The Growing Popularity of PAs

Welcome everyone to today's webinar and Happy Pa a week. My name is Megan and I'm on the marketing team at osmosis.

We're very excited to introduce our speaker today, Michelle Nesky. Michelle is a Yale pa program grad and a practicing physician assistant in oncology.

You might know her as the posh pa and her role as APA counselor. And today we'll be hearing from her on the growing popularity of PA S Take it away Michelle.

Awesome. Thank you so much, Megan.

Um Thank you for allowing me to talk on this subject. It's a question I get asked fairly often.

Um And having it be physician assistant week, what a better time to talk about the popularity of the profession. So I'm excited to be here.

So let's talk a little bit about physician assistant in the US and kind of take you back um to when it all first started back in the late 19 sixties.

Um you know, nurses and physicians have been around for a very long time, but the physician assistant profession was born um after the war where there was a shortage of health care providers and, and Eugene steed took a group of military corpsmen and developed a curriculum um to help fill the healthcare provider shortage gap after the war.

And so, um what are PS number one, number one is the PA S are medical professionals who diagnose illness develop and manage treatment plans, prescribe medications and often serve as the patient's principal healthcare provider.

With thousands of hours of medical training. PS are verat and collaborative.

We practice in every state and in every medical setting and specialty, improving healthcare access and quality. As I said, going back to the original roots of the profession um and trying to increase access to health care.

So here's the timeline that I was talking about. So here Eugene ST develops the first pa program due to a due to the I should say, do not do it due to um the MD shortage after World War two that was in 1965.

Um And so the first uh pa a class that graduated in 1967 which was all men by the way, um was in 1967 as I said by 1998.

So, you know, 30 years later, we have 41,000 pa S in the USA 110 pa programs. And now uh in 2019, the most recent data, 100 and 39,000 pa S 260 pa programs.

Although I believe that is now more. Um as we rolled into 2020 there were a lot of new programs that have been developed.

So you can see the very rapid growth of this profession over the years as the profession has grown. So has the gender trend and there's been a big shift from a previously male dominated profession into a uh more female dominated profession.

Uh With that being said, the growth of the profession overall has been pretty substantial um particularly over, you know, from 1998 to 2019.

So according to the NCCP A, which is the um national certifying body for PA S, they give a report every year that there are 100 and 39,668 practicing PA S in the US as of 2019, in 2019, that was an increase of 37% over the last five years.

There are 42 PA S per 100,000 population in that should say in the US. Um and the Bureau of Labor Statistics, which is B LS expects the profession to continue to grow by 31% from 2019 to 2029.

So that is the most accurate data that we have. And one of the fastest growing healthcare professions, here's the distribution of PA S across the country.

Um You can see some of the larger states um having greater than, you know, 3500 PA S. So Texas, California, Florida.

Um and uh up here in the northeast and then it kind of, you know, goes to a little bit less in some other states and you can really see some need here um, in some of these middle states and even down here in the South.

So, um, definitely still can have, there is room for more pa s and for access to care, particularly in states that have large rural areas.

So, um, that's important to note pa programs in the United States. Um A 260 programs uh according to the R PA as of 2019, the number is expected to increase to 303 by 2023.

I actually think there's a already 303. Um It's just that I don't know if all of them have accreditation, some of them are developing programs.

And so that's a little bit of a difference in the number. I think this number is gonna be a lot higher in 2023.

So why, why is this profession growing so rapidly and why is it so popular? Um Amongst those looking for a career in medicine?

Well, there's a lot of reasons. Number one is that the physician shortage continues and we'll go through each one of these in a little bit more detail.

Um So even though applications to medical school were actually up this year, um there continues to be a physician shortage, there continues to be a demand for health care, particularly in underserved areas.

It's, it takes a shorter time for PA S to get trained and be in the workforce, optimal team practice, which is trying to maximize the use of PA S to practice to the top of our license, the flexibilities to change specialties with no additional training and the press um you know, number three best job overall according to us news and world report and number two best job in health care.

And so I think the publicity definitely shows people that this is a versatile career that there is demand for that. They can have shorter amount of training, get out into the workforce faster.

Um and still be able to practice medicine in a collaborative way. And so I think a combination of these things is really what's contributing to the popularity of the profession.

