Characteristics of Physician Assistants/Associates Providing Care in Underprivileged Areas: A National Analysis: Q&A and Discussion

Proposal: Since the 1960s, addressing the shortage of healthcare providers in rural and underserved areas in the US has been a persistent challenge for healthcare policymakers. Despite substantial initiatives, such as the Health Professions Educational Assistance Act of 1976, aimed at increasing service provision in shortage areas, there remains an uneven distribution of healthcare providers, with many opting to practice in metropolitan locations. Prior studies suggest physician assistants/associates (PAs) are more inclined than other providers to care for underserved populations. However, a national analysis of the characteristics and attributes of PAs likely to render care in professional shortage areas (HPSAs) or medically underserved areas (MUAs) is currently lacking.

Using a cross-sectional analysis of 2022 workforce data from the National Commission on Certification of PAs, we conducted descriptive and bivariate analyses comparing demographics, practice characteristics, and PAs' contributions in HPSAs/MUAs. Multivariate logistic regression was performed to determine which PA demographic characteristics were associated with working in HPSAs/MUAs.
We found that PAs working in HPSA/MUA, compared to PAs not practicing in these settings (all p< 0.001), were more likely to identify as male (33.3% vs. 29.4%), underrepresented in medicine (14% vs. 9.0%), and reside in rural/isolated areas (15.6% vs. 5.1%). PAs working in HPSA/MUA vs. their counterparts were also more likely to practice in primary care (p < 0.001) and work in federally qualified community health centers (p < 0.001). In the multivariate logistic regression (all p< 0.001), it was found that the strongest predictors of working in HPSA/MUA were residing in rural/isolated areas (OR=3.66), identifying as Black/African American (OR=1.73), Hispanic/Latino(a/x) (OR=1.29), and speaking a language other than English with patients (OR=1.57).

These findings are essential to better understand the current PA workforce and where healthcare policies and research could contribute to expanding access for the most vulnerable population. Furthermore, efforts should be maximized to recruit PA students who are more likely to provide care in underprivileged areas.

The presenter's expertise: The presenter for this research study is a healthcare provider with expertise in diversity in healthcare education, underserved population health, healthcare workforce research, and family medicine.

Relevance of the topic to social mission in health professions education: This research centers on exploring the diversity of the healthcare workforce to identify factors contributing to PAs working in underprivileged areas. Building on this research, institutions of higher education and PA programs could shape admissions policies and initiatives to actively recruit PA students from diverse backgrounds.