Knock, knock. Who's there?

It is a familiar start to a joke. But, when it comes to health care, it is no joke. We have all seen the headline: “Physician Shortage”. In my specialty of cardiac surgery, it is predicted by the Society of Thoracic Surgeons (STS) that 50% of cardiac surgeons will retire in the next 10 years. Of course there will be new surgeons in the pipeline, but 5 years ago I sat in on an address at the STS annual meeting in which it was recognized that they were filling only three-quarters of their fellowship slots. I imagine that it is worse now. The STS has initiated a program specific for recruiting new physicians into the field of cardiac and thoracic surgery. It is the same for other specialties. Why bring this up in a PA blog? Because I believe as physicians go, so go the PAs.

Years ago, I read a paper out of the AMA which described three areas of practice in medicine. It described those physicians in a “controlled lifestyle” specialty/practice setting. These included such specialties as dermatology, plastic surgery, pathology, and radiology. There were the “uncontrolled lifestyle” specialty/practices settings, such as family practice and some surgical specialties. Finally, there were “out-of-control lifestyle” specialty/practice settings, which included cardiac and thoracic surgery and neurosurgery, to name a couple. I have always felt that this description was accurate and has had some impact on where we are today in terms of having enough people to do the work.

A presentation by James Cawley, MPH, PA-C, and Rod Hooker, PhD, PA, at our profession's annual meeting in May 2009 recognized that the number of PAs going into the specialty fields has surpassed those going into the primary care areas, and this trend is expected to continue. Cawley and Hooker had previously defined how PA practice emulates that of physicians. I wonder what we are doing educationally to better prepare PAs leaving training who seek to accept these specialty positions irrespective of the potential lifestyle? Of course, a broad basic background in medicine is necessary for all PAs. However, given the above information, we need to increase recruitment of individuals with significant health care experience. I believe we need to encourage more clinical options in the programs so that students can pursue a specialty of their interest towards the end of their clinical program experience—an internship, if you will. We need to work towards more funding of postgraduate programs to meet the need of a market demanding experienced PAs in many specialties—maybe even in cooperation with physician fellowship training. We need to further insure regulation of postgraduate clinical experiences so that it is meaningful and not just cheap labor.

With the decline of physicians in specialty areas, hospitals and health care systems are seeking to enhance the limited number of specialists available to them by employing PAs so the physician's efforts can be geared toward consulting and performing the operation and the PA assists in the surgery and cares for the patient post-op. Generally speaking, physicians and practices no longer have the financial luxury of taking inexperienced PAs and training them over several years. The expectation is that the PA will become an “income producer” from the beginning. However, in my experience it will take 2 to 5 years to train a new graduate for relatively unsupervised activity in some specialties. We need to embrace this opportunity for our profession. If we don't, someone else will answer the knock at the door. I recall that in the early 1960s, a profession declined to take on the additional responsibilities requested by physicians and the health care system. From that, a new profession was born….