Heavy Education Debt May Discourage Physician Assistants From Practicing in Primary Care or Underserved Settings

FOR IMMEDIATE RELEASE: Monday, August 18, 2014

Megan Moriarty 
American Academy of Family Physicians 
(800) 274-2237, Ext. 5223 

WASHINGTON — Given the recent concerns about the ability of the future primary care workforce to address the health care needs of the nation, factors influencing career decisions are vitally important. Nearly nine out of 10 physician assistant (PA) students owe education debt that could influence the primary care PA workforce of the future.

That’s a conclusion that could be drawn from a Robert Graham Center study funded by the Physician Assistant Education Association (PAEA), “The Impact of Debt Load on Physician Assistants,” released today. The study analyzed results of a series of focus group discussions with second-year PA students and the 2011 American Academy of Physician Assistants (AAPA)–PAEA Graduating Student Survey on career choices, education debt, and demographic characteristics of PA students.

Robert Graham Center researchers found that the median reported debt load of PA students in 2011 was $88,000. Of those with education debt reported, nearly 60 percent of PA students graduated with more than $50,000 in PA education debt, and nearly one in four students owed more than $100,000. 

Students from urban and suburban settings were less likely to plan a career in a rural practice setting. Students with minimal or extremely high debt were most likely to seek a career in a rural or underserved area. 

Although more data analysis is needed to pinpoint the reason for these associations, “There is some speculation that students with smaller debt can afford to go into primary care, and people with high debt are looking for loan repayment options that are more available in primary care and rural or underserved settings,” said Miranda Moore, economist and health services researcher at the Robert Graham Center, and lead author of the study.

PAs working in primary care earn an average of $85,000 a year, compared to those who earn $105,000 for other specialties.

“Given that the median debt load of PA students in 2011 was $88,000, this $20,000 annual difference could have a substantial impact on the specialty decision of a PA student,” the researchers wrote.

Focus group discussions held with second-year PA students also revealed that the majority of students are undecided regarding specialty choice when they matriculate to a PA program, but are open to working in primary care specialties. “A good preceptor was often cited as the key influencer in a student’s specialty choice decision,” according to the study.

The study’s authors lay out steps to help reverse the downward trend in primary care PAs. Among them are: 
• Increase PA student interest in primary care by developing curricula that distinguish primary care as a defined specialty with its own specific body of knowledge and skills. 
• Encourage payers to address the PA salary differential between primary care specialties and subspecialties. 
• Increase interest in rural and underserved areas by targeting rural-born and educated students and increasing opportunities for training exposure in rural and underserved locations. 
• Groom highly qualified and well-prepared preceptors and mentors who provide patient care in team- and information technology-driven, patient-centered medical homes. 

“The PA education community has opportunities to encourage undifferentiated PA students to choose a primary care specialty and to practice in a rural or underserved area,” said Moore. “They can take those opportunities—such as increasing clinical rotations in primary care settings—into consideration as they make educational changes now and in the future.”

PAEA Chief Policy & Research Officer, Anthony Miller stated: “One of the Association’s chief priorities is to encourage the deployment of PA students to primary care practices, particularly those in underserved communities. This is imperative in order to ensure access to quality health care for everyone in the nation. We were encouraged to see that while rising PA student debt is a concern, it is not the primary motivator for specialty choice. This report provides a foundation for planning our continued efforts in this area.”


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.