Using Online Job Posting Data for Health Workforce Research Chair: - PowerPoint PPT Presentation

Using Online Job Posting Data for Health Workforce Research • Chair: Perri Morgan • Lois Joy – Uses, Strengths, and Limitations of Real-Time Labor Market Data for Health Workforce Research • Kristine Himmerick (Perri Morgan) – National Analysis of Employer Demand for Physician Assistants • Linda Lacey – Identifying Niche Markets for NPs in South Carolina

National and State-Level Analysis of Employer Demand for Physician Assistants Perri Morgan, PhD, PA-C 1 Christine Everett, PhD, MPH, PA-C 1 Kristine Himmerick, PhD, MPAS, PA-C 2 Katherine Humeniuk, MPH 1 Brandi Leach 1 Patricia Dieter, MPA, PA-C 1 1 Duke University, Dept of Community & Family Medicine 2 University of California San Francisco, Healthforce Center

Background: Primary care need • Shortfalls of primary care physicians are widely predicted due to – Aging of the population – Increase in chronic disease prevalence – Increased insured population due to implementation of the ACA • Physician assistants (PAs) and nurse practitioners (NPs) are often suggested as a potential solution to fill primary care needs

PA specialization • Over the past 20 years, the proportion of PAs choosing specialty practice has increased • In 2014, only 27% of PAs worked in primary care (NCCPA data).

Efforts to increase primary care practice among PAs Federal • – Title VII training grants to PA programs who implement programs to enhance primary care training – National Health Service Corps scholarships and loan forgiveness programs for primary care practice State: Some states have similar loan forgiveness • programs PAEA: One of two major strategic goals is to increase • the proportion of PAs working in primary care PA training programs: Many have a primary care • mission

But the proportion of PAs in primary care continues to decline 60% 55% Estimated % PAs in Clinical Practice 50% 50% 45% 40% 35% Primary Care* 30% 30% Surgical Specialties 25% 24% Medical Subspecialties 21% 20% 19% Emergency Medicine 15% 14% 13% Other 11% 10% 10% 8% 5% 0% 1997 2001 2005 2009 2013 Year Source: AAPA Census/Annual Survey Reports, 1997 -2013 *Primary Care includes Family Medicine (with and without Urgent Care), General Internal Medicine, Primary Care, General Pediatrics and Geriatrics. This differs slightly from the definition in other analyses in this paper due to limitations in the availability of trend data.

Factors that may affect PA specialty choice SUPPLY DEMAND • Personal preferences • Availability of and values physicians • Potential earnings • Resident work hour regulations • Debt levels • Demand for care • Location (needs of the • Image of primary population) care • Willingness of • Professional organizations and satisfaction physicians to hire

Research on factors affecting PA specialty choice DEMAND SUPPLY ? Cawley J, Jones PE (2013). “Institutional • Sponsorship, Student Debt, and Specialty Choice in Physician Assistant Education ”. The Journal of Physician Assistant Education 24(4). Singer, A. M. and R. S. Hooker (1996). • "Determinants of specialty choice of physician assistants." Academic Medicine 71 (8): 917-919. Morgan, P ., C. Everett, K. Humeniuk and V. • Valentin (2015). "Specialty choice among US physician assistants: Distribution, salaries, and comparison to physicians." JAAPA In press . Snyder J, Nehrenz G, Danielsen R, Pederen D • (2014). “Educational Debt: Does It Have an Influence on Initial Job Location and Specialty Choice?” The Journal of Physician Assistant Education 25(4). Wright, K. A. and V. L. Orcutt (2011). • "Physician assistant specialty choice: a factor analysis." The Journal of Physician Assistant Education 22 (2): 20-24 Many studies of physician specialty choice…. •

Evidence for low demand • Recent graduates’ most often listed barriers to securing a job were (NCCPA survey): – Requirements for experience – Geographic limitations – Lack of jobs in preferred specialty • PA faculty report that graduates have difficulty securing primary care positions.