So let's talk about the physician shortage, the double ac projects, a shortage of up to 100 and 39,000 physicians. Um by uh by 2023 this is new from them.

Um In 2020 where I pulled the data from the double AMC. Many factors include older patients and retiring doctors.

So two out of five doctors will be 65 or over in the next decade is retirement age. Um In 2019 35% of Americans said they had trouble finding a doctor in the last 2 to 3 years.

Um There's a need in both primary care and and specialty areas and COVID has magnified this need as M DS have been mobili mobilized to the front lines and really sort of exposing the need for other providers to step in and do some of the care um that is necessary.

And so the national population is expected to increase by 14% in the next 10 year, 10 years. So now we're talking about the supply, right, and that the physician shortages of the demand.

Now we're talking about the supply. We have a growing aging population with those over 65 expected to increase by 48% um rural and underserved areas feel this acutely now.

Um And we need equity amongst race insurance coverage and geographic location. So there is demand um you know, for healthcare for healthcare providers that will continue to grow over the next 10 years and beyond.

Um and as our aging population gets older and have more um medical difficulties, particularly with those with comorbidities.

Uh PA S can play a big role in filling these gaps where providers M DS may not be available. Um or uh they, they may be um you know, overwhelmed or in another area.

So I think that between the demand for health care and the physician shortage, um it really kind of brings to light the need for PA S in the healthcare system.

Let's talk about ps itself, the education and optimal team practice. So the timeline for a traditional uh PA is four years of an undergraduate education followed by a 24 to 36 month master's program.

Residencies are currently optional. They do exist for surgery, er, and many other areas you could be out and practicing from under.

So if you went straight through, from your freshman year in college, directly through to pa school without stopping, you could be out and practice in six years, including your undergraduate degree, including your master's degree.

Many people take a gap year or two myself included, I didn't know that I wanted to be a pa until after I graduated from college.

And so it took me a couple of years to um gain the experience I needed and then go into practice. Even with that being said, you know, II don't wanna date myself or give away my age secrets, but I graduated from college in 22,000 and um I didn't attend pa school until 2003, but I was done by 2005.

So, you know, I was out and starting my, my career in medicine and in practice um within that time frame. And so I think that's appealing, you know, to a lot of people where as the MD route, um you know, you have your four years of undergraduate education, you have your four years of medical school and then you have likely a three year residency minimum plus a fellowship.

If you want to specialize even further, you also have to pick your trajectory. So for example, my husband is a head neck cancer surgeon.

So he chose a surgical residency, um which he did for five years and then did a fellowship for three years, but he only does and he can't change specialties.

And if he wants to, he has to go back and do another residency of some kind. And so I think that's appealing um that pa that pa s can move, you know, from urgent care to dermatology, to oncology without having to obtain additional residency training.

Um There is some debate about residencies in the pa profession. Um Are they required?

No, are they helpful? Yes, it depends on the person and the specialty that you wanna go in.

If somebody knows for sure, for sure, for sure they wanna be in surgery, then a residency might be really helpful for them to gain those skills to then go out into a job and already hit the ground running.

On the other hand, you can also be trained on the job uh if you have a supportive team and a good onboarding process. So optimal team practice, there's a lot of talk about this in the PA profession.

And I think COVID kind of highlighted some of the legislative differences between states when it comes to pa life insurance practice.

Optimal team practice eliminates the legal requirement for p for a specific relationship between APA, a physician or any other healthcare provider.

In order for APA to practice to the full extent of their education and training. It creates a separate uh maj majority PA board to regulate PA S or add PA S and physicians who work with PA S to medical or healing arts boards that also authorizes PA S to be eligible for direct payment by all public and private insurers.

There is a lot of um debate amongst physician groups, um and some physician groups who do not feel that we should uh be able to, you know, practice with full authority.

Um And, you know, nurse practitioners do have full practice authority in, in some states. And so I, I think what optimal team practice is doing is not saying we wanna, you know, run our own show without physicians all the time, but we do wanna have that autonomy if need be in a pandemic to mobilize to the front lines and really be able to practice to the top of our license.

Um still in collaboration with the team and help eliminate some of the antiquated state um laws and things that are prohibitory in this type of situation.

