Physician Assistants and the Doctor Shortage Question

Your average American believes in the doctor shortage we have been hearing about for years. So does your average healthcare worker. Some studies have suggested the shortage is not as severe as advertised and could be adequately addressed by leaning more heavily on physician assistants and nurse practitioners. A newly released study adds something else to the equation: physician distribution.

The study suggests that the current doctor shortage is more of a distribution problem than anything else. This is not to say severe shortages will not occur in the future. Rather, the research suggests that better utilization of doctors and physician assistants could help a stressed system and provide the basis for preventing future shortages.

Rural vs. Urban Medicine

Researchers from the Stanford University School of Medicine looked at historical data relating to emergency physicians from 2008 through 2020. Though their research focused on emergency medicine, they extrapolated to make applications to physician jobs in general. What they found offers a clearer understanding of the perceived doctor shortage.

It turns out that some 92% of emergency physicians practice in urban environments. Another 6% practice in what the researchers classified as large urban areas while the remaining 2% in small urban areas. Again, it is reasonable to assume similar statistics across the entire physician spectrum.

While it’s not unexpected that rural medicine is being shortchanged in terms of available physicians, the disparity appears to be much larger than many thought. The disparity explains why smaller rural areas have very little access to basic healthcare services. It explains why people in America’s heartland sometimes have to drive hours just to see the doctor.

A Perception of Shortage

If you were living in rural America where the closest doctor was 60 miles away, how likely do you think you would be to perceive a nationwide doctor shortage? Probably pretty likely. But then move to a large urban center where physicians abound and you might think differently. Perceptions change with experiences.

Now let us plug physician assistants (PAs) into the equation. What if the same rural areas lacking physicians for primary and noncritical care could be adequately served by PAs? What if group practices and local clinics could be adequately staffed by PAs and nurse practitioners? Suddenly, the shortage doesn’t seem as profound anymore.

PAs and NPs have been arguing for years for the right to practice without direct supervision. They are not looking to provide care for complex cases. Rather, they simply want to be able to offer primary care without having to be supervised by a physician. They contend that their training is more than adequate and that they only lack clinical hours.

States Are Loosening Up

The good news for PAs is that states are starting to loosen up. Slowly but surely, PA jobs at independent clinics are starting to show up on websites like Health Jobs Nationwide. Neighborhood clinics operated by local pharmacies are starting to hire PAs to provide primary care.

If the PA model works in urban and suburban health clinics, it should also work in rural areas. There doesn’t seem any logical reason to prevent PAs from offering primary care in areas doctors don’t want to work. Having access to a PA is still better than driving 60 miles to see GP.

How severe is the doctor shortage, really? Could it be more of a distribution problem than anything else? And if so, is it possible that PAs could be an integral part of the solution? It is starting to look that way. The question now is whether or not we are willing to accept the data.

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