Research questions • How do numbers of PA primary care job postings compare to specialty job postings? • Do other job market factors impede the uptake of PAs into primary care? – Geography – Requirements for experience – Jobs also posted for NPs

METHODS • Cross-sectional descriptive study • Compares primary care and specialty job postings to each other and to occupied PA positions

Job opening data • National 2014 job posting data purchased from Burning Glass Technologies (BGT) • BGT spiders >38,000 websites continuously • About 90% or more of highly skilled health sector jobs are posted online – Determined by comparing job posting #s with Bureau of Labor Statistics job opening estimates • Data for variables is extracted from the job opening text by BGT • Data is de-duplicated by BGT, with no repeating job posting in a 60 day window

Variables • Practice specialty: – Trained coders in our office read each posting and assigned a specialty – A research analyst coded a subset of each coder’s work until agreement was >95% • Location • Experience required (< 1 year vs. 1 year or more) • Whether job was posted for a PA or NP, or just for a PA

• 42,768 postings advertised PA jobs – 336 were for non-clinical jobs – 5 were from Puerto Rico or Guam – 8290 no specialty could be determined • 34,137 postings were analyzed

Primary care definition • Family medicine • General practice • General internal medicine • General pediatrics • This definition was chosen to match NCCPA definition

Data on occupied positions • National Commission on Certification of Physician Assistants 2014 – 2014 Statistical Profile of Certified Physician Assistants

Methods of analysis • Descriptive statistics • Geographic information systems methods were used to visualize data

RESULTS

18% of job postings were for primary care 27% of occupied positions were in primary care 80000 74443 70000 60000 50000 40000 N 28047 27534 30000 20000 10000 6091 0 Primary care* Specialty care Occupied PA positions PA job postings * Primary Care includes Family Medicine (with and without Urgent Care), General Internal Medicine, Primary Care, and General Pediatrics Source: National job postings data from Burning Glass Technologies, coded by authors; and national data on occupied positions from National Commision on the Certification of Physician Assistants.

Job postings show stronger market demand for medical subspecialties and “other” specialties PA Job Postings Occupied PA Jobs Primary Other Care* Other Specialties Primary 18% Specialties 12% Care* 18% 27% Emergency Medicine Emergency 14% Medicine 11% Surgery Medical 27% Medical Subspecialties Surgery Subspecialties 21% 26% 26% * Primary Care includes Family Medicine (with and without Urgent Care), General Internal Medicine, Primary Care, and General Pediatrics Source: National job postings data from Burning Glass Technologies, coded by authors; and national data on occupied positions from National Commision on the Certification of Physician Assistants.

Proportion of job postings that are for primary care varies widely, but tends to be higher in the mountain West Percent of Primary Care Jobs out of all PA Job Postings by State, 2014 9.1% - 13.2% 13.3% - 15.8% 15.9% - 18.8% 18.9% - 24% 24.1% - 40.3%

Other factors that might affect job search • One year or more experience required: – Primary care 37% – Specialty care 29% • Job also posted for NPs – Primary care 40% – Specialty care 35% Although these differences are small, these factors might make it harder for new graduate PAs to secure primary care positions

Discussion • The PA job market appears to be stronger for specialty jobs than for primary care jobs • This may be especially true for new graduates. – There were 7556 graduates and 6100 primary care job postings in 2014, but • 37% required experience • 40% were posted for NPs also • Jobs are not evenly distributed geographically • New PAs must compete with experienced PAs for these jobs

Potential explanations • PAs might have a bigger impact on practice profits in specialties  more incentive for specialists to hire PAs • Sociology of medicine (Ferraro and Southerland, 1989) – Status differential is larger between specialist physicians and PAs than between primary care physicians and PAs – The larger status differential causes specialists to be less threatened by PAs on their turf

Limitations • Not all jobs are posted online. • Not all postings could be assigned a specialty • Some specialty categorization may be incorrect • Some variables could be miscoded (especially experience required) • Jobs posted over 60 days could be included again

Strengths • First study to examine nationwide job market by practice specialty • First study to use real-time labor market information – Advantage of ability to examine emerging trends. – Traditional labor market information does not provide the detail needed to answer these questions (practice specialty)