The incredible expanding PA profession

Currently the PA profession is at the beginning of another substantial expansion. Several dozen institutions have indicated an interest in starting a PA program, and many existing programs have either increased enrollment or are seriously considering increases. The most recent HRSA PA training grant cycle was entirely dedicated to encouraging programs to increase their enrollment, illustrating that the federal government considers expansion of the PA profession desirable.

Currently, there are 154 PA programs accredited in the United States, up from an average of 134 programs from 2001-2006. Additionally, the average first year enrollment for programs increased from about 35 students in 2002 to about 46 in 2008. Without a doubt, the number of PAs graduating each year is currently increasing, and will likely continue to increase over the next decade.

This is not a new phenomenon, however. In the 1990s there was a substantial increase in both the number of PA programs as well as the average class size. In 1990 there were 51 accredited PA programs, a number that had been stable for the prior decade, enrolling an average of about 26 first year students. By 1996 this had increased to 89 programs enrolling about 40 first year students, and by 2002 these numbers were 132 and about 36 respectively, where they remained relatively stable until 2007.

The most recent historical expansion, 1991-2002, presented the profession with many challenges as well as substantial controversy. As would be expected, this expansion was a result of a sudden increase in both the real and projected demand for PAs, and in all but the last few years of this expansion period, clinical salaries increased rapidly. The demand for increased numbers of PA faculty, who had traditionally been recruited from the clinical ranks, as well as increasing clinical salaries, resulted in a severe shortage of PA faculty. This led to concerns that the quality of PA graduates might suffer, resulting in accreditation standards revisions. Additionally, as the increasing demand for PAs slowed toward the end of the 1990s as a result of the widespread implementation of managed care delivery models, some inside the profession called for a decrease in enrollment fearing a glut of PAs and a consequent decrease in clinical salaries. This decrease in demand for PAs was concentrated in geographic regions where many PA programs had sprung up, such as New York and Pennsylvania. In the late 1990s and early 2000s some graduates in those regions found finding a job difficult without geographic relocation.

Thus, we are currently entering another substantial expansion of the profession. Again, some of the same concerns are relevant: Will there be enough competent educators to train the increased enrollment? Will rapid expansion create a glut of inexperienced graduates in some local areas? Will PAs graduate enough clinicians to keep up with the expansion of other health care professions, which is necessary for PAs to not become a smaller piece of the overall healthcare delivery workforce?

I would be interested in how this current expansion impacts you and in your thoughts and opinions about where the profession is currently and where you think it will be in the future.