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2016

An examination of PA recruiting and employment practices in hospital settings

SURVEY OF PA RECRUITING

AND EMPLOYMENT TRENDS

Conducted by Merritt Hawkins in conjunction with the

American Academy of PAs (AAPA). Completed November

2016. Copyright, 2016. AAPA and Merritt Hawkins.

©2016 Merritt Hawkins

8840 Cypress Waters Blvd., #300 | Coppell, TX 75019

(800) 876-0500 | www.merritthawkins.com

2016

An examination of PA recruiting and employment practices in hospital settings

SURVEY OF PA RECRUITING

AND EMPLOYMENT TRENDS

Conducted by Merritt Hawkins in conjunction with the American Academy of PAs

(AAPA). Completed November 2016. Copyright, 2016. AAPA and Merritt Hawkins.

Summary Report 2-3

Key Findings 4-5

Survey Questions and Responses Received 6-18

Trends and Analysis 19-29

Conclusion 30

1 | 2016 Survey of PA Recruiting and Employment Trends

Summary Report

OVERVIEW

Among the many profound changes

taking place in healthcare today is the

restructuring of the clinical workforce.

Once an arena in which various types

of clinicians operated in silos and

often in strict hierarchies, patient care

is increasingly delivered through a

team-based approach predicated on

communication and cooperation.

A key goal of emerging team-based

models is the appropriate allocation

of tasks among clinicians and other

professionals, who may range from

physician subspecialists performing

complex surgeries to community health

advocates addressing the societal

determinants of health.

For a variety of reasons discussed in

this report, PAs, along with “advanced

practitioners”, have become increasingly

prevalent among clinical teams, and

increasingly important to the delivery of

quality, accessible care. While in 1991 there

were only 20,000 PAs, more than 108,000

have been licensed to practice medicine

throughout the United States today.

According to the U.S. Bureau of Labor

Statistics, the number of PAs is expected

to increase by 38% between 2012 and

2022. The PA Education Association, the

organization that represents PA education

programs, reports that over 8,900 new PAs

join the workforce each year. Hospitals,

medical groups, urgent care centers and

many other types of healthcare facilities

are eager to add PAs to their clinical teams.

Reflecting this trend, the number of PA

recruiting assignments Merritt Hawkins

conducted for its clients grew by 300%

between 2012 and 2016.

The 2016 Survey of Physician Assistant

Recruiting and Employment Trends was

conducted by Merritt Hawkins in

conjunction with AAPA to learn more

about employers’ perspectives on PAs

during a time of transformational change

in healthcare. Looking specifically at PAs

within hospitals, this survey examines

several facets of PA staffing. Are hospital

employers actively recruiting PAs? If so,

why, and what types of PAs are they

seeking? Are PAs in management roles?

Are their roles likely to expand? How do

employers perceive the scope and quality

of care PAs provide? These as well as

other questions are examined.

The survey data are offered as a resource

to healthcare executives, policy makers,

PAs, media members and others who

track clinical workforce recruiting and

employment trends.

2016 Survey of PA Recruiting and Employment Trends | 2

METHODOLOGY

ABOUT AAPA

The survey was emailed to approximately

4,000 hospital human resource directors

and recruiting personnel between May

2016 and August 2016. Two hundred

eighty-six completed surveys were received

for a response rate of 7%.

Though many different types of healthcare

organizations employ PAs, the survey

reflects PA recruiting and employment

patterns at hospitals only. Obtaining

data from tens of thousands of physician

practices, urgent care centers, Federally

Qualified Health Centers (FQHCs), and

other facilities that may employ PAs was

deemed beyond the scope of this effort.

Because the number of hospitals is relatively

limited at approximately 5,500 nationally,

yet approximately 30% of PAs work in a

hospital setting, it was determined that the

survey would focus solely on the hospital

sector of PA employers.

Statistical response experts at the

University of Tennessee, who reviewed

data derived from the survey and the

methodology employed, indicate that the

survey is directional in nature and that

caution should be taken in extrapolating

results to all hospitals.

The American Academy of PAs (AAPA/

www.aapa.org) is the national professional

society for PAs. It represents a profession

of more than 108,000 licensed PAs across

all medical and surgical specialties in all

50 states, the District of Columbia, the

majority of the U.S. territories and the

uniformed services. The AAPA advocates

and educates on behalf of the profession

and the patients PAs serve working to

ensure the professional growth, personal

excellence and recognition of PAs.

ABOUT MERRITT HAWKINS

Founded in 1987, Merritt Hawkins is

the leading physician and advanced

practitioner search and consulting firm in

the United States.

In addition to its clinical and academic

physician search services, Merritt Hawkins

is nationally noted for its research and

analysis capabilities. Merritt Hawkins

generates surveys, white papers, books

and other thought leadership endeavors

for internal use, and is retained by third

parties to conduct research and analysis on

their behalf. Third parties for which Merritt

Hawkins has conducted surveys, produced

white papers or other research include

The Indian Health Service, The Physicians

Foundation, Trinity University, the North

Texas Regional Extension Center/Office of the

National Coordinator of Health Information

Technology, the Texas Healthcare Trustees,

and a wide variety of individual hospitals.

Additional information about Merritt

Hawkins can be accessed at

www.merritthawkins.com.


Key Findings

Following are key findings from

the 2016 Survey of PA Recruiting

and Employment Trends:

90%

of hospitals

currently

employ PAs

• 90% of hospitals report

that they currently employ

PAs, including 96% of

hospitals with 201 beds

or more.

• 58% of hospitals anticipate

PAs will take on more roles

and job functions within

their facilities.

• The two most highly agreed

upon reasons hospitals employ

PAs are to enhance access to

care and to enhance quality

of care.

• 81% of hospitals indicate

that patients rate the quality

of care PAs provide to be

above average to excellent;

99% rated the quality of care

average or higher.

