The Perfect Storm For PAs

by Michael Funk, PA-C, MPH
Immediate Past President
Submitted to Florida Newspapers on February 29, 2008

The “perfect storm” that looms over Florida medical access is not just a problem of not enough doctors. Because Physician Assistants are dependent practitioners who require physician supervision to practice medicine, anything that affects doctors has a direct effect on PAs. The forces that are at work that will result in a decrease in the number of doctors in Florida will also, inevitably, result in a decrease in the number of PAs, further limiting access to quality health care for the growing Florida population.

The average age of doctors in Florida is over 50. These doctors are starting to think of retirement, not expansion of their practices. They are less likely to hire PAs to handle a growing patient load. There are not new doctors in the pipeline ready to move in and take over these practices. The doctors that do employ PAs now will not have a doctor to take over their practice when they retire, leaving the PAs with nowhere to go, except out of state.

With Medicare and Medicaid reimburse being at the bottom of all states, doctors don’t want to come to Florida. Fewer doctors means fewer jobs for PAs. Also, when you consider that for many doctors seeing Medicaid patients actually results in a loss of income and Medicare patients can just be break-even, the doctors who have high populations of these patients simply cannot afford to pay a PA, even though the PA costs less.

Combined with these elements of the “perfect storm” that threatens to create a severe shortage of doctors in Florida within the very near future (many think that shortage is here now and in fact all but 4 counties in Florida have been designated health care shortage areas by the government), there are other forces that are creating negative climatic conditions for PAs. Florida is one of the most restrictive in regard to PA practice laws. Couple that with the fact that the cost of living is higher in Florida than many other areas and there is negative pressure for PAs to come to Florida. Just like doctors who complete their medical schooling in Florida and then go outside the state to complete their residency and practice, PAs who are trained in the state are leaving the state because of better practice laws and better incomes relative to the cost of living.

Because the forces causing a decrease in the number of doctors in Florida directly affect PAs it is vital that PAs become involved with the physician organizations to help prevent the coming catastrophe. As a profession, our survival in the state depends on our participation in developing solutions and working closely with our physician colleagues.