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Just Your Average PA Student 4.0, Part 1

Earlier this month, the Physician Assistant Education Association (PAEA) released their third Student Report, comprised of data from the 2018 Matriculating Student and End of Program Surveys.

While the Matriculating Student Survey (MSS) has been around for a while, the End of Program Survey (EOPS), which gathers responses from near-grad PA students, is only in its third year.

Pairing the EOPS with the MSS provides a more comprehensive view of the PA student experience. And, when compared to each other, they can show some interesting shifts that occur during PA school.

PAEA is continually working to include new topics and to add information relevant to both prospective students and PA programs to each new report.

I was pleased to see that my favorite addition from last year is still included — the percentage of first-year PA students who had previously applied to PA school unsuccessfully.

(That’s right, we were deprived of this information until just last year!)

And in this latest survey, some developments and expansion in the demographics section have occurred, which we’ll hit upon.

 

There’s also a continued focus on health and well being, diversity, and financial issues of PA students, which started to expand nicely in the report last year. So, we’re gaining knowledge through both the amount and the complexity of the information included in these surveys.

Because the number of PA schools is continually growing, more programs are represented in the MSS (232 programs) compared to the EOPS (212 programs),

However, programs were well represented in both surveys, with students from 73.3% of all eligible programs participating in the MSS and 70% in the EOPS.

Though overall student response rates had declined last year compared to the year prior, happily, they were up this time around.

Based on the number of respondents, the overall matriculating student response rate was an estimated 45.8%, up from 42.1% in 2017, and the graduating student response rate was an estimated 35.1%, up from 31.8% 2017. 

Incoming PA Student Report, PAEA 2018lBe a Physician Assistant

As in prior years, PAEA notes that a limitation of these surveys is that not all PA students or programs are represented. However, these surveys represent the most comprehensive PA student data available on the national level and help to provide plenty of insights into PA students as a group as well as the PA-student experience.

As with previous Student Reports, I’ll be detailing the results of incoming PA students from the MSS in this week’s post. And, in next week’s article, we’ll be taking a look at graduating students and the EOPS.

For now, let’s dive into what the survey reveals about the “average” incoming PA student of 2018. 

Demographics

The distribution of PA students and programs represented in the MSS corresponded to the number of PA schools by region — the highest percentage of responders were from programs located in the South, followed by those in the Northeast, Midwest, and West regions. 

Of those entering PA school in 2018, 46.6% attended a PA school outside of their home state (46.5% in 2017 and 44.4% in 2016).

Interestingly, even with plenty of students crossing state lines for their PA training, the geographic origins of PA students follow the same patterns as the distribution of PA schools: most were from the South (30.3%), then the Northeast (27.9%), followed by the Midwest (23.8) and West (18%).

There’s no indication of why this is. It could be that with increased PA program saturation in a region, the more trained PAs there are around for potential future PAs to encounter and be inspired by. Or maybe it’s a build-it-and-they-will-come situation. Or, perhaps, the density of aspiring PAs in an area propels the development or growth of PA programs in the region. The survey can’t tell us the reason (or reasons) behind this correlation, but it’s nonetheless an interesting one.

Back to the stats.

PA students remain mostly female (75.5%), non-Hispanic (92.2%), and white (87.3%). These proportions aren’t very different from prior surveys of matriculating students going back to 2014.

However, last year, the MSS began to incorporate more inclusive opportunities for the reporting of race that allowed for the selection of single or combined races.

In 2018, the MSS showed that more students identified as American Indian (1.5%), Asian (10.6%), Black or African American (4.0%), and Native Hawaiian or other Pacific Islander (0.4%) either as a single race or in combination with another race compared to when this information was first reported on the 2016 MSS. 

Starting with last year’s Student Report, underrepresented minority (URM) and underrepresented (UR) minority in medicine statuses have been included. URM status seeks to identify the number of PA students who identify as racial or ethnic minorities compared to the general population.

In the survey, URM status was attributed to those who identified as Hispanic, a single non-White race, or a non-White race in combination with a White race. Based on this categorization, 19.6% of respondents were classified as having URM status (down from 23.5% in 2017). 

 

UR in medicine status is defined as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.”

PAEA defined this group by excluding non-Hispanic, single-race Asian, single-race White, and biracial Asian/White individuals. Based on these guidelines, 9.7% of respondents were considered to have UR in medicine status (compared to 12.8% in 2017). 

And while last year’s survey rolled out more inclusive racial and ethnic information, this year’s survey worked to capture a new domain of diversity not previously included: sexual orientation.

Among incoming PA students, 94.3% identified as straight, 2.3% as bisexual, 2.2% as gay or lesbian, ad 0.4% as “other,” with 0.8% of respondents abstaining from providing an answer.

The average age of students starting PA school in 2018 was 25.6 years old (median (Mdn)=24.0), which was barely changed from the prior year (25.7, Mdn=24.0). Incoming PA students who responded to the survey ranged in age from 19 to 65.

For the first time in years, the percentage of students who were single when entering PA school (75.9%) slightly decreased from the previous year (76.4% in 2017, previously 75.8% in 2016, 72.2% in 2015 and 70.2% in 2014).

