The changing professional practice of physician assistants: 1992 to 2000

Substantial changes in professional practice for physician assistants (PAs) occurred between 1992 and 2000. This paper describes a new professional practice index for the PA profession for 2000 that reflects current practice environments more accurately than did an index developed to reflect practice environments in 1992. In addition, the paper examines the relationships among the profession, its professional environment, and physicians, as well as the relationship between the PA profession and access to care for underserved populations.

Comparisons of the 1992 professional practice index for the PA profession and indices for 2000 indicate that, collectively, the scope of practice of PAs increased significantly across the United States over the 8-year period. Variation of the index scores narrowed over the same period, suggesting that the 1990s were a period of convergence of professional practice across the 50 states. During this period the numbers of practicing PAs nearly doubled between 1992 and 2000, and in 2000 there were 5.8 practicing PAs per 100 physicians in active patient care in the United States. The professional practice index for the profession is positively correlated with the numbers of PAs per capita across the 50 states for both 1992 and 2000.

Enabling legislation for PAs has been enacted in all 50 states and the District of Columbia over a 3-decade period. A period of consolidation and convergence of statutes and policies over the 1990s suggests that American medicine has endorsed the role of PAs. In spite of these findings, almost one third of states continue to have limited or restricted statutes for PA practice, mostly in the area of reimbursement.