What You'll Want to Know About New PA Grads & Primary Care

Since its inception, the primary aim of the physician assistant profession has been to fill gaps in healthcare and improve access for patients. Historically, spanning this divide meant that many PAs served in a primary care capacity.  

 

As an aspiring PA, it can sometimes feel like you should want to work in primary care. After all, it's the foundation of the profession. 

 

But many PAs don't. In fact, most PAs don't work in primary care. 

Since the advent of the PA role over 50 years ago, the landscape of medicine has shifted and, with it, so have the settings and specialties where PAs are more likely to practice. 

And, as the profession continues to grow and PAs enter the workforce in greater numbers, there are even notable year-on-year trends that hint at the future of our profession. 

If you're a near or new-PA grad, here's what to understand about the current status of PAs working in primary care and the potential effect on your future job search.

Current Status of PAs in Primary Care

Two of the best sources for information on where and how PAs are practicing include the American Academy of Physician Assistants (AAPA) and the National Commission on Certification of Physician Assistants (NCCPA). 

Through the 2019 AAPA Salary Report, we got the most recent glimpse of PA practice specialties. 

Of the 13,088 PAs who responded to the survey, 20.8% were practicing in primary care (including family medicine, general internal medicine, and general pediatrics). 

Another 27.4% of PAs who responded worked in surgical subspecialties, 12.2% in internal medicine subspecialties, 9.4% in emergency medicine, 1.4% in pediatric subspecialties, and 28.8% in "other" specialties (such as psychiatry, hospice and palliative care, obstetrics and gynecology, addiction medicine, pain management, public health and dermatology). 

It's worth noting that most sources describe "primary care" or "general practice" as including family medicine, general internal medicine, and general pediatrics. 

What to Know About New PA-Grads & Primary CarelBe a Physician Assistant


There is, however, a bit more variation in other areas, like obstetrics and gynecology sometimes being included in "surgical subspecialties" in some resources while other times being lumped into "other." 

Input from 13,000+ PAs makes for a pretty valuable resource. But the Salary Report relies on PAs responding to an annual survey, so it only captures a fraction of the 131,000+ certified PAs out there. 

However, if we go back a year to NCCPA's 2018 Statistical Profile of Certified Physician Assistants by Specialty, the sample size grows to 117,280, which, at the time, represented 89.4% of all certified PAs.

NCCPA is able to attain this large sample size by pulling information from the profiles of certified PAs. PAs still have to enter their information into their NCCPA profile voluntarily. However, rather than relying on data that comes from survey responses distributed over a relatively short window of time (like with the AAPA Salary Report), the data shared by PAs on their NCCPA profile is a bit more static. 

So, with 89.4% of certified PAs entering at least some information available into their NCCPA profile, the details about the work of these PAs is more plentiful and remains readily available.

PAs by Specialty, NCCPA 2018lBe a Physician Assistant

Based on this data, 25.8% of PAs worked in primary care (including family medicine, general internal medicine, and general pediatrics). While this percentage represents a good portion of PAs, it also means that nearly three-quarters of PAs are working outside of primary care. 

The most common non-primary care practice area for PAs is surgical subspecialties (cardiothoracic, orthopedic, colorectal, neurosurgery, and the like), in which 21.5% of PAs practice — with 10.8% in orthopedic surgery alone. 

As the percentage of PAs working in primary care continues to wane over time, the proportion of PAs practicing in non-primary care areas is, consequently, growing.

And this balance shifts even more when considering recent PA grads. 

NCCPA conducts an annual assessment of the job prospects of newly certified PAs, including offered and accepted positions, the most recent of which profiled PA grads certified in 2017.

Since the first Statistical Profile of Recently Certified Physician Assistants in 2013, the number of newly certified PAs who accepted jobs in primary care has slowly declined: 28% (2013), 27.6% (2014), 26.9% (2015), 25.3% (2016), to 22.7% in 2017. 

So, what's the deal? 

Are new PAs just less interested in working in primary care than their predecessors? Is this shift driven by job availability? Or is there something a bit less evident at play?

Dynamics of New PAs & Specialty Choice

According to the latest AAPA Salary Report, PAs working in primary care (again, classified as family medicine, general internal medicine, and general pediatrics) had the lowest median compensation ($101,000) of any specialty (overall median of $106,000).

 

But, the lower salary isn't necessarily turning off new grads. Remember that annual NCCPA profile of recently certified PAs? The latest one from 2017 showed that of those who had not yet accepted a position, 27.3% of them hoped for a role in family medicine or general practice. 

That doesn't mean they won't ultimately turn down a position due to salary, but it's a decent measure that the interest level is reasonably steady. 

 

However, what has started to change is the overall presence of specialists in healthcare. In 2013, it was estimated that, for the first time ever, Americans had more medical visits with specialists than they did with primary care providers. 

And as the demand for specialists continues to increase, so follows the need for physician assistants and nurse practitioners to support these specialty practices. 

