ABSTRACT
Objective: To prepare for future health workforce requirements, planners need an understanding of the clinical activity of physician assistants (PAs) and their career trajectory. We compared the characteristics of clinically active older PAs to younger PAs.
Method: PAs were identified from all respondents aged 60 years or older at the time they participated in the annual census of the AAPA from 2005 through 2009. The most recent year of census participation was selected for analysis. This cadre of older PAs was compared with PAs younger than 60 years. Variables included age, gender, year of PA graduation, duration of being a PA, and clinical activity by self-identified work location and specialty.
Result: A total of 48,692 PAs participated in at least one census from 2005 through 2009. Approximately 5% (2,340) met the age criteria and were clinically active. Clinically active older PAs reported working a mean of 39 hours per week and were employed in a rural setting more often than their younger counterparts. Nearly one-half of older respondents reported their specialty to be primary care.
Conclusion: Although the career span of a PA is only vaguely understood, a small but significant portion of clinicians appear to remain in the workforce into their seventh decade. They distinguish themselves by working proportionally more in primary care and nonurban areas than younger PAs. Older PAs may represent an American trend by remaining employed longer than historically observed. Gaps in the understanding of role behavior of PAs could be improved with longitudinal databases.
After 4 decades of professional development, the physician assistant (PA) profession has emerged as an established and capable workforce in American medicine. This development has boosted the profession onto the world stage at a time when health organizations are looking for new ideas in labor.
1 With the PA movement gaining momentum in various sectors of medicine, reexamination of the original group is needed to understand what can be expected of this career option.
In the United States, PAs make up a multigenerational workforce. Although age differences in preferences, attitudes, and work habits have been studied in physicians and nurses, little is known about such differences in PAs. Some of the differences in age and gender are related to recruitment and retention policies, with supply-and-demand cycles in nursing largely responsible for age gaps.2 Other research has used age to identify management and teamwork issues among different age strata of nurses, as well as for workforce planning implications.3-5 Older nurses have been a topic of study in order to identify strategies to retain an older generation as a solution to nursing shortages.6,7 Physicians have enjoyed a career that is largely recession-proof, and most have the option of staying or leaving when desired. Whereas the relatively mature sectors of the medical profession involving nurses and physicians has allowed longer observation of the career span, the PA profession is only now reaching the point that an older generation is available for observation.
Knowing the clinical activity of PAs and their career trajectory has been a topic of interest to workforce planners and modelers.8-10 What PAs do in a clinical setting is important, but how long they do it (ie, the duration of the career) is of equal importance for replacement planning. While production of PAs is established by the graduation rate and their clinical role is known through a yearly survey, attrition and retention are the parts of the career arc that are least understood. One way of understanding the stability of a labor force is by taking stock of workers employed at different times of their career. The older PA may help to fill in some gaps about duration of employment.
We set out to examine the distribution of PAs whose age is in the 90th percentile (60 years or older) and called them older PAs. Our interest centers on knowing what older PAs do from a clinical perspective. We suggest that if accurate models of workforce predictions are required for workforce planners, then knowing the labor pool input and career span are needed variables. Our research question is straightforward: "What are the characteristics of clinically active older PAs"?
METHODS
The AAPA annual census for all PA respondents spanning a 5-year period, 2005 through 2009, was probed.11 All PAs who reported being clinically active and were 60 years of age or older were isolated, and the most recent year of census participation was used for analysis. The responses of this cadre of older PAs were compared with the most recent responses of the cohort of younger PAs (younger than 60 years). Variables examined for differences between older and younger PAs included age, gender, year of PA graduation, duration of being a PA, and clinical activity by self-identified work location and specialty. Descriptive and inferential statistics were applied. Chi-square and Student
t tests were performed to characterize results found for PAs by age-group.
RESULTS
A total of 48,692 PAs participated in at least one census from 2005 through 2009. Of the aggregated survey of PAs, nearly two-thirds (64%) were female, mean age was 41 years, and mean duration of experience in clinical practice as a PA was 10 years. Table 1 details the distribution of all observed variables for all PAs.
From this population, 2,340 respondents met the criteria of clinically active older PAs (5%). In this cadre of interest, 79% were between the ages of 60 and 65 years, 16% were aged 65 to 70 years, and 4% were aged 70 years or older. One-third (31%) of the older cohort was female (Figure 1). The duration of being a PA for the older cohort ranged from 1 to 40 years, with a mean of 26 years (median, 31 years).
Clinically active older PAs reported working a mean of 39 hours per week for their primary clinical employer, compared to a mean of 41 hours per week reported by younger PAs who participated in the census (Figure 2). Each progressively older age band reported working fewer hours. However, older PAs reported spending more hours on call per month than younger ones (Figure 2).
Compared with younger PAs, older PAs were more likely to report their primary workplace to be a rural health center, community health center, or setting other than a hospital or physician office (Figure 3). These PAs were also more likely than younger PAs to report working in a rural or nonmetropolitan area based on postal codes.
Older PAs are significantly more likely to report their specialty to be in primary care (defined as family medicine, general internal medicine, and general pediatrics), compared with younger clinically active PAs (Table 2). Within the older PA cohort, the oldest PAs were more likely to report their specialty as primary care, with two-thirds (64%) of PAs aged 70 years or older in this practice sector.
