Physician assistants: current status of the profession.

In the two decades since the inception of the physician assistant concept in the United States, 52 physician assistant training programs have been established. Currently, approximately 16,000 physician assistants are employed by physicians and institutions throughout the country. Established to fill a perceived gap in primary health care delivery in the 1960s, the profession continues to serve mainly in primary care settings, with 43 percent of all physician assistants in family practice clinics. There is a trend, however, for physician assistants to fill health care gaps in other settings, such as long-term care institutions and correctional facilities. The clinical effectiveness of physician assistants has been demonstrated in terms of both quality of care and patient acceptance, and they are adept at adjusting to shifts in the health care marketplace. However, the real determinant of the future of the profession will be economic advantage. Recent changes in Medicare legislation now permit reimbursement for physician assistant services in nursing homes and hospitals, and payment under Medicaid has been approved in one half of the states. Given the cost effectiveness of physician assistants, their demonstrated competence and acceptability, and their adaptability to a variety of settings, the demand for their services is likely to continue.