In a 2018 study, Job Openings for PAs by Specialty (Morgan et al.), a final sample of 34,137 job postings for PA positions were analyzed for practice specialty (with data pulled from listings in 2014). The greatest number of opportunities existed in adult surgical subspecialties (28%) and adult medical subspecialties (23%). Primary care openings accounted for 19% of job openings. 

PA Job Openings by SpecialtylBe a Physician Assistant

If you're determined to work in primary care and that made your heart sink a little, hang on.

Because the PA profession is exploding, the US Bureau of Labor Statistics predicts a 31% growth between 2018 and 2028, making the PA career the seventh fastest-growing occupation in the US. (For reference, all occupations combined are projected to grow 5% in the same time frame.)

While there's a disproportionate growth in opportunities for PAs to work in medical and surgical subspecialties, the overall number of practicing physician assistants has grown exponentially. Therefore, there are more PAs than ever before working in every specialty, including primary care (with 15,089 PAs in 2013 compared to 25,487 PAs in 2018). 

And, if you're hoping to land a primary care role as a new grad, there are some areas where you're more likely to find opportunities. 

A 2015 study (Hing & Hsiao) showed that the percentage of primary care physicians employing PAs or NPs increased as the practice size increased. So, if there were more physicians in a practice, the likelihood of PAs and NPs being employed by that practice grew. 

Additionally, advanced practice providers (APP = PAs and NPs) were more likely to be part of a primary care practice as the office became more rural — practices in small or medium metropolitan areas more often had APPs compared to those in large central urban areas.

And, the number of primary care practices employing APPs increased when they were located in states with favorable PA scope-of-practice laws. Read as: when there's less restriction on what a PA can do or less administrative burden on a collaborating physician, a primary care practice is more likely to hire PAs. 

So, while the ratio of new PAs entering primary care has slowly declined over time, there may be aspects of a practice or region that may provide more opportunities to work in family medicine. 


Though the PA profession started with a focus on primary care, thousands of PAs over the past 50 years have worked to carve out a path for the next generation to make an impact on patients in every area of clinical medicine.  

You don't have to want to be a primary care provider to become a PA, and you don't have to fake it either — programs are wise to what’s happening with PAs in practice. The shape of medicine is changing, and the most adaptable provider role in medicine is changing with it. 

But, if you hope to work in primary care, opportunities exist to make it happen, even as a new grad. 


 

REFERENCES

American Academy of PAs. (2019). 2019 AAPA Salary Report. Alexandria, VA. aapa.org 

Bureau of Labor Statistics, U.S. Department of Labor: Occupational Outlook Handbook, 2018–2019 Edition, Physician Assistants. Last modified: September 4, 2019. http://www.bls.gov/ooh/healthcare/physician-assistants.htm

Hing, E., & Hsiao, C.-J. (2015). In which states are physician assistants or nurse practitioners more likely to work in primary care? Journal of the American Academy of Physician Assistants28(9), 46–53. 

Morgan, P., Leach, B., Himmerick, K., & Everett, C. (2018). Job openings for PAs by specialty. Journal of the American Academy of Physician Assistants31(1), 45–47. 

National Commission on Certification of Physician Assistants, Inc. (2014, October). 2013 Statistical Profile of Recently Certified Physician Assistants: An Annual Report of the National Commission on the Certification of Physician Assistants. Retrieved September 10, 2019, from http://www.nccpa.net/.

National Commission on Certification of Physician Assistants, Inc. (2015, August). 2014 Statistical Profile of Recently Certified Physician Assistants: An Annual Report of the National Commission on the Certification of Physician Assistants. Retrieved September 10, 2019, from http://www.nccpa.net/.

National Commission on Certification of Physician Assistants, Inc. (2016, September). 2015 Statistical Profile of Recently Certified Physician Assistants: An Annual Report of the National Commission on the Certification of Physician Assistants. Retrieved September 10, 2019, from http://www.nccpa.net/.

National Commission on Certification of Physician Assistants, Inc. (2017, September). 2016 Statistical Profile of Recently Certified Physician Assistants: An Annual Report of the National Commission on the Certification of Physician Assistants. Retrieved September 10, 2019, from http://www.nccpa.net/.

National Commission on Certification of Physician Assistants, Inc. (2018, September). 2017 Statistical Profile of Recently Certified Physician Assistants: An Annual Report of the National Commission on Certification of Physician Assistants. Retrieved September 10, 2019, from http://www.nccpa.net/research

National Commission on Certification of Physician Assistants, Inc. (2019, April). 2018 Statistical Profile of Certified Physician Assistants: An Annual Report of the National Commission on Certification of Physician Assistants. Retrieved September 10, 2019, from http://www.nccpa.net/research

National Commission on Certification of Physician Assistants, Inc. (2019, July). 2018 Statistical Profile of Certified Physician Assistants by Specialty: An Annual Report of the National Commission on Certification of Physician Assistants. Retrieved September 10, 2019, from www.nccpa.net/research

Robeznieks, A. (2014, April 21). More patients chose specialists over primary-care docs in 2013. Retrieved from https://www.modernhealthcare.com/article/20140421/BLOG/304219936/more-patients-chose-specialists-over-primary-care-docs-in-2013.