Differences in salaries of physician assistants in the USA by race,ethnicity and sex

Abstract

Objectives

Data from the Academy of American Physician Assistants have suggested there are no differences in salaries by race and ethnic group. Our objective was to compare salaries of physician assistants for different racial and ethnic groups and sexes using another data source.

Methods

Data from the American Community Surveys (2010–2012) to examine pay differentials of physician assistants. Ordinary least squares regression analysis to compare the salaries of males and females, and those of racial and ethnic groups.

Results

The majority of physician assistants in recent decades have been women. Their salaries are substantially below those of their male counterparts. The number from racial and ethnic minorities remains low. American Community Surveys data show salaries to be lower than that reported by the American Academy of Physician Assistants. The salaries of Black and Hispanic physician assistants lag significantly behind the salaries of those who are White.

Conclusions

American Community Surveys data suggest that previously published Academy of American Physician Assistants survey data may have been biased with a low percentage of physician assistants from racial and ethnic minorities which suggests that the Academy of American Physician Assistants need to focus on recruiting greater numbers of minorities.

Keywords

gender disparities health services research income disparities physician assistant racial disparities

Introduction

Race, racism and discrimination continue to shape the life trajectories of the nation’s most vulnerable and stigmatized groups.¹ Although health care professions have attempted to increase the percentage of minority groups in the professions and to rectify income disparities, little information is available about physician assistants (PAs) as a profession.

Carter² has argued that early PAs were recruited from the military because they had medical training during the Vietnam War. African Americans were overrepresented in the armed forces because military service typically affords more opportunities for people of color than in mainstream society.³ Thus, an increased number of African American servicemen likely received their medical training in the enlisted ranks serving as Army Combat Medics and Navy Corpsman. Upon their return home from the battlefield, these ex-military men had no way to utilize their skills and experience in the health care marketplace unless they were able to obtain an educational pathway to a bona fide credential. PA programs developed in the 1970s, primarily in response to a national shortage in health care providers. In 1971, the Health Manpower Act was established by the federal government to address the crisis. It allocated much needed financial assistance in the form of start-up funds to train more health care professionals at colleges and universities. The first wave of PA programs targeted experienced military personnel who were seasoned medics: African Americans were among those targeted.⁴

Recent research by Nunez-Smith et al.^5,6 shows that African American physicians experience several subtle forms of racial discrimination: harassment, lack of referrals from white physicians, and wage discrimination.^5,6 The result is that some black doctors leave medicine.⁷ Minority PAs, like minority physicians, often work in underserved and disadvantaged communities. Studies indicate that when patients see health care practitioners that look like them, their outcomes are better.⁵

Since minority PAs remain underrepresented in the profession, it is important to identify barriers that contribute to their low numbers. Income inequality is one possible factor. Minorities are generally paid less than non-Hispanic Whites and salaries earned by female PAs trail behind their male PA counterparts. With the continuing underrepresentation of minorities in professions and with institutional lags in the recruiting of minorities, one might expect that PAs of color might be paid higher salaries in an effort to attract them but numerous studies indicate otherwise.^8,9

Surprisingly, recent data from the Academy of American Physician Assistants (AAPA) indicate that there are no differences by race or ethnicity in the salaries of PAs.¹⁰ Our aim was to examine PA salaries and the racial/ethnic and sex composition of the profession using data from the US Census Bureau to provide a comparison to those provided by the AAPA.

