So if you follow me on Instagram, you know I just finished an essay for my PA Roles class (super interesting and honestly a wonderful buffer for our grades which is AMAZING), and I actually got a couple of comments wanting to read my paper. So….here it is. No judgement please, writing essays is definitely NOT my forte. And yes, I know I write blog posts all the time but I definitely feel like I can inject my personality into a blog post and worry less about it sounds professionally. I try to write to you guys like we’re having a conversation so that it is more interesting to read!
But anyways, enjoy! If you have the opportunity, I definitely suggest reading up on some of the references I used. They were all very informative and interesting. James Cawley is my professor and if you have any sort of question about PAs, he has probably written a paper about it. He’s been honored with a ton of life achievement awards and is just incredibly amazing to talk with. That is by far one of the best things about GWU PA program-is how outstanding all of my professors are in the profession. Any professor is going to have so much experience, and its so great to get to know them outside of the subjects they teach.
Is the evolution from Physician Assistant being a career change to a primary career affecting the age of students?
Originally, the idea of Physician Assistant (PA) was based off of the military corpsmen and medics, as they had already experience “conflict and controversy” during their tours in the Vietnam War and Americans would not slam the door to this young profession as it would be slamming the door on their heroes from the war (1). However, as the profession has aged, it has drifted away from its roots in the military, with only 2.6 students in a program being military (6), and found most of the enrolled students being female and younger. This leads to the question of why. Is the decision of individuals to enter the field as a primary career lowering the age of PA students? Or, is it even more basic than that, and simply a result of the field’s growth from its earliest days? Research indicates that it is a combination of both. As the field evolved, the age consistently got younger, and now almost five decades later, the age will stay younger as more and more individuals choose to become a PA as their initial and only career.
The 1960s is considered a time of turmoil in America’s history, with the assassinations of prominent public figures, the Vietnam war, and, most importantly to the development of Physician Assistant programs, the start of the shortage in physician providers for general care. As the population of the United States increased, physician providers chose to enter specialties rather than becoming general care providers (1). Worry among the general population as to who would treat them prompted the look for a new type of “physician extender” provider. The war in Southeast Asia created what seemed like the perfect ready-made solution to this question of who would make up these new “physician extenders”. Overseas, physicians, nurses, medics, and corpsmen worked together as a highly integrated team to save lives. Their experience with the military had significantly improved the medical training they had received and these individuals came back from the war ready to integrate their knowledge into the American healthcare system. They had learned the importance of working in a highly integrated healthcare team, and how more lives were saved that way. Yet, upon arriving back in the states, the corpsman was absent from the current medical team at home. This was due to constraints of the existing healthcare system that did not recognize the corpsmen as a provider due to their education and their accreditation (2). Thus, the idea of using these corpsmen returning from war to create a new breed of midlevel providers was born and cultivated. The first class of PA students at Duke University consisted of four ex-Navy Corpsmen. It was understood that these men could go through a shorter learning experience with the idea that they would receive on the job training and guidance from their physician superiors. For the PA career to be born during the 1960s was pivotal to the survival of the profession past infancy. The 1960s was a decade of movements and change, allowing both the general population and the government to be more open minded. During Lyndon Johnson’s presidency, a War on Poverty was declared and mechanisms were put in place to ensure a more equal healthcare experience for the different socioeconomic groups. This reallocating of funds by the State and Federal Governments allowed PA schools and subsequently providers to gain favor for fighting this War on Poverty (2). Without this support, the education systems for Physician Assistants would have faced more difficulty in getting up and running.
At the end of the 1960s, there were 29 male, veteran graduates of Physician Assistant programs. The average age was 29. In 1970, the first woman PA graduated. (3). These early PAs were on their second or third career change (4). Yet, with the Vietnam War winding down and the lack of medics and corpsmen coming home looking for jobs, the PA profession was due for a shift in who entered the field. During this time period, women began asserting themselves outside of the home, as Civil Rights Movements gained momentum. Women wanted higher paying jobs, in fields different than the typical “women’s work” career choices. It was recognized that a career as a PA offered a broader alternative to the narrower scope of practice and lower pay available with a nursing career (2). It was during the 1980s, that a marked shift in gender and previous career happened within the PA field. Shown in Johns Hopkins University Study of Physician Assistant Programs in1983, it was revealed that over half of the students enrolled were women. During the years 1978-1982, the number of enrolled women had been steadily increasing. Perhaps most interesting however, was that while the original classes were comprised entirely of former military corpsmen, only a small percentage of military personnel made up the PA classes of 1983 (4). No longer were previous military men embarking on an unknown and untested career chance. Instead, AAPA census data revealed that a third of PA enrollees, both male and female, had previous healthcare experience as a nurse. As the 1980s continued, the mean age of clinically working PAs was declining as younger graduates entered the work force and older, male, veteran PAs retired (3). These younger PAs would be comprised mainly of women who were starting their first career and would have a longer career span of being a Physician Assistant. Additionally, as the decades have past, the expected role of women as mothers in the home has changed. While previously it was thought that a woman should marry young, have children young, and stay home and married to her husband for life, this has changed during the evolution of the Physician Assistant and subsequently affect the field. Now, the notable delay of marriage and childbirth, as well as the uncertainty associated with higher divorce rates, has inspired women to choose a more economically independent and stable career path (3). With women making up a large proportion of these entering the PA field, this shift away from traditional marriage views allowed the overall ages of those entering PA school to become lower.