• 71% of hospitals employ

PAs in primary care, while

52% employ PAs in surgical

specialties and 51% employ

PAs in other specialty areas.

60%

of hospitals

actively

recruiting PAs

• 60% of hospitals are

actively recruiting PAs.

Among hospitals with 100

beds or more, over 87% are

actively recruiting PAs.


89%

of hospitals hired

>1 PA last year

• The most commonly used

term to refer to physician

assistants is “PA”.

95%

of hospitals will

accelerate PA hiring

• 89% of hospitals hired

at least one PA last year.

Among hospitals with 201

beds or more, 98% hired

at least one PA last year.

• Over 95% of hospitals will

maintain or accelerate PA

hiring this year.

• Only 9% of hospitals have

a chief PA.


Survey Questions and

Responses Received

Following are questions asked by the survey and responses received.

Responses are broken out by hospital bed size for select data points.

1

How large is your facility?

33.6%

50 beds or fewer

7.9%

51-100 beds

14.6%

101-200 beds

43.9%

More than 200 beds

2

In what state is your facility located?

Alabama 1.4% Indiana 2.2% Nebraska 2.2% South Carolina 0.7%

Alaska 0.0% Iowa 4.7% Nevada 0.4% South Dakota 0.0%

Arizona 1.8% Kansas 2.2% New Hampshire 1.4% Tennessee 0.4%

Arkansas 0.4% Kentucky 1.8% New Jersey 1.1% Texas 4.7%

California 5.1% Louisiana 1.8% New Mexico 1.8% Utah 0.4%

Colorado 5.4% Maine 1.4% New York 4.3% Vermont 0.7%

Connecticut 1.8% Maryland 1.8% North Carolina 1.1% Virginia 0.7%

Delaware 0.0% Massachusetts 1.8% North Dakota 0.0% Washington 4.7%

Florida 4.0% Michigan 2.9% Ohio 2.9% Washington D.C. 0.0%

Georgia 2.5% Minnesota 3.6% Oklahoma 2.5% West Virginia 0.7%

Hawaii 0.0% Mississippi 0.0% Oregon 1.4% Wisconsin 4.0%

Idaho 2.2% Missouri 3.2% Pennsylvania 6.5% Wyoming 1.4%

Illinois 2.2% Montana 1.1% Rhode Island 0.7%


3

Does

your facility currently employ the following?

PAs All 50 beds or fewer 51-100 101-200 200+

Yes 89.9% 87.5% 94.1% 87.1% 95.7%

No 10.1% 12.5% 5.9% 12.9% 4.3%

NPs All 50 beds or fewer 51-100 101-200 200+

Yes 92.1% 90.3% 94.1% 96.8% 96.8%

No 7.9% 9.7% 5.9% 3.2% 3.2%

4

Approximately how many PAs does your facility currently employ?

All 50 beds or fewer 51-100 101-200 200+

< 10 57.9% 95.1% 78.6% 57.7% 20.0%

11-25 18.9% 4.9% 21.4% 15.4% 27.5%

26-50 10.7% 0.0% 0.0% 19.2% 21.2%

51-99 6.9% 0.0% 0.0% 7.7% 17.5%

> 100 5.6% 0.0% 0.0% 0.0% 13.8%

5

Approximately how many NPs does your facility currently employ?

All 50 beds or fewer 51-100 101-200 200+

< 10 48.1% 88.7% 64.3% 37.9% 7.3%

11-25 21.9% 11.3% 35.7% 41.4% 19.5%

26-50 8.9% 0.0% 0.0% 10.4% 19.5%

51-99 7.6% 0.0% 0.0% 6.9% 18.3%

> 100 13.5% 0.0% 0.0% 3.4% 35.4%


6

(For those hospitals that do not employ PAs) To what degree is your facility’s

policy not to employ PAs related to the following statements?

Strongly

Agree

Somewhat

Agree

Neither

Agree Nor

Disagree

Somewhat

Disagree

Strongly

Disagree

A physician must be present

when a PA sees a patient

27.8% 5.6% 16.6% 11.1% 38.9%

PAs cannot see new patients 13.3% 0.0% 33.3% 6.7% 46.7%

Physicians must see

every patient

PAs cannot prescribe

medications

PAs cannot perform routine

medical procedures

Reimbursement for services

performed by PAs is too low

Commercial payers won’t

reimburse for PA services

21.4% 0.0% 21.5% 7.1% 50.0%

20.0% 6.7% 33.3% 0.0% 40.0%

7.1% 21.4% 21.5% 7.1% 42.9%

15.4% 7.7% 38.4% 0.0% 38.5%

14.3% 7.1% 35.7% 0.0% 42.9%

Patients do not accept them 7.1% 7.1% 14.4% 21.4% 50.0%

Staff physicians do not

accept them

Quality of care they provide

is not adequate

Do not have the budget

to hire PAs

7.1% 7.1% 28.7% 21.4% 35.7%

14.3% 0.0% 14.3% 14.3% 57.1%

14.3% 7.1% 21.5% 21.4% 35.7%


7

(For

those hospitals that do not employ PAs) To what extent would each of the

following effect your facility’s decision to hire PAs?

To a Very

Great

Extent

To a Great

Extent

To Some

Extent

To Little

Extent

To Very

Little

Extent

PAs can practice

independently

PAs can perform most of the

procedures physicians perform

35.3% 17.6% 11.8% 11.8% 23.5%

31.2% 25.0% 12.5% 12.5% 18.8%

Most physicians accept PAs 13.3% 40.0% 20.0% 0.0% 26.7%

Most patients accept PAs 20.0% 33.3% 26.7% 0.0% 20.0%

Knowing PAs could

reduce costs

Knowing PAs could

enhance quality

Knowing PAs could

enhance patient access

If we had the budget

to hire them

If PAs had more

certifications

20.0% 40.0% 13.3% 6.7% 20.0%

26.7% 33.2% 6.7% 6.7% 26.7%

40.0% 26.6% 6.7% 6.7% 20.0%

33.3% 13.3% 26.7% 6.7% 20.0%

20.0% 6.7% 40.0% 6.7% 26.6%


8

Why does your facility hire PAs?

