Head to Head: Physician Assistants in 2000 Compared to Family Physicians 1987 - 1999 Class Years

Robert C. Bowman, M.D.   rcbowman@atsu.edu

PA data is from http://depts.washington.edu/uwrhrc/uploads/CHWSWP105.pdf and FPGP data is (including osteopathic FPs) from the 2005 OfficeMax version of the AMA Masterfile. Also note that this is older data. The Physician Assistants rural distributions are quite different now as PA declines in the family practice component have involved each class year and each year after graduation as PAs move to orthopedic, ER, surgical subspecialty, and other urban and hospital and specialty careers.

It is important to understand that departures from the FP mode defeat rural workforce, especially in most needed areas. The family practice physician assistants that remain in the FP mode deliver 30% rural practice rates, 30 times the federally qualified rural health clinic contributions of non-FP physician assistants, and 6 - 7 times the Community Health Center contributions. Changes in physician and non-physician primary care are similiar - flat with no increase.

For the year 2000 prior to major deteriorations in PA rural contributions, the following comparisons can be made regarding rural distributions by state.

 Low levels across the board suggest poor support for either PA or FP regarding rural distributions. In some cases distributional training demonstrates advantages, as in Washington State and the MEDEX program. States such as Nebraska demonstrate similar levels across the board indicating a balanced emphasis of distribution. Comparisons of both PA and FPGP to population can also be interesting. Either PAs or FPs should be distributing close to the rural population distribution of the state, if not, some questions should be asked about the policies for the whole state. The numbers of PAs and PAs were also very comparable for the all PA group in 2000 and this 1987 - 1999 group of family physicians, even without percentages.

Yellow cells have 10% greater PA distribution than FPGP. Gray cells have 10% greater distribution for FPGP. PA distributions on the left, FPGP in the middle, and the rural distributions of population by RUCA 2.0 are on the right