While the number of domestic partnerships was relatively stable compared to the previous survey (1.2% from 1.3% in 2017), the percentage of students who were married when entering PA school (21.3%) was slightly up (from 20.6% in 2017).

Fewer new PA students had legal dependents (6.6%) compared to prior survey years (10.3% in 2017, 12.7% in 2016, 13.5% in 2015, and 14% in 2014). 

Pre-PA Experience

The most common health care positions for future PA students included nursing assistant (26.6%), medical assistant (21.6%), scribe (19.6%), and EMT/paramedic (17.6%); these top four positions were unchanged in ranking compared to the previous survey.

The amount of health care experience gained by new PA students in preparing for PA school continued to increase compared to prior survey years with direct patient contact experience (PCE) averaging 129.1 weeks (Mdn=99 weeks) (from 120.7 weeks, Mdn=96 weeks in 2017).

The average amount of health care experience (HCE — experience in the medical world without direct patient care responsibility) was 85.5 weeks (90 weeks in 2017, Mdn=52 weeks unchanged from 2017 to 2018).

More than half of respondents (55.4%) participated in paid or voluntary community service work (stable from 55% in 2017 and up from 49.7% in 2016, 49% in 2015, and 44.4% in 2014).

Average total hours of community service was not provided; however, an average of 43.7 weeks of service (Mdn=12 weeks) was reported by those who had community service experience. These numbers are notably down compared to last year’s average of 85.6 weeks (Mdn=30 hours) and significantly decreased from two years ago (average of 168.6 weeks, Mdn=50 weeks).

These big swings are unusual for any data survey to survey. And, plenty of subcategories are included under “community service” including domestic and international medical and non-medical work, which covers a lot of territory and may be muddying the waters on how students respond.

So, I suspect that the major shifts in the data year to year aren’t representative of significant changes in how PA students are preparing for PA school. Instead, this may be due to how the questions are being presented to or interpreted by the respondents.

But, that's just my take; I'm not the boss of your interpretation.

Now for my favorite addition to the Student Report as of last year: reapplicant numbers. Of the incoming PA students of 2018, 33.2% had previously applied to PA school. This is steady from last year’s ratio of successful reapplicants (33%).

But, more importantly, it demonstrates that a full third of current PA students had tried and failed to get into PA school previously. 

Like last year, we don’t know if students applied multiple times in the past or if they had any gaps between a prior application and their most recent cycle. We also don’t know what transpired between any prior attempts and their successful application cycle.

But having proof that one in three PA students had tried and failed in a previous application cycle is a pretty convincing argument for not giving up on your PA aspirations.

Education

Before entering PA school, the majority of incoming students (69.9%) completed a Bachelor of Science degree as their highest level of education. A Bachelor of Arts degree was the second most common (13.8%), followed by a health- or science-related master’s degree (5.9%). 

The most common undergraduate discipline among PA students continues to be natural sciences (e.g., biology, chemistry) (49.1%), which was not much changed from prior years (48.3% in 2017, 48.1% in 2016, 46.9% in 2015, and 50.8% in 2014). Biology remains the single most common primary major (42.3%) among incoming PA students (dead-on stable from 2017, previously 41.1% in 2016).

Since 2016, the MSS has allowed for greater specification of undergraduate majors (including exercise science, kinesiology, and nutrition) compared to previously, which may impact the ability to compare responses from earlier surveys.

With these new categories, health science is now the second most common primary major at 15.6% (13.7% in 2017, 12.9% in 2016), while other majors are in the single-digit percentages.

The median overall undergraduate GPA of new PA students was 3.66 (average=3.6) in 2018, with a standard deviation of 0.30 (which means most students reported a GPA somewhere between 3.3 and 3.9). 

Interestingly, when comparing previous PAEA Student Reports to Program Reports in the past, the student-reported GPAs have been slightly higher than those reported directly by PA programs.

This discrepancy could represent a difference in cohort years included on a particular survey, the failure to capture a fuller representation of student data compared to the Program Report, or an overly optimistic view of what current PA students feel their pre-PA school GPA should be.

But, we’ll have to wait for the Program Report later this year to see the latest.

The average length of time between earning a prior degree and starting a PA program in 2018 was 3 years, with a median of 2 years.

The overall time since earning a prior degree ranged from zero to 34 years for all respondents. That’s a pretty encouraging, inclusive expanse of time.


Decision to Become a PA

The vast majority of new PA students (70.4 %) decided to become a PA before or during college, stable from 71.1 % in the year prior.

If you’re a career changer, this may make you feel like you’re, yet again, a strange longer. But you aren’t!

While most future PAs decide on their path before college graduation, you’re among the other nearly 30% who came to the profession after earning their bachelor’s or advanced degree. That’s still a sizable portion.

When students were given a selection of 16 possible influences on their decision to become a PA, they picked an average of 6.3 reasons for their choice.