Um And so it's a movement in the right direction and trying to get um everybody to prac Optim practice optimally for not only for the benefit of health care and the patients, but also for professional satisfaction.

Um from pa s flexibility. As I said, options to uh change specialties, options to work shift um or more traditional schedules or part time um opportunities to be involved in teaching in research and advocacy.

Um You have a national certification, so you don't have to recertify in each state that you move to. You do have to um you do have to get a state license in every single state, but your national certification is good, you recertify every two years.

Um And so if you move to a different state, you're still certified, but you do have to get a state pa license. So I think the flexibility particularly um to be able to choose a position that fits your lifestyle and where you are in life um is actually quite helpful.

Um For example, a lot of people will say this and this kind of gets under my skin a little bit is that PA s have better worklife balance.

Well, yes and no, because you can find a job in which you are working 50 plus hours a week and taking call and working weekends and doing all of those things.

But what the pa a profession does give you is the ability to create your own worklife balance. So, for example, I worked full time for a really long time.

Well, my husband was in training, I worked a lot of hours. I worked weekends.

I took call. But now that we have a daughter and he's working and we're very busy.

I switched to part time, I was able to, you know, navigate a part time schedule. So that one of us can be more available to our daughter when things get challenging for child care or she's sick or, you know, that kind of thing.

So I think, you know, having that flexibility particularly for women, I think has been um why we have seen the shift in um the gender trend.

Number one and number two, the popularity of the profession, but II will say as a whole. Um this is what pa is really like in general, both men and women.

Um And of all different ages, the flexibility uh is really nice. And again, the media exposure I think has highlighted over the last couple of years.

Um the the popularity of this profession and how it's uh been really in demand. So like I said, the gender trend 1967 the first pa class was all male, it was like four people.

Um And then in 1970 just by 1972 just a couple of years, 16% students are female, 1976 4 years later, 32%. Then 1982 it kind of hit the equal mark as of 2020 72% female.

Uh Again, I think that has to do um with, you know, flexibility and scheduling and wanting to have families and things of that nature or maybe it just has to do with travel and you wanna pursue other things, you know, outside of your uh medical work.

And so I think that it has uh a lot to do with all of that, but that's sort of what the trend has been. PA S also have a great job satisfaction.

I forgot to mention this earlier. Um 92% of PA s are glad they became APA.

So this was a Medscape did a big survey in 2020 and uh asking P SA lot of different questions. Would you do this again?

You know, was your compensation fair? Um Are you glad you became a PA A?

If you weren't a pa A would, what would you do? So 92% of pa say they're glad they became a pa a 82%.

So they do it all do it all over again. 7% saying they would go to medical school and 7% saying they were doing something completely different health care, like go on Broadway like I would even though I have no doubt.

So I think that, you know, 82% in that specific situation is a good number. It's a solid number.

74% thought compensation was fair. That varies significantly on years of experience and location throughout the country at 5 to 9 years though pa S uh 50% of pa s experience burn out on the floor side.

They also have the highest rates of professional fulfillment. That was a very interesting um article that came out from the A APA in 2018.

So overall PA S have a high job satisfaction. Um Like many other medical providers, we need to be careful about burnout and a lot of institutions and a lot of workplaces have instituted wellness programs and things to help prevent burnout and have a good work life balance.

My opinion on why the pa profession has become so popular. Um Again, the versatility, the shorter training time, the job satisfaction and the collaborative nature of the profession makes it a desirable career for those looking for a stable career, health care with growth opportunity.

It also offers a stable income. Um And I really feel that um that those are the reasons why this profession has grown in popularity um particularly over the last 20 years.

All right. So I'm gonna take some questions.

I did well, I got to 20 minutes um and didn't over talk. So happy pa week to everybody.

I'm so thankful that osmosis um has allowed me to speak today on this topic. Um And if you have any questions after this, you can find me um at uh on any social media platform at Michelle, at the posh pa or email me directly.

So I will go ahead and see if I can see these questions here. Uh Hold on a second.

Why wouldn't that be safe? OK, I see the check but I can't see the other questions.

OK. Do you think that pa schools are recognizing this increase in popularity?