Strongly

Agree

Somewhat

Agree

Neither

Agree Nor

Disagree

Somewhat

Disagree

Strongly

Disagree

To enhance patient access

to care

67.7% 22.8% 7.5% 0.5% 1.5%

To enhance quality of care 50.8% 27.9% 18.8% 1.0% 1.5%

To reduce costs 37.2% 35.7% 20.6% 5.0% 1.5%

To enhance patient

satisfaction

43.9% 30.9% 21.6% 2.1% 1.5%

To reduce staff burnout 29.9% 31.0% 34.1% 3.0% 2.0%

To implement

team-based care

To implement population

health management

To succeed under

value/quality-based

payment systems

36.4% 38.9% 21.7% 2.0% 1.0%

26.2% 30.8% 35.8% 4.6% 2.6%

26.3% 32.0% 33.5% 4.1% 4.1%

Other 44.0% 4.0% 52.0% 0.0% 0.0%


9

How many PAs is your facility currently recruiting?

All

50 beds

or fewer

51-100 101-200 200+

1-5 47.3% 32.7% 50.0% 84.0% 50.0%

6-10 5.5% 0.0% 0.0% 4.0% 16.1%

11-15 2.5% 0.0% 0.0% 0.0% 8.1%

16-20 0.5% 0.0% 0.0% 0.0% 1.6%

21 or more 4.0% 0.0% 0.0% 0.0% 11.3%

We are not currently

recruiting PAs

40.2% 67.3% 50.0% 12.0% 12.9%

10

How many NPs is your facility currently recruiting?

All

50 beds

or fewer

51-100 101-200 200+

1-5 48.0% 42.3% 78.6% 83.3% 41.0%

6-10 5.0% 0.0% 0.0% 0.0% 14.8%

11-15 4.0% 0.0% 0.0% 0.0% 13.1%

16-20 1.5% 0.0% 0.0% 0.0% 4.9%

21 or more 5.5% 0.0% 0.0% 0.0% 16.4%

We are not currently

recruiting NPs

36.0% 57.7% 21.4% 16.7% 9.8%


11

Approximately how many PAs did your facility hire in 2015?

All

50 beds

or fewer

51-100 101-200 200+

1-5 69.1% 76.9% 92.9% 79.2% 50.8%

6-10 10.8% 0.0% 0.0% 12.5% 20.3%

11-15 3.1% 0.0% 0.0% 0.0% 10.2%

16-20 0.5% 0.0% 0.0% 0.0% 1.7%

21 or more 5.2% 0.0% 0.0% 0.0% 15.3%

We do not hire PAs 11.3% 23.1% 7.1% 8.3% 1.7%

12

Approximately how many NPs did your facility hire in 2015?

All

50 beds

or fewer

51-100 101-200 200+

1-5 54.9% 65.4% 85.8% 75.0% 22.1%

6-10 14.4% 0.0% 7.1% 25.0% 27.1%

11-15 7.2% 0.0% 0.0% 0.0% 23.7%

16-20 1.5% 0.0% 0.0% 0.0% 5.1%

21 or more 6.1% 0.0% 0.0% 0.0% 18.6%

We do not hire NPs 15.9% 34.6% 7.1% 0.0% 3.4%

13

How difficult is it to recruit PAs to your facility?

2.5%

Very Easy

18.4%

Somewhat Easy

31.3%

Neither Difficult nor Easy

38.3%

Somewhat Difficult

9.5%

Very Difficult


14

What is your facility’s current PA vacancy rate?

All

50 beds

or fewer

51-100 101-200 200+

1-10% 75.6% 92.4% 88.9% 80.0% 60.0%

11-20% 16.3% 3.8% 0.0% 10.0% 30.0%

21-30% 3.7% 0.0% 11.1% 5.0% 4.0%

31-40% 3.0% 3.8% 0.0% 0.0% 4.0%

41-100% 1.4% 0.0% 0.0% 5.0% 2.0%

15

What is your facility’s current NP vacancy rate?

All

50 beds

or fewer

51-100 101-200 200+

1-10% 71.4% 82.8% 100.0% 72.7% 57.2%

11-20% 21.4% 10.3% 0.0% 18.3% 32.7%

21-30% 5.1% 6.9% 0.0% 4.5% 6.1%

31-40% 0.0% 0.0% 0.0% 0.0% 0.0%

41-100% 2.1% 0.0% 0.0% 4.5% 4.0%

16

How do you anticipate your facility’s PA hiring will change in 2016?

2016

My facility will increase PA hiring levels 32.3%

My facility will maintain current PA hiring levels 63.2%

My facility will decrease PA hiring levels 4.5%


17

What types of PAs does your facility employ? Check all that apply.

All

50 beds

or fewer

51-100 101-200 200+

Primary care specialty 71.3% 84.6% 92.9% 62.5% 77.8%

Surgical specialty 51.5% 23.1% 50.0% 54.2% 90.5%

Other specialty care 50.5% 34.6% 42.9% 54.2% 58.7%

18

Does your organization have a PA preceptor program?

All

50 beds

or fewer

51-100 101-200 200+

Yes 46.4% 29.4% 50.0% 45.9% 61.0%

No 53.6% 70.6% 50.0% 54.1% 39.0%

19

If yes, how often does your facility hire from your PA preceptor program?

