The rise in demand for PA’s can be attributed to growing interest

from large integrated health systems, retail clinics, health centers, and concierge physician practices, says one healthcare recruiter. There is no corner of the healthcare job market that is hotter now than the search for physician assistants.

“PA searches are up 127% year-over-year in the numbers we do, which is insane. You just don’t see that spikes like that,” says Travis Singleton, senior vice president at healthcare recruiters Merritt Hawkins. “We are not quite at a feeding frenzy yet, but we are getting there.”

And that demand is transitioning to reflect the broader transitions in healthcare delivery. Singleton says about 17% of Merritt Hawkins’ PA searches are for rural areas and mostly in primary care, but that the demand for PAs in more-urban settings is intensifying.

“We attribute that to the alternative delivery sites that are now using PAs,” he says. “It used to be the one- or two-doctor clinics which certainly still use PAs. Now, large integrated health systems are hiring them in mass numbers, as are retail clinics like CVS and Walgreens, federally qualified health centers, and concierge doctors.”

“Certainly Walgreens and CVS and Walmart are a big part of that,” he said, “because they are primary care givers. But even payers recognize the different services that PAs or nurse practitioners can bill for and the more that health centers see that, even if it is under MD supervision, the more they are going to put them on staff.”

The annual survey of the American Academy of Physician Assistants also shows a strong demand that is reflected in a nationwide median compensation of $90,000 for PAs who are paid salaries and $100,000 when PAs earn a base plus a bonus.

For a little perspective, the national median household income [PDF] is about $55,000, so PAs are doing alright. However, by healthcare sector standards, they provide excellent bang for the buck. Consider that primary care physicians, who are also in high demand, had an average base salary of $185,000 in 2013, according to Merritt Hawkins.

“PAs are perhaps the single best bargain in healthcare right now and that is one of the reasons why people are snapping up PAs right as they graduate,” says AAPA President Lawrence Herman, PA-C, MPA. “More hospital systems and employers are looking and asking ‘where is my value?’ They are looking at outcomes too.”

“It’s not a matter of buying a cheaper car. It’s buying a car that may be less expensive, but has better statistics in terms of safety. So, when you are looking at patient satisfaction levels, there are high parallel to physicians and in some instances higher than physicians. When you are looking at other outcomes data there is substantial data that show that PAs do it as well as physicians in the primary care setting.”

Across specialties and practice settings, 46% of PAs in the AAPA survey say they get bonuses in addition to their base salary, and that the bonuses are largely dependent on performance outcomes such as productivity and quality improvement. Three-fourths of the PAs say their base pay is from annual salary, 22% say they’re paid an hourly wage, and 3% say they’re compensation is based on productivity measures determined through relative value units, patient encounters, charges and collections.

Employer type also factors into compensation. Higher median PA base salaries are reported in university hospitals ($93,000) and other hospitals ($95,000), while the lowest compensation is in solo physician practices ($85,000). Thirty-seven percent of PAs provide medical services in hospitals and 10.3% work in solo practices, the survey found.

Nearly one-third of PAs (32%) are practicing in primary care. However, just as with physicians, PAs who gravitate towards specialties make more money. Average compensation for PA specialties such as dermatology ($117,000), emergency medicine ($108,000) and surgery ($105,000), were considerably higher than for PAs working in primary care and family medicine, who reported earning less ($94,000 and $93,400, respectively).

Singleton says the better compensation in specialty care has not gone unnoticed by PAs.

“Yes, PAs, just like MDs, make more as specialists. Yes, that has gravitated about two-thirds of PAs into specialty care,” he says. “Unfortunately, the way the market has fallen out we need more primary care. If you are a PA you can’t blame them. If they can make 20% to 30% more in specialty care and in some cases have an easier workload it is going to be tough to pull them back into primary care.”

Herman says it’s not just the relatively lower compensation costs that make PAs a good value. It’s also their flexibility.

“If someone is a physician and they are board certified as a dermatologist that is what they do. PAs being trained as generalists are extremely nimble. PAs typically will change specialties or disciplines at least twice during their careers. Part of that is responding to
workforce and healthcare needs and it may be the PAs find they want to do something different,” says Herman, who in his PA career transitioned from an occupational therapist to the emergency department and then toward family practice.

Singleton says the demand for PAs and NPs reflects a broader trend in healthcare delivery.

“Whether or not you think there is a physician shortage, whether you think there is utilization mismanagement or mal-distribution or not, we are not going to get out of it without everyone practicing to the limit of their abilities, and a lot of that is going to fall on NPs and PAs, specifically. I don’t expect this trend to stop. I expect NPs and PAs recruiting to go through what primary care physicians did,” he says.

“Keep in mind that is all new. In the Dallas market 10 years ago 75% of the PAs were employed by independent physicians or practices. Now, 75% of PAs are controlled by health systems. You are going to see salaries escalate at least to the point they can. You are going to see health centers take a loss on an individual provider because of the downstream revenues and referrals they get. And you are going to see them get creative with signing bonuses and call coverage,” Singleton says.

“We are already starting to see some of them mimic MDs as far as RVUs and other production bonuses. I don’t see that changing, at least not in the next three or four years.”

Source: John Commins, HealthLeaders Media, February 10, 2014