Physician assistant programs grow, face bottlenecks
Hospitals and clinics are increasingly eager to hire physician assistants. But the irony is that those same health care employers can have a hard time making room for the students training to be tomorrow’s physician assistants when they need on-the-ground learning. The opening of new programs will push this issue to the fore, as more colleges work to find and keep the clinical placements they need.
“There’s a bottleneck and it’s getting tighter,” said Penelope Moyers, dean of the Henrietta Schmoll School of Health at St. Catherine University.
“There are only so many available slots for medical training and sometimes they don’t have anything left over for us,” said Dawn Ludwig, physician assistant program director, Augsburg College.
Despite those concerns, Augsburg and St. Kate’s both have a strong partner in Fairview Health Services. Laura Beeth, system director of talent acquisition, describes how important it is for Fairview to work closely with both institutions and their physician assistant programs. And yes, part of the reason is because of Fairview’s own eventual hiring needs. Last year, Beeth notes, Fairview hired more nurse practitioners and physician assistants than physicians.
For physician assistants, their name fails to convey just what they can do. Working as part of a team with a supervising physician, the role of a physician assistant or PA can include performing physical exams, treating illnesses, prescribing medications, ordering lab tests, assisting in surgery and counseling patients.
With two new physician assistant programs on the way — pending accreditation approval, Bethel University expects students to start this summer and The College of St. Scholastica expects students to start in three years — more health care systems will need to step up and help create more training opportunities, Beeth said. “It is going to take a commitment from multiple organizations to take on those clinicals,” she said. “If you look at the forecasting for demand for new physician assistant hires, they need to. We need all of these programs.”
Physician assistant demand
Over the next 10 years Minnesota will face shortages in primary care providers, according to a 2011 report from the Governor’s Workforce Development Council (GWDC). With needs for health care growing as the state’s population ages and continues to expand, we also face pending baby boomer retirements. Physician assistants can be part of the solution, “extending and expanding the capacity of primary care physicians,” said Ron Berkeland, dean of the School of Health Sciences, The College of St. Scholastica. “It’s a reasonable, logical way to approach this pending health care problem.” But it requires that there are enough physician assistants around to do just that.
The number of physician assistants has been growing dramatically, exceeding the growth in physicians and increasing over 10 years by nearly three times, according to the GWDC report. Looking ahead, there are plenty of forecasts for more of the same, from Forbes magazine to the Bureau of Labor Statistics. As for Minnesota, the report’s authors, who included Beeth, wrote that “the expanded use of physician assistants will be critical to the provision of primary care in the future.”
Expanded opportunities to educate physician assistants here in Minnesota is one piece of the puzzle. Ninety percent of Augsburg’s graduates stay in Minnesota, Ludwig noted. The hope is that the share of graduates staying nearby remains high with the new programs. That’s likely the case with applicants for Bethel’s new program, said Wallace Boeve, program director. Bethel received more than 200 applications for its inaugural class, interviewing 80 of them for 32 spots. He said that many of them have spoken about their desire to earn their degrees in the region where they want to practice.
“We’re on the cusp of more opportunities for physician assistants in Minnesota,” Boeve said. “We need to continue to actively educate clinics and hospital systems around the state about the benefits of physician assistants for their practices with the goal of more and more sites hiring physician assistants.”
Why private colleges
Augsburg College offered the first accredited program in the state and it remains the only one that is currently graduating students; St. Kate’s enrolled its first students last fall. Adding in what Bethel and St. Scholastica have planned, it stacks up to a four-goal salvo of sorts for private colleges. Nationally, the average length of a physician assistant education program is 27 months.
Why are these programs at privates and not publics? “Sometimes private colleges are able to move faster,” Beeth answered. Private college sources also cited their “nimble” natures, along with suggesting that this particular niche may not have fit with the public universities’ business plans and current health education programs. The GWDC report had called for a public university in Greater Minnesota to step forward and create a new program; Duluth-based St. Scholastica did so instead.
Another factor that may have impacted the lack of interest from the publics is the cost of entry, with a new program expected to cost as much as $1 million to get started, mostly in personnel and facilities. “These are expensive programs to start and maintain, the accrediting body requires you to have all the investment upfront, before students are admitted,” Moyers said. “With higher education having to face its own economic issues, not every university is going to be able to invest in this.”
These programs also fit in with the priority that many private colleges have had on health care education, some from their very inceptions. For example, Minnesota’s Private Colleges already award about one-third of the state’s health care master’s degrees. That existing focus on health care means that these colleges already have the infrastructure to support these programs.
The fact that 100 percent of physician assistants will be graduating from private institutions with strong faith traditions may also impact the kinds of educations students will receive. “I just think private colleges can really push mission. Here our Catholic social justice beliefs are really infused throughout our program,” Moyers said. “That’s where you’ll see the impact of us being private colleges, we’re all mission-based.”
Working through the clinical questions
While new competition is unavoidable, physician assistant programs shouldn’t start fighting over trying to get students into the same clinical spots, Ludwig cautioned. Others agreed; Boeve said he sees opportunities to “build a great physician assistant profession together.” There are in particular opportunities to expand placements outside the Twin Cities, sources said.
For these programs, the accreditation decision depends in part on having signed agreements for the necessary clinical placements lined up ahead of time. For Bethel, Boeve said that’s been a focus for him and the medical director. With each Bethel student needing to rotate among nine different clinical specialties for between four and eight weeks, he said he needs to line up close to 300 sites. Citing Bethel’s strong history in the sciences and practicing providers wanting to give back to Bethel’s mission, he said the university has letters of intent from about 90 percent of the slots needed.
The challenge of arranging the right kinds of clinical placements exist for other kinds of health care programs, Berkeland noted. But he and other sources said additional challenges exist today, with an ever-increasing focus on current staff productivity and the distractions posed by the introduction of electronic medical record systems. And government support for provider education has been declining.
“So yes, health care professional programs are seeking more and more clinical time,” Berkeland said. “And organizations are trying to reduce clinical time. It is a bit of a perfect storm.”
Policy review and discussion about government support is part of the needed response, Moyers said. She also forecasts changes in how students need to be supervised and better measurement of the value they can bring, especially after they have some experience built up in a system.
The colleges’ programs will continue to need to sell the idea of physician assistants to busy and strapped health care organizations. As Ludwig notes, they often are attracted to the idea of a controlling costs by paying a lower salary for a physician assistant than a physician, while maintaining patient safety and quality outcomes.
“Whether they are large or small institutions, it really is a matter of helping them understand how a physician assistant could augment the care at that clinic,” Ludwig said. “We can assist the clinics in thinking about all of the duties of a physician and how a physician assistant may be able to increase the access for the patient. And when you start talking about these kinds of things, it becomes attractive to that clinic.”