And that is why the application process is intense and the acceptance rate is low. Yes, I do, I do think they see the popularity but I also think the amount of applications they are receiving has what has basically been the impetus for things being more competitive and harder to get in and that directly correlates with the popularity of the profession.

So yes, I think I agree. Um about that.

When do you think PA S from the UK could be recognized in the US? That is a very difficult question.

Um I think that there are other countries that are u um beginning to utilize physician associates, they're typically called in Europe.

Um And so I think hopefully, um that would happen, you know, sooner rather than later. But the training and the just like when physicians are trained in other countries, it is challenging when you come to another country and having to do things again.

So I don't know it, I'm not gonna tell you that I know what the answer is to that. But hopefully, as this profession continues to grow in other countries, we'll be able to figure out a way that we can move more, more seamlessly, seamlessly um uh to different countries as well.

Shout out to lab scientists pursuing the pa profession. Any advice for us.

Um Michelle, I was a lab scientist. Um I worked in a research lab um for two years prior to applying to pa school.

Um advice for you is just that if you're thinking about going into a clinical side of medicine, you need to get patient care experience and really make sure that the clinical side of medicine is where you wanna be.

Do you ever feel that you're not well compensated for your job after so many years of working as a pa um uh tough one? Yes and no.

Um I would say that I feel II OK. So caveat number one, I am part time.

Um caveat number two, I work at an academic institution which typically pays less than if you're in private practice. Um And so I think I am compensated for the work that I do.

Um But I also have to realize all of the other things that I get along with being just seeing patients. So, you know, the benefits, the retirement, you know, all of that stuff that's easy to overlook when you're kind of just looking at the dollars.

Um and all of those additional benefits. So, um what I love to make more.

Absolutely. Um But I think at the same time, there are other avenues and opportunities in which I could make income as a pa with all of these experiences, whether that be teaching, whether that be, you know, starting my own business and all of that.

So, um I think my overall answer would be yes. Um ok.

So, um what do you like most about your work? And how long did it take?

You to feel like you knew what you were doing after you finished va school. What I like most about my work is the relationships I make with my patients and also with my team.

Um I love going to work and working with people that I really enjoy. Um And also I really like, you know, the issue on compensation is tough for me because I don't, yes, II need to make money and I want to make money, but that's not why I do what I do.

I actually really enjoy it. I really enjoy taking care of patients.

I really enjoy um learning clinical medicine, especially cancer care, which is always changing and so challenging. Um And so I think what I like most about it is just the relationships I develop and love working with my team.

Um and it took me about six months to feel like I got my bearings and then a year to really feel like I was, I was like, I got this now.

So I would say six months um minimum. What do you think is a better name for the professional physician assistant or associate?

Um In my personal opinion, I believe associate is uh more reflective of my relationship with a physician. Um It's also more reflective of a teamwork and how I collaborate with my doctor.

Um I think assistant can um uh have people mistake assistant for a medical assistant or somebody that is still gonna go back to school to be a doctor.

And so I think I would like to see associate, but at the same time, that education piece is still gonna be there because a pa is a pa is a pa and patients are still gonna need that education.

Um How many patients do I see an average in a day? How does that compare with the doctors on your team?

So sometimes I see more, sometimes I see less than them. Sometimes I see more.

I see. Um because my oncology patients are somewhat challenging, I see patients every 20 minutes um between 8 34 30.

So I average anywhere from um 15 plus a day. Um if not more, some days or less, some days or more.

Um What are the opportunities, possibilities, advantages, fun aspects of pursuing a pursuing research as apa Is there time somewhere?

Um Yeah. So um I do clinical research in my practice.

So I enroll patients on clinical trials and I'm part of the clinical side of um research as far as translational and sort of bench res research.

Um I think that you would have to find a field which oncology is a good one for this um where you would be willing to, you would have a physician willing to help train you in the lab as well.

Um I think that, you know, the only part about that is funding for a position like that um may be challenging in the research realm for a pa with that being said, you can serve as a sub eye.

Um So a subinvestigator on clinical trials, um like I do and um you can be part of, you know, you can conduct your own research.

Um if you have a, a physician that's willing to be api with you. So many pa s involved in different areas of research.

How did I gain patient care experience? In addition to working in the lab?

I worked. So I worked as a, I got a CNA certification and I worked as a patient care technician on a bone marrow transplant floor part time while I was working in the lab as well.

