ABSTRACT
Objective: This study identifies baseline demographic and descriptive statistics for physician assistants (PAs) in Indiana from 1978 to 2010.
Methods: Data were obtained from Indiana Professional Licensing Agency applications, the Indiana State Department of Health, and PA educational programs. Descriptive statistics were used to characterize the PA workforce as well as their supervising physicians.
Results: Most PAs working in Indiana were born and educated outside the state. Of those educated in Indiana, 77% obtained an initial license in Indiana; as of May 2010, 62% were still licensed in the state. In the past 8 years, Indiana had a 97% increase in active licensed PAs. Only 24% of PAs work in primary care; 92% work in metropolitan areas. For 40 years, PAs have increasingly worked in areas that are medically underserved or experiencing a shortage of health professionals. However, the overall numbers of PAs working in those areas remain low.
Conclusions: More PAs in Indiana are practicing in medical specialties than in primary care. As health care policy and regulatory changes evolve, future studies will be needed to understand the impact on the health care workforce of Indiana PAs. This study will serve as a baseline for those studies.
Establishing teams of physicians and nonphysician clinicians will help meet the needs of primary care patients covered by recently proposed changes in health care policy.
1 In Indiana, physician assistants (PAs) have been in clinical practice since 1974.
2 However, Indiana did not pass authorizing legislation until 1977.
3 Current Indiana law requires that PAs graduate from an educational program recognized by the Accreditation Review Commission on the Education of Physician Assistants, that they pass a national certification examination, and that they apply to the Indiana Professional Licensing Agency (IPLA) for licensure to practice in the state. A second application must be submitted to the IPLA to obtain prescriptive privileges and a Controlled Substance Registration (CSR) when the applicant has met the following requirements: completed at least 30 contact hours in pharmacology from an approved educational program and worked as a PA for more than 1,800 hours. In Indiana, PAs must complete 100 hours of continuing medical education every 2 years, renew state licensure with the IPLA every 2 years, and take a national recertifying examination every 6 years to maintain state licensure. A physician may supervise a maximum of two PAs at any one time.
4
Since 1974, three accredited institutions have graduated PAs in Indiana. The first program, which was offered by Indiana University (Fort Wayne), granted a certificate at completion of the curriculum, but the program closed in 1977. According to the Director of Medical Student Records, Indiana University School of Medicine (IUSOM), in Indianapolis, that program graduated 70 students (Dennis Deal, e-mail communication, May 26, 2010). While several Indiana universities are planning to start PA programs, two educational programs are currently in operation and have transitioned from a bachelor's degree to a Master of Physician Assistant Studies degree: Butler University (Indianapolis) graduated 289 students with bachelor's degrees (1996-2007) and 80 students with master's degrees (2008-2009), and the Department of Physician Assistant Studies at the University of St. Francis (Fort Wayne; formerly Lutheran College) reports graduating 38 students with bachelor's degrees (1997-2003) and 123 students with master's degrees (2004-2009) (Dawn LaBarbera, PhD, PA-C, e-mail communication, May 12, 2010).
The availability of primary care providers in Indiana is based on geographic, demographic, and socioeconomic factors and varies widely.5,6 Primary care is defined as family/general medicine, general internal medicine, general pediatrics, geriatrics, and obstetrics and gynecology.7 While 40% of physicians who graduate from the Indiana University School of Medicine (IUSOM), in Indianapolis, choose a primary care specialty, one-half of graduates leave the state to practice medicine. Because the allopathic IUSOM is currently the only medical school in the state, a subcommittee of the Indiana University Health Reform Study Group concluded that the total number of practicing primary physicians in
the state of Indiana by the year 2020 will be little impacted by increasing class size at IUSOM.5 In early 2010, plans were announced to develop an osteopathic medical school
at Marian University in Indianapolis.8,9 This program is anticipating admission to its first class in August 2013.
Similar to their physician counterparts, PAs across the country have been lured from primary to specialty and subspecialty care over the past 40 years.10 The impact of specialty care on the Indiana PA workforce is unknown. This study quantifies the number of Indiana PAs in primary care versus specialty care. The US Department of Health and Human Services defines health professional shortage areas (HPSAs) as "having a shortage of primary medical care, dental, or mental health providers"11 and medically underserved areas (MUAs) as areas that have high poverty rate, elderly population, infant mortality rate, or shortage of primary care providers.12 Fifty-six of the 92 counties (61%) in Indiana have been designated by the federal government in whole or in part as MUAs, and 39 (42%) were designated primary care HPSAs.12 The number of Indiana PAs who work in MUA/HPSA areas is investigated in this study.
The Bureau of Labor Statistics forecasts a 27% increase in the number of practicing PAs between 2006 and 2016, making the profession one of the fastest-growing occupations in the United States.13 The actual growth rate may be higher in Indiana than it is nationally given the fact that in July 2007, Indiana became the last state to authorize PA prescriptive privileges.14,15 This is particularly important considering that within 3 years of receiving prescriptive privileges in Texas, the number of PAs practicing in rural health clinics in that state tripled in a single year.16
The rapid increase in the number of PAs in the United States and the change in prescriptive law in Indiana highlight the importance of developing a set of baseline demographic and descriptive statistics associated with the profession. In addition, this study evaluates the number of Indiana PAs in primary care versus specialty care and the number of Indiana PAs who work in HPSAs and/or MUAs. The study also identifies the number of PAs with CSRs since being granted prescriptive authority. The beneficiaries of such a study include policy makers, employers, and educators, who will ultimately shoulder the responsibility of crafting future policy as the PA profession in Indiana evolves.