All

50 beds

or fewer

51-100 101-200 200+

Very Frequently 6.6% 0.0% 28.6% 0.0% 8.3%

Frequently 26.4% 13.3% 14.3% 18.1% 41.7%

Occasionally 41.7% 40.1% 57.1% 36.4% 36.1%

Rarely 20.9% 33.3% 0.0% 36.4% 11.1%

Very Rarely 4.4% 13.3% 0.0% 9.1% 2.8%


20

Does your organization prefer to hire PAs or NPs?

All

50 beds

or fewer

51-100 101-200 200+

Our preference

is usually for PAs

Our preference

is usually for NPs

We have no preference

and will hire either

11.6% 11.6% 0.0% 4.1% 8.2%

26.9% 26.9% 35.7% 41.7% 34.4%

61.5% 61.5% 64.3% 54.2% 57.4%

21

Do you track how patients rate the quality of care PAs provide?

All

50 beds

or fewer

51-100 101-200 200+

Yes 81.9% 90.4% 92.9% 77.3% 79.3%

No 18.1% 9.6% 7.1% 22.7% 20.7%

22

If yes, how do patients rate the quality of care the typical PA provides?

All

50 beds

or fewer

51-100 101-200 200+

Excellent Quality 26.6% 31.9% 46.1% 11.8% 21.7%

Above Average Quality 54.4% 48.9% 38.5% 52.9% 60.9%

Average Quality 18.4% 17.1% 15.4% 35.3% 17.4%

Below Average Quality 0.6% 2.1% 0.0% 0.0% 0.0%

Poor Quality 0.0% 0.0% 0.0% 0.0% 0.0%


23

Do you see PAs taking on more roles or job functions within your facility?

All

50 beds

or fewer

51-100 101-200 200+

Yes 57.7% 48.0% 78.6% 60.9% 63.9%

No 42.3% 52.0% 21.4% 39.1% 36.1%

24

How familiar are you with your state’s regulations on the PA scope of practice?

33.3%

Very Familiar

16.7%

Neither Familiar nor Unfamiliar

40.4%

Somewhat Familiar

5.6%

Very Unfamiliar

4.0%

Somewhat Unfamiliar

25

What terms do staff at your organization generally use when referring to PAs?

Check all that apply.

2016

PA 78.7%

Physician assistant 70.3%

Physician associate 0.5%

Advanced practitioner (APP/APC) 25.2%

Allied professional 5.9%

Midlevel provider 50.0%

Non-physician clinician 3.5%

Advanced practice provider 21.8%


26

Are there any PAs at your facility in management/leadership positions, such as

department chair or committee member?

All

50 beds

or fewer

51-100 101-200 200+

Yes 15.2% 9.8% 21.4% 8.3% 20.0%

No 72.7% 86.3% 78.6% 83.4% 53.3%

Unsure 12.1% 3.9% 0.0% 8.3% 26.7%

27

At your facility, to whom do most PAs report? Check all that apply.

2016

Medical staff 52.2%

Nursing staff 2.0%

A chief PA 6.5%

A chief NP 2.5%

A chief medical officer 17.4%

Human resources 1.5%

Chief nursing officer 3.5%

Department administrator 28.4%

Director of PA Services 4.0%

Director of PA and NP Services 3.5%

I do not know 2.0%


28

Do you have a Chief PA?

All

50 beds

or fewer

51-100 101-200 200+

Yes 8.6% 2.0% 14.3% 4.2% 18.9%

No 91.4% 98.0% 85.7% 95.8% 81.1%

29

Approximately how many PAs at your facility have been granted medical staff

privileges?

All

50 beds

or fewer

51-100 101-200 200+

1-5 42.9% 68.0% 71.4% 33.3% 10.7%

6-10 16.7% 22.0% 14.4% 12.5% 17.9%

11-15 8.4% 2.0% 7.1% 8.3% 16.1%

16-20 4.2% 2.0% 0.0% 0.0% 7.1%

21 or more 19.9% 2.0% 7.1% 25.0% 44.6%

No PAs at our facility

have clinical privileges

7.9% 4.0% 0.0% 20.9% 3.6%

30

Approximately how many PAs are credentialed at your facility?

All

50 beds

or fewer

51-100 101-200 200+

1-5 44.0% 66.6% 64.4% 45.8% 8.8%

6-10 17.6% 23.5% 14.3% 16.7% 17.5%

11-15 8.3% 2.0% 7.1% 12.5% 10.5%

16-20 3.6% 3.9% 7.1% 0.0% 1.8%

21 or more 24.9% 2.0% 7.1% 20.8% 61.4%

No PAs at our facility

are credentialed

1.6% 2.0% 0.0% 4.2% 0.0%


2016 Survey of PA Recruiting

and Employment Trends

Trends and

Analysis

MARKET CONTEXT: WHAT

IS DRIVING DEMAND FOR

PHYSICIAN ASSISTANTS?

The 2016 Survey of PA Recruiting and

Employment Trends was conducted in a

period of unprecedented change in the

healthcare system. Results of the survey

should be considered within the context

of these changes and how they are

affecting the employment of PAs.

Factors to be considered include:

TEAM-BASED CARE AND

POPULATION HEALTH

MANAGEMENT

Through the Affordable Care Act (ACA),

approximately 20 million people have

been added to the ranks of the insured

through state insurance exchanges and

Medicaid expansion.

Payment formulas increasingly reward

providers for the value of services

provided, rather than or in addition

to volume of services, with further

rewards possible for achieving cost

effectiveness goals and measures. This is a

transformational paradigm shift that holds

important implications for all stakeholders

in healthcare, including clinicians. Who

clinicians are, how they practice, who they

work for, and how they are reimbursed

are all evolving, and PAs are playing a

central role in this evolution.

In the emerging healthcare delivery

paradigm, PAs are a key part of integrated

systems in which hospitals, primary care

physicians, medical specialists, therapists,

pharmacists and other professionals

work in teams to manage the care of

large population groups, coordinating

the care of individual patients within

the group while addressing the larger

societal determinants of health. Each type

of professional works to the top of his

or her training, and duties are assigned

appropriately. Budgets are global, risk is

shared, and outcomes, readmission rates,

patient satisfaction, and other quality

measures are used to determine payment.