  PA PA1 PA2 PA3 PA4 FPGP FP1 FP2 FP3 FP4 Pop 2 Pop 3 Pop 4
  Number Urban Large Rural Small Rural Isolated Rural Number Urban Large Rural Small Rural Isolated Rural Large Rural Small Rural Isolated
AK 253 44.3% 21.3% 20.2% 14.2% 181 59.7% 12.2% 19.9% 8.3% 22.6% 15.3% 11.9%
AL 269 85.9% 6.7% 4.5% 3.0% 559 70.5% 13.6% 10.7% 5.2% 13.7% 12.0% 5.9%
AR 56 64.3% 16.1% 14.3% 5.4% 528 58.7% 21.0% 17.0% 3.2% 27.8% 23.2% 10.6%
AZ 726 76.2% 12.5% 8.1% 3.2% 739 81.6% 6.6% 9.7% 2.0% 10.4% 6.0% 2.6%
CA 3,895 92.6% 3.8% 2.6% 1.0% 4031 93.0% 4.6% 1.4% 1.0% 3.0% 1.8% 0.5%
CO 913 86.4% 1.9% 7.1% 4.6% 884 78.8% 6.8% 9.7% 4.6% 2.0% 7.8% 5.0%
CT 779 97.6% 1.2% 0.6% 0.6% 235 91.1% 6.8% 0.0% 2.1% 2.7% 1.5% 2.2%
DC 185 100.0%       102 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
DE 94 93.6%   6.4%   137 80.3% 14.6% 5.1% 0.0% 0.0% 20.4% 0.6%
FL 2,111 92.3% 2.2% 4.0% 1.5% 1873 94.8% 2.8% 1.9% 0.6% 2.2% 3.9% 1.7%
GA 1,313 77.6% 13.7% 5.6% 3.0% 1068 77.6% 9.9% 8.8% 3.7% 14.6% 11.4% 4.4%
HI 93 69.9% 20.4% 5.4% 4.3% 172 63.4% 29.1% 4.7% 2.9% 18.3% 4.0% 5.8%
IA 499 50.1% 12.8% 21.0% 16.0% 674 57.1% 13.6% 22.3% 7.0% 14.5% 19.2% 19.1%
ID 212 53.8% 23.1% 13.7% 9.4% 263 63.1% 12.5% 16.7% 7.6% 30.6% 14.5% 11.3%
IL 909 75.8% 12.0% 8.6% 3.6% 1732 84.6% 7.9% 6.8% 0.7% 7.3% 5.2% 3.3%
IN 277 82.3% 6.1% 9.0% 2.5% 1049 74.9% 14.5% 9.2% 1.4% 13.1% 11.8% 5.5%
KS 465 50.1% 26.0% 11.4% 12.5% 525 60.0% 18.7% 11.8% 9.5% 23.8% 9.9% 11.1%
KY 519 60.9% 17.7% 15.2% 6.2% 485 51.8% 24.1% 15.5% 8.7% 17.3% 21.2% 15.5%
LA 272 81.6% 11.8% 4.4% 2.2% 506 79.1% 13.4% 6.7% 0.8% 13.2% 12.9% 5.2%
MA 869 92.9% 2.0% 4.1% 1.0% 573 97.4% 0.9% 1.2% 0.5% 2.7% 2.6% 1.9%
MD 1,080 95.3% 3.2% 0.9% 0.6% 479 90.2% 5.4% 3.5% 0.8% 4.0% 2.2% 2.2%
ME 380 47.9% 12.6% 21.8% 17.6% 351 51.0% 18.8% 13.7% 16.5% 15.0% 17.3% 22.8%
MI 1,635 79.3% 9.8% 4.6% 6.2% 1706 79.8% 10.9% 7.0% 2.3% 7.4% 4.3% 6.9%
MN 586 68.5% 9.2% 9.2% 12.6% 1188 64.9% 14.9% 12.5% 7.7% 10.9% 8.9% 12.5%
MO 299 75.3% 8.7% 10.0% 6.0% 822 66.5% 17.4% 10.6% 5.5% 10.2% 11.4% 10.8%
MS 36 83.3% 11.1% 5.6%   337 48.4% 31.2% 13.9% 6.5% 27.1% 21.5% 13.2%
MT 179 40.2% 15.6% 19.6% 24.6% 208 29.8% 22.6% 32.2% 15.4% 27.2% 16.7% 20.6%
NC 2,094 73.1% 12.1% 7.8% 7.0% 1195 73.2% 15.0% 6.9% 4.9% 15.5% 11.3% 10.5%
ND 194 42.8% 9.3% 11.9% 36.1% 160 54.4% 18.8% 8.8% 18.1% 18.0% 8.4% 30.2%
NE 456 55.9% 14.7% 15.1% 14.3% 335 52.2% 18.5% 17.6% 11.6% 18.4% 12.1% 17.0%
NH 220 60.5% 25.5% 6.4% 7.7% 237 57.4% 22.8% 7.6% 12.2% 17.3% 5.8% 12.9%
NJ 484 97.9% 2.1%     800 97.8% 2.3% 0.0% 0.0% 1.2% 0.4% 0.1%
NM 332 55.7% 28.6% 10.5% 5.1% 317 63.4% 27.8% 5.4% 3.5% 29.0% 8.3% 5.6%
NV 221 83.3% 7.2% 5.9% 3.6% 258 89.1% 7.0% 3.1% 0.8% 6.7% 4.9% 2.0%
NY 4,917 88.7% 4.4% 3.8% 3.1% 1826 89.4% 5.3% 3.7% 1.7% 5.0% 3.7% 3.3%
OH 1,143 89.9% 7.3% 2.0% 0.8% 1839 80.3% 13.1% 5.2% 1.5% 13.7% 5.8% 2.5%
OK 597 64.0% 16.4% 13.9% 5.7% 564 61.2% 17.7% 15.2% 5.9% 19.1% 14.1% 7.9%
OR 362 69.3% 21.3% 3.6% 5.8% 610 68.4% 22.1% 7.7% 1.8% 19.9% 8.0% 3.1%
PA 2,211 77.6% 7.1% 9.9% 5.4% 1943 84.3% 10.9% 2.6% 2.2% 7.1% 8.0% 6.8%
RI 126 99.2%     0.8% 127 100.0% 0.0% 0.0% 0.0% 0.8% 0.0% 0.1%
SC 328 82.6% 6.7% 7.6% 3.0% 635 69.0% 22.4% 6.0% 2.7% 12.0% 14.1% 6.8%
SD 238 34.9% 25.2% 10.5% 29.4% 151 49.7% 18.5% 9.3% 22.5% 24.0% 10.6% 28.8%
TN 483 70.0% 13.5% 9.9% 6.6% 816 69.2% 15.0% 11.3% 4.5% 16.2% 16.7% 7.2%
TX 2,475 80.9% 9.2% 6.6% 3.3% 2891 83.9% 8.8% 5.4% 2.0% 8.5% 5.7% 3.6%
UT 332 77.7% 9.9% 6.0% 6.3% 380 83.9% 3.9% 10.0% 2.1% 7.9% 5.9% 4.3%
VA 641 85.0% 7.6% 3.7% 3.6% 1030 84.8% 2.8% 7.5% 5.0% 6.8% 6.9% 8.6%
VT 122 38.5% 9.0% 27.0% 25.4% 142 34.5% 19.0% 18.3% 28.2% 12.1% 22.5% 38.7%
WA 1,156 80.4% 8.9% 5.7% 4.9% 1198 84.9% 6.6% 5.3% 3.2% 8.9% 4.7% 3.3%
WI 843 70.5% 8.3% 11.9% 9.4% 1082 67.3% 9.7% 14.9% 8.1% 8.6% 11.1% 12.7%
WV 457 30.4% 28.7% 16.6% 24.3% 375 58.9% 17.3% 15.7% 8.0% 17.9% 17.7% 24.5%
WY 111 34.2% 20.7% 28.8% 16.2% 110 34.5% 21.8% 34.5% 9.1% 28.7% 26.2% 15.3%
  39,477 79.7% 8.6% 6.7% 5.0% 40428 78.4% 10.7% 7.4% 3.5% 9.1% 7.2% 5.4%

Rural Coding for poverty and population numbers by RUCA 2.0.

Such comparisons should not be seen as competitive, but complimentary. PAs have slightly greater distribution to isolated rural areas. Family Physicians have greater large rural and small rural distributions.

There is one difference however.

For Health Access Contributions - Try the Report Card Comparing Primary Care Forms in the Major Elements Many failing grades and clear evidence of design failure.

Five Periods of Health Policy and Physician Career Choice

Primary Care Retention

Retention Within the Specialty of Family Medicine

Instate Retention of Family Physicians - those with origins most similar to the populations in a state and those with humble origins are the most likely to be found in a state. Family medicine choice facilitates a return to desired location and population.

Patterns of Rural Workforce - FP state distributions

Patterns of Distribution - distributional medical schools graduate distributional physicians

www.basichealthaccess.org

www.physicianworkforcestudies.org

www.ruralmedicaleducation.org

 

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