Table of Contents
Abstract
Throughout the course of history, the prominence of females in the workforce has increased tremendously. Females now comprise over sixty percent of the physician assistants in the United States (Lindsay, 2008). This represents over half of providers being females! This dramatic increase began in the 1970s and continues to be seen today. With this increase of female physician assistants, both positive and negative implications have been seen.
Several studies have shown that female physician assistants tend to be more encouraging and reassuring, use shared decision-making, ask more psychosocial questions, and spend more time with their patients (approximately 10% more) as oppose to male providers. However, the increase in female providers has raised concerns in the medical field. Females have been shown to work fewer hours worked and the gender has faced significant wage gaps.
Positive and Negative Implications
Throughout the history of the physician assistant profession, males have primarily been the individuals overtaking the field; however, according to new statistics, females now comprise over sixty percent of the physician assistants in the United States (Lindsay, 2008). According to statistics updated October 2018; in Pennsylvania alone, there are a total of 5,641 physician assistants (“Total Number of Physician Assistants, by Gender”, 2018). Of those 5,641 physician assistants in Pennsylvania, 4,036 are female, 1,461 males, and 144 unspecified (“Total Number of Physician Assistants, by Gender”, 2018).
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Why this dramatic increase in female providers? Many reasons have been suggested by researchers. For instance, it is believed the profession offers satisfying work that is well compensated, and more flexible than that of a doctor, especially for those females who wish to be both physician assistants and mothers. But the real question…How will this feminization impact the medical field? Studies have shown that females provide more sympathetic and patient-oriented care as oppose to male providers. Studies have also shown that the increased female population in this field as created amazingly wide wage gaps and many individuals are concerned with female physician assistant choosing to work few hours in comparison to men.
Prior to discussing the implications of the notable gender gap; it is important to recognize those influential women that marked the beginning of this monumental change in medical history. Joyce Nichols, the first female physician assistant, graduated from Duke University’s physician assistant program in 1970 (“Women’s History Month”, 2018). Her interest in pursuing the career shocked members of the Admission committee because at this point in time in United States’ history, a majority of college students were male. Members of the admission committee had several concerns with the idea of accepting a female into their program.
Prior to her acceptance, she was denied on three different occasions because she was not a military corpsman and she had children (“Women’s History Month”, 2018). It was believed that Nichols would not properly devote her time due to her family at home. However, Nichols proved her naysayers wrong by graduating and undergoing years of practice as a successful physician assistant. Not only did she become extremely successful, but she went on to advocated for rural health care, health care to underserved populations, and for minorities to get involved in the medical field. (“Women’s History Month”, 2018).
Suzanne Greenberg also played a vital role in history by being the first woman and non-physician to help start and direct Northeastern University’s physician assistant program. (“Women’s History Month”, 2018). Greenberg also proceeded to represent the female population by going on to become the secretary and treasurer for the American Registry of Physician’s Associates Assocation and become president of the Association of Physician Assistant Programs in 1988 (“Women’s History Month”, 2018). Greenberg has been recognized as the longest serving program director with having 35 years of service prior to stepping down from the Northeastern University’s physician assistant program in 2006 (“Women’s History Month”, 2018).
Karen Bass was the first physician assistant to be elected to the United States House of Representatives in 2010 and she continues to serve to this day (“Women’s History Month”, 2018). On top of this major achievement, Representative Bass became the first African American woman to be elected Speaker of the California House and prior to her career in her politics; she became the first physician assistant to be hired in the Emergency Department at the LSU Medical Center (“Women’s History Month”, 2018).
Finally, of these women, COL Pauline Gross has had many “firsts” for her career. Gross became the second woman physician assistant to receive the rank of Colonel in the Army, she was the first female physician assistant to be deployed to Palmerola Air Force Base in Honduras, was the first physician assistant to be a clinic officer in charge of South Korea, the first physician assistant assigned to the United States Army Recruiting Command, and the first physician assistant to be the installation management command surgeon for the United States Army (“Women’s History Month”, 2018).
