The US-PA labor supply has experienced a sustained growth phase mainly due to educational program expansion.21 Supply appears roughly in balance with marketplace demand as PA wages rise ahead of inflation.8,22
Workforce estimations of the projected numbers of available healthcare providers with reasonable accuracy are helpful to employers and policymakers. Since the US lacks central government regulation of graduation rates of American medical workers, estimating the caliber of the workforce depends on calculators of labor activity. Our modeling showed that the overall supply of clinically active PAs is likely to increase to over 200,000 by 2035.
Retention in the PA workforce is predicted to remain at the current level for several reasons. PAs are in increasing demand, and job satisfaction is generally considered high.23 The value of a PA employee is their cost-effectiveness to deliver care at the same or better level than a comparable physician.24 PAs appear to respond to market forces, and at least half change another specialty throughout a career.25 The ability to change specialties suggests mobility and adaptability and an occupational characteristic that may contribute to retention.
Furthermore, procedural-based specialties coupled with physician shortages tend to attract PAs. This may be due to high salaries associated with labor-intensive specialties.25 Finally, traditional retirement patterns are changing, and bridging strategies to remain at least partially involved in one’s career into their 70s is rising.
PAs contribute to medical care delivery and influence the gap between the supply and demand of physicians.2 This is especially true in primary care, where team-based care is growing.26 In total, PA contributions improve access to care in America and globally.27 The utilization of PAs and APRNs as providers in hospitals and vertically integrated health systems represents significant US workforce trends. Employment of these providers in multispecialty practice sites, specialty practices, and health systems offering a health plan and participating in a Medicare accountable care organization increases.28
Predictive models depend on variables, parameters, and estimates which can differ amongst researchers and health workforce analysts. What a PA reports as clinically active and actual activity has not been assessed, and thus self-report data remains a weak link variable. A 2013 Dutch study on predictive modeling using a 5- and 10-year back-tested strategy of physicians in a country the size of Maryland illustrated that 10-year projections are less reliable than those for shorter periods.29 Predictive models can lose usefulness when understanding the supply and demand effect from technology, a growing, and aging population, declining birth rate, economic perturbations, sustainability of chronic disease, and increasing efficiency in service delivery are unaccounted for. Forecasting complex trends in demand for types of health care providers will remain challenging for a long time.
The utilization of PAs and APRNs as providers in hospitals and vertically integrated health systems represent significant workforce trends in the US. Employment of these providers in hospitals, multispecialty practice sites, specialty practices, and health systems offering a health plan and participating in a Medicare accountable care organization is increasing.28 We acknowledge that forecasts are vulnerable in several areas, including the adequacy of model documentation, the frequency of evaluative information on model validity, and data quality. Additional limitations include the inability to adjust the data to fit part-time employment nor parse the data for age and gender.
As with any modeling exercise, these projections depend on the parameters and estimates used. While the rate of attrition in the models may be subject to some margin of error, on the other hand, are accounted for by using differing scenarios. Adding retirement goals provides some insight into occupational stability.