However, the ACA, in conjunction with

a wide range of healthcare industry

innovations, has combined to do more

than merely alter how people obtain

health insurance. “Healthcare reform” also

embraces the movement to restructure how

healthcare is delivered and the basis upon

which healthcare services are reimbursed.


Though still aspirational in some cases, the

“population health management model” is

being implemented in a growing number

of accountable care organizations (ACOs),

large, integrated medical groups, hospital

systems, and other organizations.

In this model, PAs play a crucial role as

providers of clinical care, with particular

emphasis on disease prevention and the

management of chronically ill patients.

Addressing the needs of chronically ill

patients, and reducing the time and

resources they absorb, is the lynchpin of

population health management. Without

the presence of PAs and advanced

practitioners to ensure treatment

follow-through, patient compliance and

prevention, the team-based, population

health management model is virtually

untenable. For this reason alone, PAs are in

high demand today and are likely to be for

the foreseeable future.

of their patients would need to spend

18 hours per day to provide a full range

of diagnostic and preventive services

(Transforming Primary Care: From

Past Practice to the Practice of the

Future. Health Affairs. May, 2010). This

statistic reinforces the implementation

of the team-based model of care in

which patient care duties are divided

appropriately among a variety of clinicians.

THE PHYSICIAN SHORTAGE

Many healthcare policy analysts agree

that the United States is in the midst

of a widespread and growing physician

shortage. The dearth of physicians has

placed a growing premium on practitioners

such as PAs who can perform many of the

services provided by physicians.

The Association of American Medical

Colleges (AAMC) projects a deficit of

91,000 physicians by 2025, including a

deficit of 31,000 primary care physicians.

Estimates outlined in Health Affairs

suggest that primary care physicians

taking sole responsibility for the care

In an era of physician shortages, it will be

necessary for physicians to redefine their

roles. In order to accommodate patient

demand, physicians will need to practice at

the upper limits of their training, performing

the most complex duties of which they

are capable, while PAs and other clinicians

provide other care consistent with their

training and experience.

It is clear that as shortages persist, many

patients will be less likely to see a primary

care physician and more likely to see a

PA, and that PAs will play a key role in

maintaining patient access to primary care.


The physician shortage is not limited

to primary care, however. The AAMC

projects that there will be a deficit of

up to approximately 60,000 medical

specialists by 2025, due in part to the

health needs of an aging population. As

the chart below indicates, patients 65 and

older, though comprising only 14% of the

population, account for a relatively high

volume of procedures and services:

IN-PATIENT PROCEDURES

BY AGE GROUP

34.8%

28.0%

34.0%

14.0%

Given these demographic trends and the

limited supply of medical specialists, the

shortage of medical specialists is projected

to be even more severe than the shortage

of primary care physicians, creating an

expanded role for PAs in specialty care.

Approximately 75% of PAs now practice in

general surgery or surgical subspecialties,

in emergency medicine, internal medicine

subspecialties and in other specialty

areas. They will be of critical importance

to maintaining patient access to specialty

services as both the general and the

physician population ages. Indeed, in

2015 the AAMC downgraded its 2010

projections of a physician shortage from a

deficit of 131,000 physicians by 2025 to a

smaller deficit of up to 91,400 physicians by

2025, largely because of the increased role

of PAs in maintaining patient access to care.

3.2%

Under 15 16-44 45-64 65+ U.S.

Population

65+

NUMBER OF DIAGNOSTIC

TREATMENTS/TESTS BY AGE

3.4%

29.2% 30.0% 37.4%

14.0%

Under 15 16-44 45-64 65+ U.S.

Population

65+

Source: Centers for Disease Control and Prevention

MULTIPLE SITES OF SERVICE

In the past, physician practices and acute

care hospitals have been the primary

employers of PAs. Today, demand for PAs

is being driven in part by a proliferating

number of service sites, many of them

offering convenience as their primary

attraction to consumers. According to the

Convenient Care Association, pharmacybased

clinics will be the largest providers of

primary care services by 2020 as the number

of retail clinics grows from approximately

2,100 in 2015 to 3,000 by 2020. Urgent care

centers, also a part of the convenient care

movement, continue to grow and expand,

as well. There are currently 9,300 such

centers nationwide, with 40% projecting to

expand their facilities or add new sites, and

85% expecting to see new patient growth

(Becker’s Hospital Review, August, 2013).


Federally Qualified Health Centers (FQHCs),

whose mandate is to provide convenient,

affordable care to underserved patients,

also are expanding rapidly. FQHCs now

provide care through 1,300 Health Center

organizations nationwide, with sites in more

than 9,000 communities, and see 24 million

patients a year, according to the National

Association of Community Health Centers

(NACHC). FQHCs were early adopters of

the team-based model and utilize PAs at a

higher rate than traditional private practices,

according to NACHC data.

Of the many proliferating sites of service

in today’s healthcare market, the ones that

are expanding the fastest, including urgent

care centers, retail clinics, and FQHCs, have

staff models built around PAs. PAs have

the specific skills to treat the low-acuity

patients who typically visit retail clinics

or urgent care centers in a cost effective

manner. The continued growth of these

service sites will be predicated on the

availability and skills of PAs.

requirement, as states lift hurdles and

allow PAs more direct access to patients.

COST AND QUALITY

With median salaries of approximately

$100,000, PAs are a cost-effective

supplement to physicians, who may earn

well over two or three times this amount

or more. PAs score consistently well on

patient satisfaction surveys, are trained to

diagnose, treat and prescribe prescription

medication, and can enhance the quality of

care. As payment models switch from fee

for service to fee for value, and bundled

payments become more common, demand

for PAs is likely to accelerate.