The first distinct changes in the profession began in the 1970s when Joyce Nichols became the first female physician assistant to graduate from Duke (Hooker, Robie, Coombs & Crawly, 2013). At this time, women began to enter the workforce after a series of amended laws were created. These laws included the 1963 Equal Pay Act, 1964 Civil Rights Act, 1972 Title IX of the Education Amendments, and 1979 Pregnancy Discrimination Act (Seamone, 2014). Women, particularly those with children at home, were now able to apply for higher paying jobs that were once only available to men, attend professional schools, and continue working while pregnant (Seamone, 2014). According the United States Department of Labor, females working outside of the home increased from 27% in 1960 to 54% in 1980 to 70% in 2012 (Seamone, 2014).
Around this time, physician assistant programs across the nation started to grow largely due to federal support from the Title VII of the Public Service Act and the growing number of individuals seeking to pursue to profession (Hooker, Robie, Coombs & Crawly, 2013). The Title VII of the Public Service Act encouraged the recruitment of diverse populations, deployment in underserved areas, and focused on primary care practices (Hooker, Robie, Coombs & Crawly, 2013).
Researchers published results for a study performed in 2008 exploring why female providers at that time chose to be physician assistants. In addition to this study, researchers analyzed data from the American Academy of Physician Assistants Census review. Throughout the twenty-one qualitative interviews with both male and female physician assistants, female physician assistants reported entering the profession because it allowed them to practice within the medical model without having the high expense and demanding schedule of medical school (Lindsay, 2008). Many of the females claimed that the profession was quite compatible with family life (Lindsay, 2008). This study also determined that women tend to concentrate in practice areas of women and children’s health; however, evidence suggests that females are moving beyond these traditional roles into areas such as internal medicine and surgery (Lindsay, 2008).
The increase in female providers has had both positive and negative implications. Interestingly enough, studies have shown that female providers have better recovery rates in comparison to men! A team of Harvard researchers studied thirty-day mortality rates for 1.58 million hospitalizations for Medicare enrollees (621,412 male and 961,616 female) and 30-day readmission rates for 1.54 million Medicare enrollees (602,115 male and 938,682 female) across eight common medical conditions (sepsis, pneumonia, congestive heart failure, chronic obstructive pulmonary disease, urinary tract infection, acute renal failure, and gastrointestinal bleeding) treated by male and female physicians from 2011 to 2014 (Keckley & Karp, 2017). Of those patients who were treated by female physicians, a lower adjusted mortality rate of 11.07% was seen as oppose to those patients who were treated under the circumstances of a male physicians with 11.49% (Keckley & Karp, 2017). This shows a 0.42% difference. Readmission rates were also examined with female physicians having 15.02% versus the 15.57% for male physicians (Keckley & Karp, 2017). This shows a 0.55% difference between the two genders.
Could this potential difference in mortality rate be due to the fact that studies show female physicians provide more patient-centered communication in comparison to their male counterparts? For instance, an experiment involved two male and two female actors who portrayed physicians spoke to patients using high and low patient-centered scripts while ensuring nonverbal cues were not varied (Hall, Roter, Blanch-Hartigan, Mast, & Pitegoff, 2015). 192 medical students evaluated and rated these videos based on these consultations (Hall, Roter, Blanch-Hartigan, Mast, & Pitegoff, 2015).
Greater verbal patient-centeredness had a stronger positive effect on satisfaction and evaluations for male than for female physicians (Hall, Roter, Blanch-Hartigan, Mast, & Pitegoff, 2015). This pattern remained consistent. Overall, this study concluded that the associations between patient-centeredness and patients’ satisfaction for male physicians occur because of the overlap between stereotypical female behavior and behaviors that comprise patient-centered medical care (Hall, Roter, Blanch-Hartigan, Mast, & Pitegoff, 2015).
Researchers have even discovered that patients seen by female providers were more likely to receive recommended cancer screenings, recommended diabetes management, and have fewer emergency department and hospitalization than were patients with male physicians (Alspach, 2018). In addition, of 104,630 patients studied in Ontario, Canada, patients undergoing procedures performed by female surgeons were less likely to have complications within 30 days of their surgery with rates of 11.1% for female providers and 11.6% for male providers (Alspach, 2018).
With the increase in female physicians, patients are now able to utilize females for areas of medicine regarding obstetrics and gynecology. A sample of 67 obstetric patients during their postpartum hospital stay were asked open-ended questions regarding gender preferences of health care providers and satisfaction with their health care (Howell, Gardiner & Concato, 2002). Of these patients, 58% of the females had no gender preference, 34% preferred female physicians, and 7% preferred male physicians (Howell, Gardiner & Concato, 2002).
