Determinants of specialty choice of physician assistants

Although physician assistants (PAs) became part of the U.S. health scene in 1967 and have made important contributions to primary care, available information about the factors that may influence the career choices of this rapidly-growing group of health care providers is sparse. The intent of this analysis was to identify the main factors underlying the specialty-choice decisions of PAs in the first practice year after completing PA training and the reasons for their selections.

Data were collected from a 1994 survey of 4,416 PAs who had graduated in 1991-1993. Usable responses were obtained from 1,472 PAs (33%). Each PA was asked to state the specialty he or she had entered in the first practice year and also to rate each of 33 possible reasons for this decision. Primary care specialties were defined as family medicine, general internal medicine, and general pediatrics. The ratings were subjected to a factor analysis.

The 33 original variables were reduced to nine basic factors influencing the specialty-choice decisions of the PAs, accounting for 47.3% of the variance. The two most important factors were intellectual content of the specialty and a technical orientation. Then factor scores were computed for each PA and subjected to further examination, in which the PAs were divided into two groups: 776 who had entered primary care specialties, and 646 who had entered non-primary-care specialties (50 did not specify their specialties). For the PAs in non-primary-care specialties, the most influential factors were technical orientation and income/employment. For the PAs in primary care, the most influential factors were prevention, academic environment, debt/scholarship, intellectual content, and peer influence.

For this recently graduated group of PAs, factors representing the kinds of activities they would be engaged in as health care providers were among the most influential, but the relative importances of the factors varied according to whether the PAs were in primary care or non-primary-care specialties, with the latter group being more strongly influenced by marker forces such as income and employment opportunities.