The top reasons for wanting to be a PA included:

  1. Desired to care for patients (82.8%)

  2. Mobility within PA specialties (76.2%)

  3. Work-life balance (74.6%)

  4. A “calling” to the health care profession (64.0%)

  5. Financial stability (60.2%)

  6. Length of education (59.0%)

  7. Excitement of health care (55.7%)

Once again, geographic mobility was, in my opinion, woefully underappreciated (18.6%). But, I think this is one that practicing PAs probably recognize more over time, and it wasn’t something I really realized before becoming a PA myself.

Additionally, the survey asked about how incoming PA students chose what programs to apply to. Students were asked to rank 16 characteristics that impacted their school selection. The top-ranking choices included: 

  1. Good program reputation (98.6%)

  2. Desirable program location (98.1%)↑

  3. Many opportunities to gain clinical experience (97.3%)

  4. Quality program facilities (96.7%)↑

  5. High PANCE pass rates (96.6%)

  6. Good faculty reputation (96.5%)

  7. Program mission consistent with personal values (94.9%)↑

  8. Rigorous clinical curriculum (94.6%)

  9. Small class size/student-faculty ratio (93.0%)

  10. Low tuition (87.0%)

(↑ = moved up one spot since last year’s survey)

Cost

The financial aspects of the Student Report are some of my favorite parts of the survey report. I know, it’s a touch demented.

But I remember the difference between the student debt I thought I was accumulating in PA school and the tally of what I actually owed at the end. Clearly, I had forgotten to multiply by two and carry the denial while I was taking out loans as a student.

Incoming PA Student Report, PAEA 2018lBe a Physician Assistant

And, plenty of prospective and actual PA students follow a similar path — ignoring their finances until they’re out of training.

So, when the PAEA Student Report allows for a peek behind the scenes at PA school finances to get the dirt directly from PA students, it’s wise tamp down the fight, flight, or freeze response it might induce.

While we’ll cover the EOPS financial information next week (and comparing incoming and outgoing PA student information), the MSS offers some interesting money tidbits on newbie PA students. 

First, independent PA students outnumber those who are considered dependent by their parents by more than 2:1 (n=2,468: 1,147). This ratio shifted from last year, when it was closer to 1:1 (3,088 independent: 2,921 dependent). Though, notably, more total students responded to this question in the prior year’s survey.

Nearly half of incoming PA students (48.5%) had outstanding student loans from their pre-PA education, averaging $33,927 (Mdn=$25,000). (They haven’t yet piled on PA school loans.)


For expenses leading up to PA school, the majority of incoming PA students (50.5%) spent less than $1000 to apply and interview for PA school, with largest percentage (24.5%) spending between $500-999.

While accounting for those who ponied up a bit more, 81.2% still spent under $2,000 for the entire application and interview process. Only 11.5% of eventual PA students spent over $2,500 on applying to and interviewing for PA school.

Most incoming PA students (73.5%) had already begun to take out student loans for PA school, averaging $63,282 (Mdn=$56,000). Keep in mind that, like every other university-level program, you pay over time. So, these early loans are just the beginning — and incoming PA students anticipating using student loans to cover 85.6% of their total cost of PA school. 

About 17% of matriculating PA students were set to receive a grant, scholarship, or stipend for their PA education, averaging $17,906 (Mdn=$6,550).

[And if you’re in the market for some free PA-school money, start your scholarship search in this previous article.

Outside of educational debt, 29.2% of new PA students also reported non-educational consumer debt (e.g., car loans, credit card debt, and mortgages), which averaged $11,133 (Mdn=$9,000) when mortgage balances were excluded. 


MSS complete!

This report contains a wealth of information beyond what’s included here. But the expansion of demographic information in the past couple of years — last year with greater detail in race and ethnicity and this year with the inclusion of sexual orientation — has been a nice evolution in the report.

My prediction is that the demographic details of the report will continue to expand in the future to include greater representation and more nuanced responses from students. (I’m anticipating gender identity on the next one. I hope I’m right.)

It’s important for everyone who aspires to be a PA feels as if someone just like them has successfully done it before.

And while white ladies continue to comprise the majority of PA students, it’s nice to see the emergence of less frequently represented groups through PAEA's more detailed information gathering process.

If you want to check out the full PAEA Student Report, it’s available to the public. 

Next week, we’ll give the same treatment to the End of Program Survey of PA students and get the details on how some things shift between the start and finish of PA training.

REFERENCES

Physician Assistant Education Association, By the Numbers: Student Report 3: Data from the 2018 Matriculating Student and End of Program Surveys, Washington, D.C.: PAEA, 2019. doi: 10.17538/SR2019.0003

Physician Assistant Education Association, By the Numbers: Student Report 2: Data from the 2017 Matriculating Student and End of Program Surveys, Washington, DC: PAEA; 2018. doi: 10.17538/SR2018.0002

Physician Assistant Education Association. 2017. By the Numbers: Student Report 1. Washington, DC: PAEA. doi: 10.17538/SR2017.0001

Physician Assistant Education Association, By the Numbers: Program Report 32: Data from the 2016 Program Survey,
Washington, DC: PAEA; 2017. doi: 10.17538/PR32.2017