The Physician Assistant Profession During The Next Decade Dominic Agresta

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The Physician Assistant Profession During The Next Decade

  • Dominic Agresta

  • Luis Ayala

  • Erica Cheng

  • Tahmina Ferdous


Managed Care

  • Health Care program designed to ensure that patients receive the highest quality medical care for the lowest cost, in the most appropriate setting.

  • Managed Care programs are based on pre- paid membership instead of fee- for- fee service payment each time service is delivered.

3 Basic Types of Managed Care Health Insurance Plans

  • Health Maintenance Organization’s

    • HMOs
  • Preferred Provider Organization’s

    • PPOs
  • Point of Service Plans

    • POSs

Health Maintenance Organizations (HMOs)

  • Managed healthcare system that reduces healthcare costs by focusing on preventative care.

  • HMOs provide medical treatment on a pre- paid basis so members pay a fixed monthly fee, regardless of how much medical care is needed in a given month.

  • HMOs medical treatment provides a variety of medical services including office visits, hospitalization, and surgery.

  • The size of the network varies depending on the individual HMO.

Advantages and Disadvantages of HMOs


  • Low out-of-pocket costs

  • Focus on wellness and preventative care

  • No lifetime maximum payout

Preferred Provider Organizations (PPOs)

  • Networks of doctors/ hospitals that provides medical service only to specific groups or associations.

  • Organizations, employers, and insurance companies that sponsor PPOs increase patient volume by creating incentives to use the physicians and facilities within the PPO network.

  • In return, the sponsors are provided discounted medical services and control programs to help reduce the cost of medical care.

  • PPO members pay for services that are prenegotiated by the healthcare providers and the PPO sponsors.

Advantages and Disadvantages of PPOs


  • Free choice of healthcare provider

  • Out- of- pocket costs generally limited

Point of Service Plan (POS)

  • Managed healthcare system that resembles both HMOs and PPOs.

  • Similarly to HMOs, patients with a POS plan pay no deductible and a minimal co- payment when they use a healthcare provider within their network. Patients must also choose a primary care physician who will be responsible for all referrals within the POS network.

  • If the patient chooses to go outside the network for healthcare however, the POS plan switches to act more like a PPO rather than HMO.

  • Patients become subject to a deductible and their co- payment becomes a substantial percentage of the physician’s charges.

Advantages and Disadvantages of POSs


  • Maximum freedom

  • Minimal co- payment

  • No deductible

  • No “Gatekeeper” for non- network care

  • Out- of – pocket costs limited

What Does Managed Care Dominance Mean For The PA Profession?

  • Increase in opportunities for Physician Assistants

  • Increase in the rights and responsibilities for PAs

    • MCOs – cheaper
    • Doctors- more reliant on PAs
    • PAs through organizations like NYSSPA

PA Job Opportunities

  • Jobs occupied by PAs are higher than the total number of PAs.

  • Many PAs hold two or more jobs: hospitals, out-patient centers, HMOs, Fed. Gov’t, universities, professional schools, clinics, etc.

  • Increased need for PAs in underserved areas (rural & inner city).

PA Statistics

  • PA is a rapidly growing profession:

    • 20th fastest in 1997
    • 12th fastest in 2001
    • 3rd fastest in 2004
  • 2002 – 2010 jobs for PAs expected to increase 49%, yet total US employment expected to increase only 15%.

PA Statistics cont.

  • 2002 – 63,000 jobs vs. expected 94,000 in 2012.

  • AAPA predicts 50,121 PAs currently in clinical practice.

  • 2002 – 183 million patient visits to PAs.

  • 2003 – 192 million patient visits to PAs.

What do these Statistics Mean?

  • Illustrate how PAs are becoming more recognized & desirable.

  • About 43 million Americans do not have health insurance: therefore, serious need for low-cost & efficient treatment.

  • PAs promote time management & convenience; able to run clinics if Physician not present while providing equal level of patient care.

How Aging of America Will Affect Practitioners

  • In America today 27% of 80 million people are aged 50 or older. As the nation ages, about 76 million baby-boomers will be turning 65 in 2011, and the percentage of people who will be 50 or older will rise to 35%. (Pitt, 2005)

  • Dr. Alan Kronhaus, founder of Doctors Making Housecalls, said that about 80% of patients in his program are seniors.

  • According to the Journal of the American Medical Association, house calls to Medicare beneficiaries rose by 40% from 1998 to 2004.

  • Krishnan, Ohio, 2006

How Aging of America Will Affect Practitioners cont:

  • Demand for house calls on the rise and physician’s loss of interest in the geriatrics field, house calls will be more difficult to provide.

  • It is expected that other healthcare practitioners, including Physician Assistants will help make house calls more available to the elderly.

How Aging of America Will Affect Practitioners cont:

Methods to Improve PA Programs

  • Diversity & Cultural Awareness

  • Program Evaluations

  • Medical Equipment

  • Local Conferences

  • Geriatric Education Days

Methods to Improve PA Programs cont:

  • PA Organizations

  • Arranging Informational Sessions

  • Lobbying

  • Expanding PA Professions around the world

  • Community Service

Those of us in the Allied Health Profession know that humor is the best medicine, so here is a great medical joke to help you through your day!

Works Cited



  • Ballweg, R. Physician Assistant: A Guide to Clinical Practice 3rd ed. PA: Saunders, 2003.

  • Berlin, Linda E. and Hooker, Roderick S. “Trends in the Supply of Physician Assistants and Nurse Practitioners in The United StatesHealth Affairs. Volume 21, Number 5. Pgs. 174-181

  • Roblin, Douglas W. et al. “Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Practice of an MCOHealth Service Research. Volume 39, Number 3. Pgs. 607-626

  • Health Insurance: HMOs, PPO & POS Plans.


  • Physician Assistant. U.S. Department of Labor Bureau of Labor Statistics Occupational Outlook Handbook. Aug. 4th, 2006.


  • Intel to Address Healthcare through Technology Innovation. Dec. 12th, 2005


  • Are Older Patients Satisfied With Physician Assistants And Nurse Practitioners? Daisha J. Cipher, PhD, 2006.


  • Definition of "Managed Care"


  • Physician Assistant, 3rd Fastest-Growing Profession. Mar. 3rd, 2004.


  • Different Types Of Managed Care. Pam Silberman, Feb. 24th, 2000.


  • "Can a PA order restraints?"


  • Aging Population, Medicare Changes Mean Doctors Make House Calls. Anne Krishnan, Mar. 29th, 2006


  • Pitt Researchers Investigate Aging. Nov. 28th, 2005.


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