PAs have come a long way since the birth of the profession in 1965, when the very first PA class was taught at the Duke University Medical Center. Today, the profession is rapidly growing, and PAs are in demand more than ever. According to the Bureau of Labor Statistics, there are currently 86,700 PAs practicing in the US, and the PA job market is expected to grow 38% by 2022. Originally meant to serve in primary care, the profession is now seeing a greater number of PAs choosing to hone their skills and branch off into medical specialties instead.

Whereas the PA profession is expanding, the number of PAs focusing on primary care is not. According to a study published in The Annals of Family Medicine, the percentage of PAs working in primary care dropped from 51% in 1996 to 31% in 2010. “Physician assistants are growing more rapidly in surgical and specialty care than primary care,” says Perri Morgan, director of PA research at the Duke University Physician Assistant Program. “This is concerning since we know more people are going to have health insurance soon due to health care reform. There is a lot of concern about whether there will be enough primary care providers.” In the past, medical schools have generally had little success recruiting students into primary care, but why?

There are a number of reasons why more PAs are choosing a specialty, and salary may be one of them. Medical students graduate with an overwhelming average of $140,000 in loan debt, and the lucrative salaries of specialty practice may be luring students away from primary care. The average salary of a PA is $86,410 per year, but a PA specializing in radiology can make as much as $150,000. Another reason may simply be that specialty practice is where the jobs are. “It’s not just what they’re choosing to do, but where the market is hiring,” says Morgan. The reasons are often economic. Specialty care is expensive, so hospitals, clinics, and private practices are hiring PAs to handle many of the medical procedures at a fraction of the cost that a cardiologist or neurosurgeon, for example, would charge. In addition, working in specialty practice often provides more flexibility and is perceived to offer a better work-life balance.

As the need for PAs who focus on primary care increases, researchers recommend hiking primary care reimbursement, offering loan repayment assistance, and expanding state and federal programs aimed at increasing the primary care workforce to lure medical students back to primary care.

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