By 2025--less than nine years from now--the US will face a shortage of somewhere between 61,700 to 94,700 physicians. This prediction in a 2016 study by the American Academy of Medical Colleges isn't simply a wake-up call. The alarm has been ringing for years.
Schools of medicine and health professions have geared up to educate more students, but would-be future physicians and physician extenders, including physician assistants and nurse practitioners, are running into the same bottleneck--the cap on support for federally funded clinical rotation training.
"We've had 1,500 applications for only 90 slots," James R. Kilgore, PhD, PA-C, DFAAPA, director of the physician assistant program in the UAB School of Health Professions, said. "In expanding the program from 60 to 90 students, one of our biggest challenges was securing clinical training opportunities. The limiting factor isn't a lack of qualified applicants or schools that want to train them. The problem is a lack of clinical rotation sites and the funding to support them."
Physician assistants, nurse practitioners, nurses, physician and other health professions have to compete for clinical slots require hands-on residency training. However, federal support for residency programs in medical education is capped and hasn't gone up since 1997. Schools are struggling to prepare many more healthcare providers with the same number of dollars that buy less.
Access to care is already a problem in rural areas and it's likely to become even more critical unless more providers can be trained and persuaded to practice in underserved areas.
| James R. Kilgore, PhD, PA-C, DFAAPA |
"62 of 67 counties in Alabama are already medically underserved," Kilgore said. "PAs could help relieve the physician work load by handling common care issues, follow-up appointments and other needs. We're already recruiting students from those areas who are likely to return to practice there. We also desperately need physician practices and hospitals in underserved areas to participate as clinical rotation sites. Our PA students need an opportunity to learn what it's like to practice in a small town so they may consider working there after graduation."
Like many other states, Alabama has expanded the scope of practice of PAs, who can see patients, diagnose conditions and treat them, and they now have full prescribing privileges. As nationally certified and state-licensed medical professionals, PAs practice medicine on healthcare teams with physicians and other providers. A recent law allows PAs who have worked with physicians for a time to work independently without necessarily needing a physician present to cosign every order. This change could go a long way toward easing access to primary care in underserved areas.
The excellent track record for care provided by PAs and the high level of patient satisfaction have led to legislative efforts to make them part of the solution to the recent epidemic of opiate addiction. PAs can now prescribe Buprenorphine and work in addiction recovery programs.
Reimbursement is another area of PA practice that has seen major changes.
"For many years, it was difficult to file insurance claims to get reimbursement for services provided by PAs. After we won a lawsuit that changed things, insurers have seen our track record for quality and good outcomes. Now they have made a 180-degree turn and are very positive in working with us. Our services are billed under our own PA provider codes," Kilgore said.
Interest in becoming a physician's assistant has grown as quality of life and the cost of medical education have become more prominent issues, and as more women have gone into health care.
"PAs are trained on the medical school model and are usually ready to start earning around age 26. Hours are more predictable, and those who want to begin their families aren't under as much pressure as those who complete their training in their mid-30s and still have to deal with setting up a practice," Kilgore said.
Becoming a PA also has its advantages in career-long earnings potential.
"PAs begin earning years before physicians, and the median salary is more than $90,000 a year, with PA's in emergency medicine earning up to $120,000 a year," Kilgore said. "Physicians also have many more years of debt from education, plus the cost of setting up a practice and the stress and expense of running it."
Many of the satisfactions of patient interaction and hands-on healing that attract students to medicine can also be experienced as a PA.
"PAs are now practicing in many different specialties, especially in surgery and emergency medicine. In addition to primary care, we have a tremendous need for PAs trained in obstetrics and gynecology as well as pediatrics," Kilgore said.
2025 is less than nine years away. Training a physician can take five to 10 years or more. PAs can be trained in 27 months. As the Medicare population grows, and more people have access to insurance, along with the uncertainty of Medicaid funding, PAs and other physician extenders could become literal lifelines for patients needing care.