SCOPE OF PRACTICE

PAs practice medicine in collaboration with

physicians and other clinical providers, and

the degree in which they do so is based

on location. Some states allow PAs and

a collaborating physician to establish a

written agreement outlining the PA’s scope

of practice, while others require scope

of practice approval by the State Medical

Board, or simply list the services PAs may

provide. The trend in state scope of practice

legislation is favoring broader practice

parameters for PAs, which will further spur

demand for their services. For example, New

Jersey recently joined nearly 30 other states

to abolish the physician countersignature

Given this context, following are

observations regarding results of the 2016

Survey of PA Recruiting and Employment

Trends and their implications for PA

recruiting and employment within hospitals.

SURVEY RESPONDENTS

Completed surveys were received from

286 hospitals in 44 states, indicating

a broad geographic variance in the


survey with all regions of the country

represented, except Alaska and Hawaii.

Respondents were asked to indicate the

number of beds at their hospitals, in the

following categories:

• 0 to 50 beds

• 51 to 100 beds

• 101 to 200 beds

• 201 beds or more

Responses to select questions in the survey

are broken out by hospital bed size to

show variations among very small, small,

moderate-sized and large hospitals.

Below is a comparison of hospital

survey respondents to all hospitals

in the U.S. in three categories for which

data are available from the American

Hospital Association.

RESPONDING HOSPITALS

BY NUMBER OF BEDS

41.5%

43.9%

As the chart indicates, survey responses are

somewhat overrepresented in the category

of hospitals with 201 beds or more and

underrepresented in the category of 50

beds or less.

HOSPITAL EMPLOYMENT

OF PAs IS COMMON

The survey indicates that the great

majority of hospitals today employ PAs.

Ninety percent of respondents indicated

their hospitals employ PAs. The number

employing PAs is somewhat smaller for

hospitals with 50 beds or less (88%) than

for larger hospitals with 201 beds or more,

96% of which report that they employ PAs.

The survey also asked hospital human

resources and recruiting personnel to

indicate whether or not their facilities

employ NPs. Over 92% indicated that they

do, while 8% indicated that they do not.

According to this research, larger facilities

with 201 beds or more are somewhat

more likely to employ PAs and NPs than are

smaller facilities with 50 beds or less.

100 or less

14.6%

101-200

201 or more

HOSPITALS BY BED SIZE IN THE U.S.

51%

100 or less

21%

101-200

28%

201 or more

Source: American Hospital Association Annual

Survey of Hospitals 2015

Of those hospitals that employ PAs, the

majority (58%) employ 10 or fewer, with

rates of employment varying by hospital

size. The majority of smaller hospitals with

50 beds or less (95%) employ 10 or fewer

PAs, while the majority of larger hospitals

with 201 beds or more (80%) employ 11

or more PAs. Of those hospitals with 201

beds or more, the majority (53%) employ

26 or more PAs.

The survey also asked respondents to

indicate how many NPs their hospital

employs. The majority (52%) employ 11

NPs or more, while 48% employ 10 NPs

or less, indicating hospitals on average


employ more NPs than they do PAs. This

is to be expected, however, as there are

substantially more practicing NPs than

there are PAs.

WHY DO HOSPITALS

EMPLOY PAs?

The survey asked respondents to indicate

their reasons for hiring PAs. “Enhancing

patient access to care” was the primary

reason respondents identified for hiring

PAs, with over 90% somewhat or strongly

agreeing their hospitals hire PAs for

this reason. As noted above, physician

shortages can limit access to patient care,

which encourages hospitals and other

employers to supplement their clinical

staffs with PAs, NPs and other clinicians.

In addition, patient satisfaction scores

will increasingly drive reimbursement in

emerging value-based reimbursement

models, and providing timely access to

care is a key variable in achieving positive

patient satisfaction ratings.

Enhancing access to care was followed by

“enhancing quality of care” as a key reason

hospitals hire PAs. Seventy-nine percent of

respondents strongly or somewhat agreed

that enhancing quality factors into their

decision to hire PAs. The emerging delivery

systems referenced above will increasingly

be reimbursed based on their ability to

implement and sustain a variety of quality

measures. PAs are an important part of

this effort as they not only diagnose and

treat patients, but are often responsible for

patient education, compliance and preventive

services -- all keys to enhancing quality.

The third reason most cited by survey

respondents for hiring PAs was to

“implement team-based care.” Over 75% of

respondents somewhat or strongly agreed

that this is a key reason their hospitals

hire PAs. As noted above, the team-based

model is a central component of emerging

delivering systems that seek to manage and

coordinate patient care and address the

societal determinants of health.

Survey respondents cited “enhancing

patient satisfaction” as the fourth most

important reason their hospitals hire

PAs. Approximately 75% of respondents

somewhat or strongly agreed their

hospitals hire PAs for this reason.

Patient satisfaction is an increasingly

important measure factoring into hospital

reimbursement. In the digital age,

with online consumer and government

rating systems easily accessible, patient

satisfaction ratings also are a key method

by which hospitals maintain their

reputation and marketability. The survey

underscores that most hospitals view PAs

as important to this effort.

The fifth reason most cited by survey

respondents for hiring PAs was to “reduce

costs.” Approximately 73% of survey

respondents somewhat or strongly agreed

that this is a key reason why their hospitals


hire PAs. PAs continue to represent a

sound return on investment for hospitals

and other employers by providing many

of the services physicians provide at

considerably less cost and by allowing

physicians to focus on high acuity patients

and on complex treatments or procedures.