Negative implications with the transition have also been seen. According to a September 2017 study published in the Journal of Women’s Health Issues that examined male and female physician assistant salaries from 1998 to 2014, researchers found that female physician assistants are compensated 89 cents for every dollar received by a male physician assistant (Smith, Cawley, & McCall, 2017). This creates an 11% income disparity (Smith, Cawley, & McCall, 2017). This is unacceptable considering the growing number of individuals graduating from physician assistant programs and becoming practicing providers.
L Gail Curtis, president and chair of the American Academy of Physician Assistants Board of Directors stated, “As a PA educator, I feel keenly the burden of student debt. One way to think about the impact of the gender pay gap is in the context of the $150,000 in student loans facing a typical PA upon graduation…A male PA earning $10,000 a year more than his female PA counterpart could use that extra money to pay off his student loan debt in 15 years. The disparate treatment of women in the PA profession is simply unacceptable (Valtorella, 2017).”
Many individuals also express the concern that females choose to work fewer hours due to family. A research letter published in JAMA internal Medicine stated that of 5000 couples with both partners being physicians or surgeons, men worked an average of 57 hours while women worked 52 hours weekly (Ly, Seabury & Jena, 2017). Interestingly enough, men without children compared to men with children work similar number of hours (Ly, Seabury & Jena, 2017). Women without children compared to women with children showed significantly fewer hours worked weekly with women that have the children working fewer hours (Ly, Seabury & Jena, 2017).
In conclusion, a feminization movement has been evident amongst the physician assistant profession. This movement has had and will have both positive and negative implications continuing into the future. Females have played such an amazing role in history and the evolution that continues to be seen today is remarkable.
References
- Alspach, J. (2018). Are Women Really Better Physicians Than Men Are?. Critical Care Nurse, 38(3), 13-15. doi: 10.4037/ccn2018609
- Hall, J. A., Roter, D. L., Blanch-Hartigan, D., Mast, M. S., & Pitegoff, C. A. (2015). How Patient-Centered Do Female Physicians Need to Be? Analogue Patients’ Satisfaction With Male and Female Physicians’ Identical Behaviors. Health Communication, 30(9), 894–900. https://doi.org/10.1080/10410236.2014.900892
- Hooker, R., Robie, S., Coombs, J., & Cawley, J. (2013). The changing physician assistant profession. Journal Of The American Academy Of Physician Assistants, 26(9), 36-44. doi: 10.1097/01.jaa.0000433914.54617.a0
- Howell, E., Gardiner, B., & Concato, J. (2002). Do Women Prefer Female Obstetricians?. Obstet Gynecol, 99(6), 1031-1035.
- Keckley, P., & Karp, M. (2017). Male vs. Female Physicians: A Closer Look at Differences in Care. Retrieved from https://www.hhnmag.com/articles/7955-male-vs-female-physicians-a-closer-look-at-differences-in-care
- Lindsay, S. (2008). The Feminization of the Physician Assistant Profession. Women Health, 41(4), 37-41.
- Ly, D., Seabury, S., & Jena, A. (2017). Hours Worked Among US Dual Physician Couples With Children, 2000 to 2015. JAMA Internal Medicine, 177(10), 1524. doi:10.1001/jamainternmed.2017.3437
- Pasquini, S. (2018). Physician Assistant Stats, Data, and Demographics. Retrieved from https://www.thepalife.com/physician-assistant-stats/
- Seamone, E. (2014). Life And Work: What Was It Really Like For Women In The 1970s?. Retrieved from http://www.womenworklife.com/2014/07/30/work-life-really-like-women-1970s/
- Smith, N., Cawley, J., & McCall, T. (2017). Examining the Pay Gap: Compensation Disparities Between Male and Female Physician Assistants Women’s Health Issues, 27 (5), 607-613. Total Number of Physician Assistants, by Gender. (2018).
- Vartorella, L. (2017). 70% of physician assistants are women, yet gender pay gap still persists. Retrieved from https://www.beckershospitalreview.com/compensation-issues/70-of- physician-assistants-are-women-yet-gender-pay-gap-still-persists.html
- Women’s History Month. (2018).