Method

We examine the salaries of PAs in the American Community Surveys (ACS) data collected annually by the United States Census Bureau for 2010 to 2012 for the population of the country. The ACS conducted 1.9 million interviews in 2010, 2.1 million in 2011, and 2.4 million in 2012 with response rates of 99%. In addition they surveyed individuals’ residences (e.g. college halls, military barracks, correctional facilities, work dormitories) with coverage rates of 81% in 2010, 99.8% in 2011, and 91.5% in 2012.¹¹

We used the Statistical Package for the Social Sciences and ordinary least square (OLS) regressions to examine salary differences with the following variables included in the analysis: hours worked, age, sex, region and whether or not they are native English speakers. Unfortunately, the ACS data do not include consistent and detailed information about the medical specialties of PAs. We compare and contrast the ACS data to the AAPA data. The AAPA surveyed members regarding their current and past roles in medicine. In 2009, the AAPA obtained its information by sending emails and reminders to all PAs for whom they had an email addresses, advertising the survey, when possible sending a paper copy to PAs. They obtained data from 15,275 participants from its membership pool (34% of those contacted). The AAPA membership consists of about half of the estimated number of PAs in the country so may not present a complete picture of PAs. Even though the ACS sample is smaller, it is a large sample with a high rate of respondents.

Results

Salaries of PAs

Salaries from the ACS are lower than those of the AAPA data ($69,103 in 2010–2102 compared to $88,545 in the 2009 AAPA sample). The ACS figure is also below that reported by the National Commission on Certification of Physician Assistants (NCCPA) which reported median incomes in 2013 of $85,000 for PAs in primary care and $95,000 for PAs in non-primary-care positions. The ACS data suggest that the AAPA sample may be skewed, with higher income PAs responding. PAs with higher incomes and greater longevity in the profession may be responding more than other PAs. The same is possibly true of the NCCPA data since not all PAs recertify or respond on time.¹²

Proportions of PAs by race

The percentage of minority PAs in the ACS data is higher than that reported by the AAPA (Table 1). The underestimation of the percentages of minority PAs in the AAPA may result from a selective response with whites reporting at a higher rate than others. At the same time, minority PAs may be less likely to belong to the AAPA than whites which in turn may reflect salary differences. The comparisons of the AAPA data, the ACS data and the census numbers suggest that there may be more minority PAs practising than show up in the AAPA numbers. The NCCPA data are more consistent with AAPA figures; in 2013, the NCCPA showed that 3.9% of PAs were Black, 5.1 were Asian and 6.0% were Hispanic.

Table 1.

Physician assistants in the American Community Surveys by race 2010–2012 compared to the United States 2010 census.

Race/Ethnicity	Number in ACS	Percentage in ACS	Percentage in U.S. 2010 Census	Numbers in AAPA Data^a	Percentage
Non-Hispanic White	2749	75.5	72.4	13,363	88.8
Non-Hispanic Black	224	6.2	12.6	428	2.8
Hispanic	335	9.2	16.2^b	554	3.7
Asian	232	6.4	4.8	593	3.9
Other	102	2.8	2.8	164	1.1
Total	3642	100	116.2^c	15102	100.3**

AAPA: Academy of American Physician Assistants.

Source 2009 AAPA census.

Hispanics may be of any race in the census categories.

Total exceeds 100% because Hispanics is a separate question from race and can be double-counted in the census data.

In the ACS data, Asian PAs are the only minority group that had a slightly higher percentage of PAs in the ACS than they were in the 2010 census of the population of the United States. The percent of PAs that identified in both the ACS and the census data (other race, two or more races, and Native groups) was the same, 2.8%.

Despite the proportions of minorities in the ACS being higher than in the AAPA survey, the percentages of minority PAs, except for Asians, are below their percentages in the general population. Non-Hispanic blacks and Hispanic PAs appear to be underrepresented in the profession compared to the US population. Those that checked “other” in the census were 10.2% of the census.