When comparing the previous statistics of enrollees in Physician Assistant programs to those enrolled more recently, an interesting change in requirements is noted. The 2000 AAPA Physician Assistant Census Report revealed that 17.4% of respondents had no college degree prior to entering PA school (6). In the 2010 AAPA Physician Assistant Census Report, students had an average GPA of 3.5, and programs now required the completion of at least a Bachelor’s Degree as well as certain prerequisites to enroll in the program (7). This change from a profession that one could enter based off of merit and experience versus one based on merit, experience, and previous schooling has most definitely had an impact of the evolution of the profession. For individuals to have an initial career, then go back to school and complete the prerequisites or get a college degree in its entirety has changed the ease of Physician Assistant being a career change. Additionally, more programs are requiring hours of clinical patient care, making it more difficult for those who do have a college degree that satisfies the prerequisites, but an initial career not in health care, to maintain their previous standard of living while obtaining their hours. Studies are now showing that younger PA students are having statistically significant higher PANCE scores than the older students with controlling for gender. Older students tend to be male, so it was necessary to clarify if age was the primary variable or if gender was a cofounding variable influencing the trend of negative correlation between age and PANCE score (5). These changes to the requirements for entry into a PA program have made the path to becoming a PA one with more work and thought process. Entry must be carefully thought with plans on how to obtain hours, how to excel in prerequisite classes, and financial backing for the application process-one that is lengthy and expensive. All of these make becoming a Physician Assistant as a career change more challenging.
From the beginning, the profession was viewed as a career that could allow those with aversion to the traditional medical or nursing school educations an opportunity to spend a lifetime in the medical community (3). It has been viewed as a career that allows flexibility for a family life, a career with opportunity to move horizontally between specialties, and a career that is challenging and thought provoking. It has been ranked as one of the best jobs to have in the United States due to job satisfaction and salary. But, is the trend towards a younger age of students enrolling in the programs, and subsequent younger age of providers, simply the evolution of the field? Or is it mainly due to the movement away from becoming a Physician Assistant as a second or third career to becoming a PA as an initial career. As mentioned in The Changing Physician Assistant Profession: A Gender Shift, “four decades later, a typical PA student is a young woman who obtains an undergraduate degree with competitive grades, graduates from a PA education program with a Master’s degree, and starts her first career.” So, while the profession is evolving due to its young age, much of the trend towards a younger age of the professionals can be accounted to the shift from a predominately male, veteran, second career to a more female primary career (3). There is a magnitude of smaller factors that additively have made this shift possible, such as increased job satisfaction associated with PA versus MD or RN/NP, increased women in the workforce, increased requirements for entering the program that require more time, and many others. However, at the end of the day, it needs to be recognized that this career has gained momentum and recognition of a highly regarded and sought after profession, and it no longer considered a career primarily of those changing professions. While there are still many individuals who do use the shorter education path of being a PA versus a MD to enter the medical field, it is no longer the norm for these individuals to use it as a career change.
1. Cawley J, Cawthon E, Hooker R. Origins of the physician assistant movement in the United States. Journal of the American Academy of Physician Assistants. 2012;25(12):36-40. doi:10.1097/01720610-201212000-00008.
2. Hooker R, Cawley J, Asprey D, Hooker R. Physician Assistants Policy and Practice. Philadelphia: F.A. Davis Co.; 2010.
3. Hooker R, Robie S, Coombs J, Cawley J. The changing physician assistant profession. Journal of the American Academy of Physician Assistants. 2013;26(9):36-44. doi:10.1097/01.jaa.0000433914.54617.a0.
4. Carter R, Emelio J, Perry H. Enrollment and demographic characteristics of physicianʼs assistant students. Academic Medicine. 1984;59(4):316-22. doi:10.1097/00001888-198404000-00005.
5. Asprey D, Dehn R, Kreiter C. The Impact of Age and Gender on the Physician Assistant National Certifying Examination Scores and Pass Rates. The Journal of Physician Assistant Education. 2004;15(1):38-41. doi:10.1097/01367895-200415010-00006.
6. Physician Assistant Foundation Update. The Journal of Physician Assistant Education. 2000;11(3):178. doi:10.1097/01367895-200011030-00008.
7. Physician Assistant Foundation Update. The Journal of Physician Assistant Education. 2010;11(3):28.