If someone had told me a year ago that a PA could spend a full 12 months looking for a full-time job, I would have been doubtful at best. After all, are we not the “recession-proof” profession? Was our profession not ranked second by Money magazine this year, with a projected job growth of 27% over the next decade?1 Do not our own AAPA statistics demonstrate that less than 2% of PAs are unwillingly unemployed?2
Not from where I sit, which is in the middle of a major Northeast metropolitan area that has no less than 50 acute and specialty hospitals, 30 behavioral health facilities, and 20 rehabilitation institutions.3 Not at all.
When my position at a major medical center was eliminated last year, I figured on being gainfully re-employed within a few months. I began a confident and systematic search of PA and NP positions within a 50-mile radius of my home. Of course, my search has included plenty of networking. You never appreciate your colleagues more than at a time like this.
My portfolio contains an excellent academic and employment record, good references, and a CV that includes 6 years of medical and surgical experience. I have been open-minded in my job search and willing to work any shift. Okay, at age 55, I have more than a few gray hairs. But I am hardly decrepit, and I have been blessed with the cheerful endurance of Gunga Din.
So why have neither my efforts nor my credentials catapulted me over the chasm of unemployment into the next job?
Could it be that the economy has finally caught up with us? After all, overall unemployment now approaches 10% in this country. We know that our own hospitals are struggling while making painful staff reductions. Physicians in private practice are loath to add staff in light of plummeting reimbursements. Job openings are few because many PAs are holding onto their jobs (and benefits) in these uncertain times. This scenario does not bode well for PAs seeking new jobs, nor for the 5,000+ new graduates each year looking for a place to start.
Why does the job market seem so much tighter now than it was 10 years ago? If you spread all 75,000 PAs across the country, it seems there should be plenty of elbow room.
We already recognize that we have a distribution problem—especially in poor rural areas. Yet how many of us can reasonably pull up stakes and relocate to central Arkansas or to an Indian reservation in New Mexico?
What will be the impact of the Patient Protection and Affordable Care Act of 2010 on our profession? Opinion among PAs seems mixed. The AAPA applauded the legislation, particularly the incorporation of PAs into the new "medical home" and chronic disease management models. However, these programs are just starting to take shape, and our advanced practice nursing colleagues are eyeing them too.
From just about any vantage point, the elephant sitting on the exam room table is an even greater reduction in physician reimbursement. Gifted but disgruntled physicians will retire early. Fewer new physicians will fill the ranks, especially in primary care and other less procedure-driven specialties.
My own informal e-mail survey about unemployment among PAs of all 50 AAPA state chapters stirred mixed interest. Responses varied from "we don't keep employment statistics" to "we see no problem here" to "maybe we'll look into that." One chapter expressed concern about PAs competing unfavorably with nurse practitioners for the same jobs. This concern was echoed by a local PA who fears that PAs are being "run over" by NPs whose relative autonomy and less complicated supervision requirements may make them more attractive candidates.
We all know times are tough and are not likely to get easier anytime soon. Like it or not, our fellow PAs are not just our colleagues but also our competitors—at least within our local job markets. That being said, kudos to all PAs who have held onto their jobs through these difficult times—and who are no doubt working harder than ever to keep the system afloat.
Like everyone else, PAs may now be facing a lack of available jobs, which is no reflection on our value as individuals or as a profession. The fact is that we are the only non-physicians who are licensed to practice medicine. The new system will need us badly.
These are the things I tell myself as I (optimistically) print another batch of resumes. I do not regret my decision, made some 10 years ago, to become a PA. At the end of the day, being a PA is not just what I do—it's what I am. And I will always be proud of it—employed or not. JAAPA
Carol Mackenzie Jackson lives in Plymouth Meeting, Pennsylvania.
REFERENCES
1. Best jobs in America. CNNMoney.com. http://money.cnn.com/magazines/moneymag/bestjobs/
2009/full_list/index.html. Accessed September 2, 2010.
2. National Physician Assistant Census Report. Results from AAPA's 2009 Census. http://www.aapa.org/images/stories/Data_2009/National_Final_with_Graphics.pdf. Accessed September 2, 2010.
3. Delaware Valley Healthcare Council. http://www.dvhc.org. Accessed September 2, 2010.