Global physician shortages and the PA profession (2008)

Health care policy experts generally agree that the United States will face a medical provider shortage in the near future. In recent years, however, other developed nations have also recognized emerging health care provider shortages; and in many of these countries, the establishment of a PA-like profession is a serious option. Recent data suggest that worldwide physician shortages-and thus the establishment of additional PA-like professions outside the United States-are likely. Scheffler RM, Liu JX, Kinfu Y, Dal Poz MR. Forecasting the global shortage of physicians: an economic- and needs-based approach.Bull World Health Organ.2008;86:516-523. ABSTRACT: Objective: Global achievements in health may be limited by critical shortages of health care workers. To help guide workforce policy, we estimate the future demand for, need for, and supply of physicians, by WHO region, to determine where likely shortages will occur by 2015, the target date of the Millennium Development Goals. Methods: Using World Bank and WHO data on physicians per capita from 1980 to 2001 for 158 countries, we employ two modeling approaches for estimating the future global requirement for physicians. A needs-based model determines the number of physicians per capita required to achieve 80% coverage of live births by a skilled health-care attendant. In contrast, our economic model identifies the number of physicians per capita that are likely to be demanded, given each country's economic growth. These estimates are compared to the future supply of physicians projected by extrapolating the historical rate of increase in physicians per capita for each country. Findings: By 2015, the global supply of physicians appears to be in balance with projected economic demand. Because our measure of need reflects the minimum level of workforce density required to provide a basic health service that is met in all but the least developed countries, the needs-based estimates predict a global surplus of physicians. However, on a regional basis, both models predict shortages for many countries in the WHO African Region in 2015, with some countries experiencing a needs-based shortage, a demand-based shortage, or both. Conclusion: The type of policy intervention needed to alleviate projected shortages, such as increasing health care training or adopting measures to discourage migration, depends on the type of shortage projected. Parle JV, Ross NM, Doe WF. The medical care practitioner: developing a physician assistant equivalent for the United Kingdom.Med J Aust.2006;185(1):13-17. ABSTRACT: A range of demographic, social, and other factors are creating a crisis in the provision of clinical care in the United Kingdom for which the physician assistant (PA) model developed in the United States appears to offer a partial solution. Local and national moves are underway to develop a similar cadre of registered health care professionals in England, with the current title of medical care practitioners (MCPs). A competence and curriculum framework document produced by a national steering group has formed the basis for a recent consultation process. A limited evaluation of US-trained PAs working in the West Midlands region of England in both primary care and acute secondary care suggests that PA activity is similar to that of doctors working in primary care and to primary care doctors working in the accident and emergency setting. The planned introduction of MCPs in England appears to offer, first, an effective strategy for increasing medical capacity, without jeopardizing quality in frontline clinical services; and, second, the prospect of increased flexibility and stability in the medical workforce. The deployment of MCPs may offer advantages over increasing the number of doctors or taking nurses out of nursing roles. The introduction of MCPs may also enhance service effectiveness and efficiency. Larson EH, Hart LG. Growth and change in the physician assistant workforce in the United States, 1967-2000.J Allied Health.2007;36(3):121-130. ABSTRACT: The physician assistant (PA) profession grew rapidly in the 1970s and 1990s. As acceptance of PAs in the health care system increased, roles for PAs in specialty care took shape and the scope of PA practice became more clearly defined. This report describes key elements of change in the demography and distribution of the PA population between 1967 and 2000, as well as the spread of PA training programs. Individual-level data from the American Academy of Physician Assistants, supplemented with county-level aggregate data from the Area Resource File, were used to describe the emergence of the PA profession between 1967 and 2000. Data on 49,641 PAs who had completed training by 2000 were analyzed. More than half (52.4%) of PAs active in 2000 were women. PA participation in the rural workforce remains high, with more than 18% of PAs practicing in rural settings, compared with about 20% in 1980. Primary care participation appears to have stabilized at about 47% among active PAs for whom specialty is known. By 2000, 51.5% of practicing PAs had been trained in the states where they worked. The profession has grown rapidly; 56% of all PAs were trained between 1991 and 2000. In 2000, more than 42% of accredited PA programs offered a master's degree, compared to no master's degree programs in 1986. Although many critical issues of scope of practice and patient and physician acceptance of PAs have been resolved, the PA profession remains young and continues to evolve. Whether the historical contribution of PAs to primary care for rural and underserved populations can be sustained in the face of increasing specialization and higher-level academic credentialing is not clear. O'Connor TM, Hooker RS. Extending rural and remote medicine with a new type of health worker: physician assistants.Aust J Rural Health.2007;15:346-351. ABSTRACT: The purpose of this paper was to demonstrate that the medical workforce shortage is an international phenomenon and to review one of the strategies developed in the USA in the late 1960s: the physician assistant model of health service provision. The authors consider whether this model could provide one strategy to help address the medical workforce shortage in Australia. A systematic review of the literature about medical workforce shortages, strategies used to address the medical workforce shortage, and the physician assistant role was undertaken. Literature used for the review covered the period 1967-2006. Physician assistants provide safe, high-quality, and cost-effective primary care services under the direction of a doctor and respond to workforce shortages in rural and remote areas, family practice medicine, and hospital settings. This model of health care provision has been adopted in several other developed countries, including England, Scotland, the Netherlands, and Canada. The physician assistant concept might provide Australia with a novel strategy for addressing its medical workforce shortage, particularly in rural and remote settings. DISCUSSION Medical workforce articles published in American journals describe a consensus of predictions of future health care provider shortages.1 However, a review of workforce literature from outside the United States describes medical workforce shortages worldwide. In an article by Scheffler and colleagues, skilled health care practitioner supply and demand is described for each nation. Two forecasting methods were used; the first (needs-based estimate) was determined by the resources needed to have 80% of live births attended by a skilled health worker. The second (demand-based method) was determined by calculating economic growth and projecting from this the likely demand in medical services. Data demonstrated that worldwide, physician demand would equal supply by 2015 but geographical misdistribution would result in severe shortages in certain regions, particularly in Africa and South Asia. Larson and Hart examined multiple sources of PA data to produce numerical and geographic descriptions of changes in the PA profession between 1967 and 2000. The most notable findings were the transformation from an almost totally male to more than 50% female profession, the shift from predominantly primary care practice to a mix of primary care and specialties, and a change in geographical distribution as PA practice laws supported PA practice in more states. Currently, PAs are distributed in an urban-to-rural ratio similar to that of the US population as a whole-unlike physicians, who are much more heavily urban distributed. In the late 1990s the use of PAs was proposed to address health care workforce shortages in the United Kingdom. Parle and colleagues describe the UK experience of utilizing PAs. Unlike the United States, the United Kingdom was able to recruit experienced American PAs for demonstration projects before determining whether to create the new profession as well as before designing an educational process for training PAs. This article describes the problems confronting the UK health care system, the early data, observations of demonstration projects, establishing PA education in the United Kingdom, and current plans for future PA utilization. O'Connor and Hooker describe the factors contributing to Australia's medical workforce problems. Described in detail, these challenges are remarkably similar to those in the United States. The authors present data describing how PAs have been used in several countries to alleviate health care shortages, with particular emphasis on data supporting the successful use of PAs in the United States. Overall, these four articles paint a picture of worldwide health care worker shortages primarily caused by provider misdistribution and action taken in several developed countries to address these shortages by establishing a new profession modeled after the US PA profession. Data describing the US experience are being utilized as the profession is considered and adopted in other counties, demonstrating the value of the profession's research efforts.