Physician assistants (PAs) are health professionals licensed to practice medicine with physician supervision. PAs work on disease prevention, diagnosis, management, and treatment, providing a broad range of health care services traditionally performed by physicians.
Introduction of PAs into the United States health care system was both in response to a physician shortage in primary care in the 1960s and a way to increase access to health care, particularly for the underserved population in rural areas.1 The PA profession is in demand as the US health care system faces great pressure from increasing physician shortages, the burden of chronic disease due to aging, social disparities in health, and lifestyle factors. PAs have the potential to play an important role in health care reform as well as policy interventions to address supply and demand in the health care workforce.2
However, medical services provided by physician assistants are usually reimbursed under their supervising physicians.3 For this reason, it is often difficult to assess and distinguish health care services provided by PAs from those performed by their supervising physicians in insurance claim records. Thus, without separating billing numbers for physicians and PAs, it is impossible to directly assess the role, contribution, and impact of PAs in health care services on a national scale. Furthermore, national health surveys usually collect data on physicians and do not support analysis at either the individual PA level or the medical team level.4 Lack of national PA data has made comprehensive PA workforce research difficult. PA-related research has been conducted unsystematically, generally producing more breadth than depth. In addition, very few existing research studies are generalizable; most have small sample sizes and are limited to a section of the health care system or use highly context-specific variables.5
The objective of this report is to introduce a data collection methodology by the American Academy of Physician Assistants (AAPA) to address the national PA data insufficiency and support PA research. AAPA is improving its data collection methods and making the data more useable and relevant for a new era. Built on the current AAPA annual census,6 an enhanced national PA census survey has been implemented. The enhanced census has multiple survey modules and will be followed up with case study interviews. Data collected by this methodology is expected to significantly improve the data inventory available to increase the current understanding of PA roles, duties, and responsibilities in a health care team; PA interaction with supervising physicians and other team members; social and clinical status of patients seen by PAs; as well as the health condition of PAs.
PAs IN AN EVOLVING HEALTH CARE SYSTEM
The physician assistant is a widely recognized provider working within the US health care system. All states, the District of Columbia, and the majority of US territories recognize and authorize PA practice either through a system of licensure or certification/registration.7 As of 2010, about 77,700 PAs are either licensed by a state authority or certified by the National Commission on Certification of Physician Assistants to practice medicine in the United States. This number has been continuously increasing and is predicted to reach six figures by 2018, according to the US Bureau of Labor Statistics.8
Physician assistants play an important role in primary care and are believed to contribute to improving the health of underserved populations and to reducing health disparities.9 The history of the profession has focused on working closely with patients, placing PAs in a unique position to help patients with emerging challenges such as obesity, diabetes, and other chronic conditions that Americans now face.10 Because PAs ensure that patients receive the personal attention they need, they significantly contribute to patient satisfaction.11-16
Population aging, social disparities in health, lifestyle factors, high health care costs, projected physician shortages, and expanded health insurance coverage for previously uninsured Americans as a result of recent health care reform have been highlighted as reasons for continued growth in the PA profession.
AAPA AND PHYSICIAN ASSISTANT DATA
AAPA is the national professional association that represents PAs across all medical and surgical specialties in all 50 states, the District of Columbia, the US territories, the armed forces, and the federal services. AAPA provides comprehensive support and advocacy for physician assistants so that they may, in turn, provide patients with increased access to quality and cost-effective health care.
As part of its mission, AAPA takes progressive steps to improve PA data, both within its own data sources and in partnership with state and federal data sources. Externally, AAPA works with state medical boards to recommend that they collect the minimum data set during PA licensing, as well as with the federal government to ensure that PAs can be identified for the role they play in providing patient care in routinely collected data. Within the PA profession, AAPA is collaborating with other PA organizations to develop a national PA research agenda as well as strategies to enhance data collection to support PA research.
AAPA routinely conducts two national surveys targeting the entire PA population (including both AAPA members and nonmembers): the PA Opinion Survey and the AAPA Census. The former provides an opportunity for PAs to express their needs and opinions to help AAPA support the profession through products and services. The latter is used to collect information that describes the PA profession. The AAPA Census has been widely used to support PA research and will continue to serve as a major instrument to collect PA data. Thus, the AAPA Census is the focus of this report.
AAPA began conducting an annual census survey of its members in 1990 and then expanded to include both members and nonmembers in 1996. While the survey instrument and data collection process have undergone some revisions since the inception of the census, the general approach and data elements have remained much the same.
In the past, the AAPA Census collected information on clinical practice status, specialty distribution, salary and fringe benefits, location of practice, training, and other relevant issues. Because of insufficient resources on statistical methodology and marketing measures, however, the response rate was around 30%, the respondents were mainly AAPA members, and census results could not be directly generalized to represent the entire PA population.
To support systematic research on the PA profession and the role PAs play in an evolving health care system, AAPA is currently creating a national research agenda aimed at developing practice-based evidence to better understand how the profession can best contribute to patient care. AAPA has also developed data collection methodology to help achieve these PA research goals. The driving force behind developing this new data collection methodology is to make the AAPA Census scientifically sound and comprehensive.
The new AAPA Census, which is launched in October, the anniversary of the PA profession each year, includes all voluntarily participated physician assistants who are eligible to practice as PAs prior to the launch date.