PA Workforce Volume Strives to Meet Patient Demand

Written by on November 30, 2012 in Practice tips - No comments

In this time of health care reform, medical practices and health systems must find ways to provide high quality health care services while remaining cost effective. The health care system is facing a shortage of primary care clinicians. This is critical when looking at health reform and examining the concept of increasing numbers of patients seeking access to medical care under a reformed system.  Currently, there is a shortage of primary care physicians and the Association of American Medical Colleges estimates that by 2020, the country will face a shortage of 90,000 physicians.  Increasingly informed patients and a cost-conscious marketplace are demanding new models of care that utilize all providers to their fullest potential in order to increase access to care and demonstrate improved health outcomes.  Utilization of physician assistants (PAs) may be part of the delivery solution.  Studies suggest that the addition of a PA to a medical practice may offer enhanced patient satisfaction, improved physician work-life balance, improved revenues and greater access to care for patients.

According to the American Academy of Physician Assistants ( AAPA) there are 86,500 certified physician assistants practicing medicine nationwide. This is an increase of more than 100-percent over the last 10 years.

Many successful Accountable Care Organization (ACO) models are embracing a shift from volume-based reimbursement to value based reimbursement and the formation of population health management hubs.  With the development of these new structured organizations, PAs and NPs will also act as extenders to support the primary care physician within the medical home model.

Accrediting bodies such as (NCQA) and the Utilization Review Accreditation Commission (URAC) support the concept of the patient centered medical home (PCMH) as a proven model for delivering high quality, cost-effective patient care and encourage the inclusion of Physician Assistants.  Nationally, the American Academy of Physician Assistants (AAPA) supports the fundamental premise that standards used to define the PCHM and newer care delivery models are not limited to physicians.

Approximately 35,000 PAs practice in primary care of all PAs nationwide. Many PAs will practice in health care PCMHs; lead patient care teams and participate in and be an integral component of quality performance reporting.

By integrating the care delivery system and restructuring the delivery of primary care services across settings from outpatient to hospital, populations and conditions may be managed more efficiently.  A team approach to care delivery will help to improve patient satisfaction and improve quality care for chronic diseases.

Utilization of PAs in the PCMH model may exist in several ways.  In some settings, PAs may be focused on acute care or on management of chronic conditions, while in other communities, PAs may maintain their own panels of patients alongside physicians, and in rural communities, PAs may practice alone with a physician located off site.  Optimal utilization supports the patient to choose a PA as a primary care provider, ensuring and increasing access to care while the physician maintains oversight of the PA scope of practice.  This utilization model allows for continuity of care, fosters patient/provider relationships, and underscores chronic disease management efforts for challenging care conditions including diabetes and asthma.  Ultimately, the role of the PA within the PCMH will depend on the clinical setting, patient population, clinical competency and experience, and the professional relationship between the PA and the physician(s).

Using broad legislative language to describe the primary providers of health care encourages flexibility and innovation as practices shift toward developing systems of care that focus on value and quality rather than volumes of patients.   Population management of chronic diseases will meet the needs of patients and community through models like PCMH and utilization of PAs will be an essential part of the successful workforce solution.


Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at

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