Role & Growth
NPs and PAs are similar in many respects, and we are all aware of the tendency to group the two professions under various undesirable names. In truth, the professions have evolved in distinct ways. Examination of recent demographic survey data highlights interesting contrasts.
Each year, the American Academy of Physician Assistants conducts a census survey believed to be representative of the total universe of practicing PAs. The 2010 census determined that the mean age of PA graduates is 30.1, and the mean age of PAs in clinical practice is 40.5.1 Respondents in the final study sample averaged 40.9 years. The census found that 64.7% of respondents were women, 88.4% were white, and the average age at graduation from a PA program was 30.3.
The demographic profile of the typical PA, therefore, is a 41-year-old white woman who has a bachelor’s degree and has been in practice for 10.1 years. She has been in her current position for 9.4 years and in her current specialty for 7.1 years.1 She is employed full time by a single-specialty group practice, has hospital privileges, works an average of 44 hours per week, and lives and works in a metropolitan area.
The principle trend derived from this profile is the continuing gender shift of the PA profession: Women now comprise nearly two-thirds of the PA workforce.1
Women also constitute the majority of the NP profession. The California Board of Registered Nursing recently published a survey of nurse practitioners and certified nurse midwives in that state. The findings correlate well with similar profiles of NPs and can be considered representative of NPs across the country. The survey response rate was 62.5%, and it yielded information from 1,384 of 2,213 eligible survey participants from a universe of 14,428 APNs in California.2
As expected, advance practice nursing attracts more women than men, with only 7.1% of men holding NP or CNM certification. Men make up 7.6% of NPs, but only 0.8% of CNMs and 0.8% of dually-certified NP/CNMs.
The average age of NPs was considerably higher than that of PAs. In the California sample, the average age of NPs was 50.1. The average age of those dually certified was 51.5.2
More than 26% of NPs and CNMs reported they were not employed as APNs in 2010. More than 58% of NPs and 60% of CNMs reported that they were working as RNs.
An Aging Workforce
Of some concern is the aging and retirement of the NP and PA workforce. Twenty-four percent of working NPs in California reported reducing their hours or planning to retire in the next 5 years.
Nationally, data from the American Academy of Nurse Practitioners show that the average NP is a woman (96%) and 48 years old. She has been in practice for 12.8 years providing family practice services (49%).3 Nearly 20% of NPs practice in a rural or frontier setting.
The NP demographic profile represents in part the fact that many nurses enter advanced practice after working for years as an RN. On the other hand, an increasing proportion of PAs enter the profession as a first professional step, and the mean age of entering students has been falling into the mid-20s.
Health workforce policy makers expect NPs and PAs to augment the delivery of medical care in the coming years – and primary care services in particular. The track record for NPs and PAs in filling primary care roles is quite good: Nearly 60% of NPs and one-third of PAs work in primary care. It is important to understand the dynamics of this workforce if successful strategies to increase PA and NP practice in primary care are to be realized.
1. American Academy of Physician Assistants. Annual Census, 2010. http://www.aapa.org/uploadedFiles/content/Common/Files/2010_Census_Report_Final.pdf. Accessed Feb. 8, 2012.
2. California Board of Registered Nursing. 2010 Survey of Nurse Practitioners and Certified Nurse Midwives. http://www.rn.ca.gov/pdfs/forms/survey2010npcnm.pdf. Accessed Feb. 8, 2012.
3. American Academy of Nurse Practitioners. Nurse Practitioner Facts. http://www.aanp.org/NR/rdonlyres/B899F71D-C6EE-4EE6-B3EE-466506DFED60/5145/AANPNPFactsLogo72011.pdf. Accessed Feb. 8, 2012.
James F. Cawley is professor and interim chair of the Department of Prevention and Community Health in the School of Public Health and Health Services at the George Washington University in Washington. He is the 2011 recipient of the American Academy of Physician Assistants Eugene A. Stead Jr. Award of Achievement.
Demographic Issues To Consider
• The NP and PA workforces are aging; the average age of practicing NPs and PAs is between 41 and 48.
• The majority of NPs and PAs in practice today are women.
• Although NPs and PAs have a strong presence in primary care, specialties are becoming more attractive.