Career span of a PA

The span of a PA career is a concept slowly emerging in the literature. After 50 years of documenting various components that make up the PA's vocational arc, the details are starting to fall into place. To learn about the characteristics and behavior of PAs, we can draw on five major databases: the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), the American Academy of Physician Associates (AAPA), the Bureau of Labor Statistics (BLS), the National Commission on Certification of Physician Assistants (NCCPA), and the Physician Assistant Education Association (PAEA). For example, we know that 99% of PA graduates pass the PA National Certification Examination (PANCE), administered by the NCCPA. This agency calculated that in 2020, the mean age of all clinically active PAs was 40 years and 76% were women.1

From the PAEA, we learn that in 2021, the 277 PA programs in the United States graduated 11,000 PAs; 70% were female and the median age was 29 years.2 PA education is in a growth phase and ARC-PA reports that the 287 institutions that have accreditation or provisional accreditation status in 2024 will grow to 321.3 PA programs add graduates to the clinical pool each year—almost 10,000 in 2020.4 Growth in PA employment is baked in, and one prediction is that there will be 204,000 to 212,000 PAs by 2035, based on an average number of 45 graduates per program and a median age of 29 years at graduation.5 The BLS predicts a similar number of PAs by the next decade.6

The BLS estimated in 2021 that 125,280 PAs were employed in the medical workforce (which excludes those overseas or self-employed).6 The NCCPA estimated that 148,560 PAs were in active practice the same year. Although the BLS only surveys employers, the NCCPA data are updated regularly with PAs entering their professional activity information every 3 years or so.1 Both are useful data points depending on the question.

Three agencies (BLS, AAPA, and NCCPA) report wages or salary. This triangulation of data tends to complement one another and gives confidence in the findings. The mean annual wage in 2021 was about $125,280, with a wide range depending on medical or surgical specialty, hours worked per year, and additional pay for special activities.6

Role flexibility or voluntarily changing medical specialty has emerged as a defining attribute of PAs. This is because PAs can change their specialty (and employer) throughout their career. From earlier work, we find that about half of all PAs change significant medical roles—such as shifting from family medicine to orthopedics or gynecology to psychiatry.7 In fact, this first switch occurs in half of graduates within the first 10 years.8

Completing the career path to the final leg, we now know something about retirement. Based on surveys at two different time points, what is emerging is that the average career span as a clinical PA is about 35 years (typically ages 29 to 65 years) with a rapidly diminishing number employed beyond a 40-year career.5,9,10

What shapes the career curve for a cohort is remarkably like that of physicians and nurses (Figure 1). Using this stylized curve, almost 100% of graduates will pass the PANCE, a requirement for employment in all states and the federal government. Virtually all newly graduated PAs enter clinical practice and remain in clinical practice for the first 10 years.4 What occur in the second decade are departures due to health, time off for a family, and nonclinical careers. Somewhere in the third decade, more clinical departures occur due to taking up new roles in education, administration, research, emigration, or due to health concerns, or death. For example, senior PAs in the federal government (military or civilian) tend to provide less and less patient contact as they move up the administrative hierarchy.11 This holds for physicians and RNs as well. Their contribution outside of direct patient care is no less important and their influence on employment and policy plays significant roles in US society.

F1-1FIGURE 1.:

Estimated percentage of PAs clinically active in the workforce over 40 years

Providing some counterweight to this exiting clinical scenario over 3.5 decades are the PAs who (like some physicians) work beyond 4 decades and well into their 70s. However, most have tapered down their activity by then and few provide stressful procedural services such as surgery.12

For the viewer of healthcare professionals, the career arc is a widening field of health workforce research with more granular data gained annually. The refined picture of the 21st-century PA reveals the culmination of clinical productivity in improving the lives of so many. For this observer, PAs are a value that appears to be in the United States' best interests and their career trajectory an important area of workforce science.

1. National Commission on Certification of PAs, Inc. 2020 statistical profile of certified pas: an annual report of the National Commission on Certification of PAs. www.nccpa.net/wp-content/uploads/2021/07/Statistical-Profile-of-Certified-PAs-2020.pdf. Accessed April 8, 2022. 2. Physician Assistant Education Association. By the numbers: program report 35: data from the 2019 program survey. https://paeaonline.org/resources/public-resources/research-reports/program-survey-and-reports. Accessed April 8, 2022. 3. Accreditation Review Commission on Education for the Physician Assistant. www.arc-pa.org/accreditation/program-data. Accessed April 14, 2022. 4. National Commission on Certification of Physician Assistants, Inc. 2020 statistical profile of recently certified physician assistants: an annual report of the National Commission on Certification of Physician Assistants. www.nccpa.net/wp-content/uploads/2022/02/2020-Statistical-Profile-of-Recently-Certified-PAs-Final-2_23_22.pdf. Accessed April 8, 2022. 5. Hooker RS, Kulo V, Kayingo G, et al. Forecasting the physician assistant/associate workforce: 2020-2035. Future Healthc J. 2022;9(1):57–63. 6. US Bureau of Labor Statistics. Occupational Employment and Wages, May 2021. Physician assistants. www.bls.gov/oes/current/oes291071.htm. Accessed April 8, 2022. 7. Hooker RS, Cawley JF, Leinweber W. Career flexibility of physician assistants and the potential for more primary care. Health Aff (Millwood). 2010;29(5):880–886. 8. Quella AK, Hooker RS, Zobitz JM. Retention and change in PAs' first years of employment. JAAPA. 2021;34(6):40–43. 9. Hooker RS, Robie SP, Coombs JM, Cawley JF. The changing physician assistant profession: a gender shift. JAAPA. 2013;26(9):36–44. 10. Coombs J, Hooker RS, Brunisholz K. Physician assistants and their intent to retire. Am J Manag Care. 2013;19(7):e256–e262. 11. Smith NE, Kozikowski A, Hooker RS. Physician assistants employed by the federal government. Mil Med. 2020;185(5–6):e649–e655. 12. Hooker RS, Ramos C, Daly RP, Fang R. The characteristics of clinically active older physician assistants. JAAPA. 2012;25(1):48–53.

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