The impact of state-level physician assistant regulations on utilization and wages
Creators: name: White, Ryan Douglas
Publisher: name: No Publisher Supplied
Year: 2022

description: Introduction: Efforts to address physician workforce shortages frequently cite the potential for the physician assistant (PA) profession to increase access to care. Professional organizations and researchers have advocated for reducing PA scope of practice restrictions, which are primarily enacted at the state level, arguing that overly narrow scope of practice and burdensome supervisory requirements limit the profession’s ability to meet labor demands. This dissertation examines the effect of the “Six Key Elements of a Modern PA Practice Act”, a policy platform adopted by the American Academy of Physician Assistants (AAPA) in 2008 to reform PA scope of practice, on PA utilization and wages. Specifically, variation in the adoption of the “Six Key Elements” between states is exploited to study the impact of these policies on the likelihood that patients will encounter a PA in a primary care setting and to investigate the impact of these policies on PA wages. Methods: States were categorized as Restrictive (adopted 1-2 Key Elements), Moderate (adopted 3-4 Key Elements), or Permissive (adopted 5-6 Key Elements). First, a logit regression model was estimated to determine the health care, economic, workforce, and political conditions to which states respond when adopting new Key Elements between the years 2008 - 2017. Statistically significant variables were used as endogeneity controls in subsequent analyses. Second, data from the 2012-2013 National Ambulatory Medical Care Survey – Community Health Center component (NAMCS-CHC) were used to estimate a multinomial logistic regression model to determine the relationship between each category and the likelihood of patients encountering a PA in Community Health Centers (CHCs). Third, data from the Bureau of Labor Statistics (BLS) and American Community Survey (ACS) for the years 2008 - 2017 were used to produce ordinary least squares two-way fixed effects estimators to determine the relationship between each category and PA wages. Results: States were more likely to enact new Key Elements if they had prior experience adopting Full Practice Authority for nurse practitioners (NPs), had a greater proportion of the population with Medicaid, and had a greater proportion of the population living in an urban area. States with a greater percentage of the population over age 65 were less likely to adopt new Key Elements. Patients in Moderate states were more likely than patients in Restrictive states to encounter PAs and NPs in CHCs. This effect was not observed in Permissive states, which may signal the presence of an access effect. No significant effect was observed of scope of practice category on PA wages. Conclusion: These findings suggest that additional efforts to reduce PA practice restrictions may have positive effects on access to care. The adoption of new Key Elements did not exert influence on PA wages, suggesting that these reforms may not be sufficient to influence PA productivity, that PA wages are not responsive to productivity gains, or that PA labor market mobility is limited.