;88(4): Morgan P, Hooker RS. Choice of Specialties among physician assistants in the United States. Health Aff. 2010;29(5): Singer AM, Hooker RS. Determinants of specialty choice of physician assistants. Acad Med. Aug 1996;71(8): Wright KA, Orcutt VL. Physician assistant specialty choice: a factor analysis. JPAE. 2011; 22(2):5. 20

21 Questions? 21

22 Contact Information Annamarie Streilein, MHS, PA-C Director of Preclinical Education Duke PA Program