Sixty percent of survey respondents

somewhat or strongly agreed their

hospitals hire PAs to “reduce staff

burnout,” 58% somewhat or strongly

agreed their hospitals hire PAs to “succeed

under value/quality-based reimbursement,”

and 57% somewhat or strongly agreed

that their hospitals hire PAs to “implement

population health management.” Patient

access, quality of care, team-based care,

succeeding under value/quality-based

reimbursement, and population health

management are all components of the

larger effort to restructure how healthcare

is delivered and paid for, and the survey

suggests hospitals consider PAs to be

integral to this process.

The majority of all hospitals responding

to the survey (52%) indicated they

employ PAs in surgical specialties, while

51% indicated they employ PAs in other

specialty areas. For hospitals of 201 beds

or more, the number is much higher;

91% employ surgical specialty PAs and

59% employ PAs in other specialty

areas. Overall, according to AAPA, more

than 25% of PAs practice in general

surgery or surgical subspecialties while

approximately 11% practice in emergency

medicine. PAs practicing in specialty

areas are supplementing the supply of

physician specialists, who, like primary

care physicians, are projected to be in

increasingly short supply.

WHAT TYPES OF PAs DO

HOSPITALS EMPLOY?

The survey asked respondents to indicate in

what areas PAs practice in their hospitals.

Over 71% indicated their hospitals employ

PAs in primary care, including family

medicine, general internal medicine and

pediatrics. The number is higher for smaller

facilities of 50 beds or less (85%) and for

those of 51 to 100 beds (93%) where

services often are limited to primary care

and include few subspecialty services,

than for larger hospitals. The number is

lower (78%) for hospitals of 201 beds or

more, which often focus on specialty and

subspecialty services.

About one quarter (23%) of hospitals with

50 beds or fewer employ PAs in surgical

specialties while 35% employ PAs in other

specialty areas, indicating that even some small

hospitals are maintaining specialty services

in part through the employment of PAs.

WHY SOME HOSPITALS

CHOOSE NOT TO EMPLOY PAs

Approximately 10% of survey respondents

indicated their hospitals do not employ


PAs. Reasons vary for why they choose

not to do so, many of them based on

misperceptions. The most strongly held

reason cited by survey respondents for why

they do not employ PAs is that “a physician

must be present when a PA sees a

patient.” Over 33% of respondents whose

hospitals do not employ PAs somewhat or

strongly agreed that this is a reason they

do not do so. While physician collaboration

with PAs at some level is required by all

states, a physician does not have to be

present when a PA sees a patient under

any state (or federal) law or regulation.

Other reasons given also are based on

misperceptions, including “physicians must

see every patient” that PAs see, “PAs cannot

perform routine procedures,” “PAs cannot

prescribe medications,” and “PAs can’t see

new patients.” None of these are, in fact, the

case. While the sample size of those hospitals

that do not employ PAs is small, the survey

suggests that confusion still exists about the

role PAs play and the duties they are able

and permitted to perform.

other respondents in the survey cited for

why their facilities already employ PAs.

HOW MANY HOSPITALS ARE

RECRUITING PAS?

The survey indicates that approximately

60% of hospitals are actively recruiting

PAs, though the number is higher

for larger hospitals than for smaller.

Approximately one-third (33%) of hospitals

with 50 beds or fewer report that they

are recruiting PAs, compared to over 87%

of hospitals with 201 beds or more. Of

hospitals with 101 to 200 beds, 88%

report that they are actively recruiting PAs.

As is to be expected, smaller hospitals

typically have more stable staffs and fewer

personnel needs than do larger hospitals,

and are less likely be actively recruiting PAs

or other clinicians at any given time than

are larger facilities.

Of all survey respondents, about 10%

said they are somewhat or very unfamiliar

with their state’s regulations on PA scope

of practice, which may explain some

of these misperceptions. However, the

majority (74%) said they are somewhat or

very familiar with their state’s PA scope of

practice regulations.

Those respondents who indicated their

hospitals do not employ PAs were asked

what factors would effect a change in this

policy. The most frequently cited answers

given were “knowing PAs could enhance

patient access to care,” “knowing PAs

could enhance quality,” and “knowing PAs

could reduce costs” -- all reasons many

Close to half of respondents (47%) are

currently recruiting five PAs or fewer, with

larger hospitals actively recruiting more

PAs than smaller hospitals. Over 37%

of hospitals with 201 beds or more are

recruiting six or more PAs, compared to

0% of hospitals with 50 beds or fewer.


The numbers are somewhat similar for NPs.

64% of all respondents indicated their

hospitals are recruiting NPs, including 83%

of hospitals with 101 to 200 beds and

90% of hospitals with 201 beds or more.

The majority of respondents (89%)

indicated their hospitals hired at least

one PA in 2015, with the number larger

for larger facilities. Ninety-two percent

of hospitals with 101 to 200 beds hired

at least one PA in 2015 as did 98% of

hospitals with 201 beds or more. Even a

significant majority of hospitals with 50

beds or fewer (77%) hired at least one PA

in 2015. Among larger hospitals with 201

beds or more, 48% hired 6 or more PAs in

2015 and 15% hired 21 or more PAs.

About half of survey respondents (48%)

indicated that recruiting PAs is somewhat

difficult or very difficult, while less

than half that number (21%) said that

recruiting PAs is somewhat or very easy.

An additional 31% said that recruiting PAs

was neither difficult nor easy.

As referenced above, PA numbers have

grown significantly in recent years.

There are currently 218 accredited PA

programs in the country, up from 78 in

1996, according to the Physician Assistant

Education Association. There are additional

programs in the pipeline, with no lack of

applicants to fill program openings. In

2014, Duke University, one of the nation’s

top-ranked PA programs, had 1,600

applications for 88 PA slots, while Boston

University had 1,024 applicants for 25 slots

(New York Times, August 1, 2015).

Though the pipeline of potential candidates

is expanding, it is significant that only one

in five survey respondents indicated that

recruiting PAs to their hospitals is somewhat

or very easy. In Merritt Hawkins’ experience,

recruiting PAs has become more time and

resource intensive in the last five years,

rivalling in many respects the effort needed

to recruit physicians.