Um When working as an oncology, pa do you feel the salaries adequate compared to an oncologist MD in the academic setting?

It's uh first of all, no, I uh oncologists are paid a lot more. Second of all in the academic setting, it's closer in the private practice setting.

I would have to say, I don't really, I know, I know that private practice oncologists do get paid more. Um uh If an undergrad is interested in being involved in research, would you suggest you better to do this in a gap year?

Uh or possible after it doesn't matter if you're involved in research though, it will help your application as A PPA. So if you're doing that during a gap year, I think that's a great idea.

Um How do you feel about a holistic approach? I guess, I'm not sure about that question.

I think, you know, in oncology, we treat people holistically all the time. Um, where a lot of times we will combine, you know, alternative medications, um or alternative medicine techniques, like ones that have been uh proven effective like acupuncture um for certain things.

Um wi with traditional medicine and so, you know, we don't recommend a lot of herbs and supplements and things like that, that may interfere uh with their treatments that they're getting.

Um And so if that's what you mean by that, I'm not sure. But otherwise, we do take a very holistic approach to patients in terms of thinking about the person, the environment, um their, you know, individual thoughts about, you know, their treatment um and, and their cultural beliefs and backgrounds, you know, before making, making recommendations and before talking to patients in a different way.

Um OK, what do you recommend currently for shadowing during this limited environment during the pandemic? Um So shadowing obviously, very challenging.

Um Right now, I would continue to try and reach out and just if you find somebody that's willing to take you as a shadow, but you can't right now just make sure you're keeping in contact with them.

Um Also, I, a lot of pa s on Instagram and social media are uh are uh are offering virtual shadowing opportunities. I would do that.

I would list it on your application, it doesn't replace in person shadowing, but it's the best we can do right now. So, um so that's what I would do.

Um Can you circle back on the disparities in insurance coverage? How does the pa a create more equity in health care for those on different insurance plans?

So, the reimbursement is different um for different insurance plans, whether they see a pa or a doctor. So, um if a pa sees a patient by themselves on Medicare, the reimbursement is 85% where the physician is 100%.

However, if I'm seeing a high volume of patients, it equals out over time. Uh private payers usually pay 100 percent, but it varies on the payer.

So that's the difference. Um Do I still have moments where you're not sure what to do, meaning what to do?

Yeah, of course. I don't know everything.

Um I, oh, I ask for help all the time. Do not.

You cannot be um arrogant in health care. You cannot.

So a absolutely. Have I ever regretted being a pa and said no, no.

Um I get this question all the time. I II made a actual decision not to go to medical school.

I thought about it for a few minutes. Um I said it out loud and I II could have, um I could have applied to medical school.

I truly believe I would have, you know, been accepted to medical school. Um, but II, because I was with Dave at the time and he was applying and, um, you know, I feel like I could have done that but I, that's not the life I wanted, that's not the career I wanted.

Um, and so I ultimately feel that this was the b best career choice for me. Um, it has a, it has, this career, has grown with me as I've grown both personally and professionally over the last 15 years.

Um I think we're out of time, right? I think it's 30 minutes, but I can take these last two questions.

I just found someone who is willing to let me shadow in person. Do you have any recommendations on do s and don'ts um I would say um uh you know, show up ready to go ask questions, don't be overbearing.

Um you know, and make sure that you're just dressed professionally. Um And again, always thank the person at the end of the day and see, you know, talk to them about whether or not you can come back.

Um You can even mention to them if they'd be willing to write you a letter for recommendation if you, if they allow you to shadow multiple times in a row.

Oh My loom cube just died. My light.

Um And then what initially, what made you initially choose to specialize in oncology? I actually didn't um work in oncology first.

I did internal medicine first and then, um and then a little bit of gi and then transitioned to oncology. I always had a little bit of an interest in oncology.

I was doing basic science, cancer research prior to pa school. And when this opportunity came up for a position, I went and spent the day there and I just thought it would be a great fit and it's been 15 years since so I love it.

Um Thank you so much. Uh Happy pa a week to you.

Um And I really appreciate you. Thank you Megan um for letting me speak here.

This was recorded and it will be um available on osmosis and I will share that as well.