Feminization of the profession

The PA profession has grown dramatically in recent decades.¹³ The most significant change in the profession is the proportion of female PAs. According to the AAPA 2010 census data, 88% percent of the PAs are white women.¹⁴ Possibly more women than men responded to the AAPA survey, but in reality, the PA profession has become predominately female. One reason for the increase in the proportion of women could be the increased number of women in the workforce in general. A second reason is that women may be drawn to a career as a PA as the perception is that it is “family friendly,” allowing them some flexibility in balancing home and work life. For example, Nonnemaker¹⁵ found that women who graduated from medical schools were more likely to pursue academic positions compared to men because academia offered more flexibility for working mothers and their families. Family practice residents have been likewise moving toward a traditionally female occupation.¹⁶ Even Forbes Inc. lists several medical fields as the top best-paying jobs for women including nurse practitioner.¹⁷ The increase in proportion of female PAs has not translated into equitable compensation between sexes. In the ACS data, female PAs earn $21,084 less than men, about three-quarters of what their male colleagues earn (Table 1). These salary differences persist after controlling for hours-worked, age, region and whether or not English is the primary language. Age, of course, often reflects length of time in the profession. The data do not include medical specialties and that may explain some of the remaining differences which are statistically significant. This is consistent with that found by Lo Sasso et al.¹⁸ It may be that female PAs choose to work in specialties and areas that pay less than others.

Racial and ethnic differences in salaries

Unlike the AAPA, the ACS data show distinct differences in salary by racial minority. Though the AAPA data showed no statistical differences in the salary of PAs of color, non-Hispanic Blacks in the 2010–2012 ACS sample earned about $15,000 less (21%), and Hispanic PAs earned 13% less ($9129) than White PAs (p < 0.001 level). Asian PAs in the ACS earn almost $5000 less than White PAs as do those in the “other” category but these differences are not statistically significant (Table 2). These differences may reflect where they serve and their chosen medical specialties.

Table 2.

Total personal income of physician assistants by decade and race and sex with control variables.

	Income
Variables	2010–2012
Black	−15398.93***
Asian	−3280.05
Hispanic	−8152.49*
Other	−4912.31
Age	781.66***
Female	−21083.77***
Hours worked per week	1427.61***
English	1687.68
Regions
New England division	10649.64**
Middle Atlantic division	6159.26*
East North Central division	−3573.63
West North Central division	−71.30
East South Central division	−5387.87
West South Central division	3391.79
Mountain division	57.37
Pacific division	7202.02**
Comparison groups
White	71402.22
Men	90,553.38
South Atlantic division	67446.50
Total	69103.27

*p < .05, **p < .01, ***p < .001.

Note: The 2010–2012 data are from the American Community Surveys for the combined years.

Both hours worked and age in the ACS data are significantly related to earnings. Salaries also vary by region with New England, Middle Atlantic and pacific divisions generally paying the highest salaries. These data show some difference from the AAPA data (particularly for New England) suggesting that the AAPA data may not be representative. The east north-central and east-south regions have the lowest salaries in the most recent data but those differences are not statistically significant.

Discussion

PAs from racial minorities earn less than non-Hispanic Whites. While the ACS data set does not contain information on medical specialty, specialties probably does not fully explain this difference. Likewise, many minority PAs may work in minority communities in urban areas but compensation may be higher there than in suburban or rural areas. Thus, we cannot say whether or not place of practice results in higher or lower salaries of minority PAs.

The profession has become overwhelmingly white and female. Female PAs, however, earn significantly less than men, something shown in both the AAPA’s own data and the ACS data. Despite efforts by the AAPA to survey its constituents, the ACS data suggest that the AAPA data may be from a biased sample. The ACS data reveal that the salary differentials for non-Hispanic Blacks and Hispanic PAs lag behind those of other groups. Attracting prospective non-Hispanic Black PA faculty, students and mentors has been an ongoing struggle for the profession.¹⁹ Minority PAs bring with them a wealth of knowledge and experience not only about clinical aspects of health care but also about life of our most disadvantaged groups that are sometimes distrustful of a white-controlled health care system. The data show that the PA profession needs to step-up its recruitment efforts to attract minority students.

While the PA profession has become increasingly female, there is a need for greater parity. While age (as a proxy for time in the profession) is not a perfect measure, it does account for part of the salary differences as does hours worked. Other data sets may include medical specialty as a factor affecting salaries, but that alone is unlikely to explain the large salary disparity experienced by female PAs.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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