DETERMINANTS OF SPECIALTY CHOICE OF PHYSICIAN ASSISTANTS

Purpose. Although physician assistants (PAs) became part of the U.S. h ealth scene in 1967 and have made important contributions to primary c are, available information about the factors that may influence the ca reer 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 selection s. Method. 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 reaso ns for this decision. Primary care specialties were defined as family medicine, general internal medicine, and general pediatrics. The ratin gs were subjected to a factor analysis. Results. The 33 original varia bles were reduced to nine basic factors influencing the specialty-choi ce 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 i nto 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 i nfluential factors were technical orientation and income/employment. F or the PAs in primary care, the most influential factors were preventi on academic environment, debt/scholarship, intellectual content, and p eer influence. Conclusion. For this recently graduated group of PAs, f actors representing the kinds of activities they would be engaged in a s health care providers were among the most influential, but the relat ive importances of the factors varied according to whether the PAs wer e in primary care or non-primary-care specialties, with the latter gro up being more strongly influenced by market forces such as income and employment opportunities.