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There is a growing belief in the United States that within the relatively near future there will be a shortage of physicians in the health system. It was not long ago that so-called expert advisory groups were warning of a physician surplus. Do we now really need more physicians? And a corollary question: If we do need more physicians, does that not also suggest a need for more PAs?
Last year, the U.S. Council on Graduate Medical Education (COGME), a national advisory body that makes policy recommendations regarding the adequacy of the supply and distribution of physicians, predicted that if current trends continue, demand for physicians will significantly outweigh supply by 2020. COGME recommends that medical schools expand the number of graduates by 3,000 per year by 2015.1
A Physician Shortage?
COGME's prediction is striking not only because of the apparent magnitude of the expected shortage but also because the prediction represents a significant reversal of numerous earlier reports by the Council stating that the country would be facing a surplus in the number of practicing physicians. COGME now estimates that there will be roughly 970,000 practicing physicians in 2020, and that the country will need at least 30,000 new doctors to raise the 2020 figure to 1 million.1
Workforce experts who contributed data projections to the COGME report indicate that both of these numbers will be insufficient to meet demand and that far greater increases likely will be required. The Association of American Medical Colleges appears to concur with the notion of a shortage of physicians and is taking steps to support its member institutions in expanding the size of medical student classes.2
Richard A. (Buz) Cooper, MD, is perhaps the most prominent health workforce policy expert predicting a shortage of physicians. He asserts that four major trends in the health sector drive demand for medical care services: economic expansion, population growth, the work effort of physicians and the services provided by nonphysician clinicians.3
Most, but not all,4 experts in this field accept the notion that there will be a physician shortage in the future. Assuming that such predictions are accurate, what are the implications of a physician shortage for the PA profession?
A Medical Service Shortage
One obvious answer is that the expected demand in medical care services may be addressed by considering a concurrent expansion of the supply of PAs. After all, historically, a physician shortage was a major rationale for the initial creation of the PA profession. Some also have suggested that a more appropriate way to look at this issue is to consider that the anticipated need expressed in future physician estimates is really a need for additional medical care services, and that a number of provider types, not just physicians, are available to meet this service demand.5
Thus, it would appear that the groundwork is being laid for an expansion of the physician sector, and one would think that this could suggest an increased need for PAs, as well. Recent anecdotal reports seem to indicate that the requirements for PAs in the workforce will grow substantially in the future.6 The question arises: Do we need more PAs?
Despite these seemingly favorable trends, remarkably little discussion has occurred within the PA profession about the opportunity that such circumstances present. Would it make sense to take a closer look at future workforce trends to assess the degree to which PAs could be part of the solution to shortages of medical care services?
PAs Can Fill the Need
The PA profession, after a period of rapid expansion in the later part of the 1990s, has been in a relatively stable position, with 134 educational programs and approximately 4,650 annual graduates. At one point, it was feared that numbers in this range would outpace marketplace demand, yet that has not come about. Even with a doubling of the output of PA graduates from 1996 to 2002, no apparent "flooding of the market" has occurred, and jobs for PAs remain plentiful.
Experts such as Cooper believe that the combination of a robust economy and graying population insures that the demand for medical care services will increase considerably over the next decade. They expect that medical schools will be slow in responding to this perceived increase in demand, just as they were in the late 1960s and early 1970s.
In view of the likely trend of an increasing demand for medical care services, is it time for the PA profession to consider further expansion of the number of graduates? This circumstance may be an opportunity to increase the status of PAs in the health workforce as well as increase the profession's contribution to health service delivery. Is there a case for increasing the supply of PAs? Closer examination of this question by the profession may be warranted.
James F. Cawley is director of the PA/MPH program and professor and vice chair of the Department of Prevention and Community Health, School of Public Health and Health Services at The George Washington University in Washington. He also is professor of health care sciences at the university's School of Medicine and Health Science.
References
1. Council on Graduate Medical Education. Minutes of Meeting, July 28-29, 2004. Available at: http://www.cogme.gov/minutes07_04.htm. Accessed February 14, 2005.
2. Association of American Medical Colleges. Rural medicine programs aim to reverse physician shortage in outlying regions. Available at: http://www.aamc.org/newsroom/reporter/nov04/rural.htm. Accessed February 14, 2005.
3. Cooper RA, Getzen TE, McKee HJ, Laud P. Economic and demographic trends signal an impending physician shortage. Health Aff (Millwood). 2002;21:140-154.
4. Blumenthal D. New steam from an old cauldronthe physician-supply debate. N Engl J Med. 2004;350:1780-1787.
5. Crane SC. The physician-supply debate [letter]. N Engl J Med. 2004;351:934-935.
6. US Dept of Labor Bureau of Labor Statistics. Occupational Outlook Handbook. Physician assistants. Available at: http://www.bls.gov/oco/ocos081.htm. Accessed February 14, 2005.
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