PA VACANCY RATES

AND HIRING PLANS

About three-fourths of survey respondents

(76%) indicated the PA vacancy rate at

their hospitals is 10% or less, while 24%

indicated their PA vacancy rate is 11%

or greater. The vacancy rate is higher for

hospitals with 201 beds or more, however,

than for smaller hospitals. Forty percent of

hospitals with 201 beds or more indicated

their PA vacancy rate is 11% or higher,

while 10% said their PA vacancy rate is

21% or higher. Among smaller hospitals

with 50 beds or fewer, only about 8% said

their PA vacancy rate is 11% or higher.

Vacancy rates for NPs are slightly higher

than for PAs, the survey indicates.

The great majority of survey respondents

(96%) indicated their hospitals plan to

either maintain or increase current PA

hiring levels in 2016. About one-third


(32%) indicated they will increase PA hiring

this year, while only 4.5% indicated they

will decrease PA hiring. The remainder

(63%) indicated they will maintain current

PA hiring levels.

EMPLOYMENT PATTERNS

The survey asked respondents to provide

data on the job structures, leadership

roles, and reporting patterns for PAs at

their hospitals.

The majority of respondents (52%)

indicated that PAs at their hospitals report

to the medical staff. Other titles to whom

PAs report were less frequently cited. Over

28% of respondents indicated PAs at

their hospitals report to their department

administrator, while 17% report to the chief

medical officer. A few respondents (6.5%)

indicated PAs at their hospitals report to the

chief PA, while 4% said PAs report to the

director of PA services and 3.5% said PAs

report to the director of PA and NP services.

An additional 3.5% said PAs report to the

chief nursing officer, while 2% said PAs

report to the nursing staff. Only 1.5% said

they report to human resources.

The reason few survey respondents indicated

PAs at their hospitals report to the chief PA

is that most hospitals do not have a chief

PA on staff. Only 8.6% of those surveyed

indicated their hospitals have a chief PA,

though the number is larger for hospitals

with 201 beds or more (19%).

Similarly, few survey respondents indicated

that PAs hold leadership positions at their

hospitals, such as department chair or

committee member. Only 15% indicated that

PAs hold one or more leadership positions

at their facilities, while 73% said they do

not, and 12% were unsure. As is to be

expected, fewer small hospitals with 50 beds

or less, with their limited staffs, have PAs in

leadership positions than do larger hospitals.

Only 3.6% of hospitals with 50 beds or

fewer have PAs in leadership positions,

according to the survey, compared to 20%

of hospitals with 201 beds or more.

Nevertheless, the majority of survey

respondents (58%) indicated PAs will

take on more roles or job functions

within their facilities in the future,

emphasizing the increased importance

of PAs to the clinical team.

The majority of those surveyed (54%)

indicated their hospitals do not have a

PA preceptor program, though responses

varied by hospital size. Only 25% of

smaller hospitals with 50 beds or fewer

have a PA preceptor program, the survey

indicates, while 61% of hospitals with

201 beds or more have such a program.

Of those which do, however, the majority

only hire PAs from the preceptor program

occasionally or rarely. The exception is

larger hospitals with 201 beds or more,

25% of which frequently hire PAs from

their preceptor program.


A PA BY ANY OTHER NAME

PAS OR NPS?

The survey asked respondents to indicate

what term or terms staff members used

at their hospitals when referring to PAs.

While the terms used to refer to other

clinicians such as physicians or nurses are

relatively standardized, terms used to refer

to PAs may vary.

Survey respondents were asked if their

hospitals preferred to hire PAs or NPs.

While the majority (58%) said their

hospitals have no preference and will hire

either, 12% said their hospitals have a

preference for PAs, and 30% said their

hospitals prefer to hire NPs.

The term most frequently indicated to refer

to PAs by survey respondents was “PA.”

Close to 79% of those surveyed indicated

staff at their hospitals use the term PA

when referring to physician assistants.

This was followed by “physician assistant”

(70%), “midlevel provider” (50%),

“advanced practitioner” (25%), and

“advanced practice provider” (22%). Less

frequently cited was “allied professional”

(6%), “non-physician clinician” (3.5%),

and “physician associate” (0.5%).

RATING QUALITY OF CARE

Survey respondents were asked to indicate

how patients rate the quality of care PAs

provide at their hospitals. Eighty-percent

said patients at their facilities rated quality

of care provided by PAs as above average

or excellent, 18% rated PA quality of care

as average, and 0.6% rated quality of

care provided by PAs as below average.

About 18% said their hospitals do not

have a mechanism for tracking patient

satisfaction with PA services.


Conclusion

The 2016 Survey PA Recruiting and

Employment Trends indicates that the

great majority of hospitals, including

virtually all hospitals with 201 beds or

more, currently employ PAs and many

are actively recruiting them.

A primary reason why is that PAs play

a key role in emerging delivery models,

which are predicated on convenient

access to care, enhanced quality, cost

effectiveness, a preventive approach, and

a team-based model in which clinicians

manage the care of individuals and large

population groups. The great majority of

hospitals plan to maintain or accelerate

their hiring of PAs, and the majority see

the role of PAs expanding. Hospitals are

employing PAs in both primary care and

specialty areas, and report that patients

highly rate the quality of care PAs provide.

More information about this survey and about Merritt Hawkins and the AAPA can be found at:

Merritt Hawkins

8840 Cypress Waters Blvd #300

Dallas, TX 75019

800-876-0500

merritthawkins.com

AAPA

2318 Mill Road, Suite 1300

Alexandria, VA 22314

703-836-2272

AAPA.org


©2016 Merritt Hawkins | 8840 Cypress Waters Blvd., #300 | Coppell, TX 75019 | (800) 876-0500 | www.merritthawkins.com

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