JAAPA Podcast Episode Summary
Episode: The Effect of Educational Debt on PA's Specialty Choice
Date: March 4, 2025
Guests: Andre (Senior Director of Research, NCCPA), Alicia (Director of Communications & PA Relations, NCCPA), Mirella (PA, PhD, NCCPA)
Host: JAAPA
Episode Overview
This episode explores the impact of educational debt on the specialty choices of physician assistants (PAs), based on recent NCCPA research. With educational costs soaring and debt increasing among healthcare graduates, many worry how this debt shapes the professional landscape—particularly, whether it discourages PAs from entering primary care, an area of critical need. The NCCPA research team, including experts in PA education and workforce trends, delve into how decisions are made, factors influencing specialty choices, and what educators and policy makers can do to address current challenges.
Key Discussion Points & Insights
1. Backgrounds of the Research Team
- Luck and Diverse Experience:
- Each panelist described a “lucky” path to their roles, bringing a mix of research, education, and clinical perspectives.
2. NCCPA Data Collection and Its Uses
- How Data Is Gathered:
- NCCPA collects ongoing data from PAs starting from 2012, using three modules: “About Me” (demographics), “My Practice” (practice attributes), and “Recently Certified” (new graduates) (04:52).
- Research and Collaboration:
- Data supports workforce monitoring, publication, advocacy, and is available to external researchers for collaborative projects (07:11).
- Misconceptions:
- Many PAs perceive NCCPA solely as a certifying body, not realizing the breadth of research conducted with this data (07:44).
3. The Growing Problem of Educational Debt
- Rising Debt:
- Among new graduate PAs, those with >$100,000 in debt rose from 51.9% (2013) to 63.6% (2022) (08:37).
- Compared to a 25% increase in medical school debt over the previous decade.
- Limited Aid:
- PA students typically rely heavily on loans, with few institutional/federal grant options (09:13).
- Need for More PA-Specific Research:
- While much research exists for physicians, little focuses specifically on PAs, making this study timely and important.
4. Factors in Specialty Choice
- Study Design:
- Built on prior medical education literature, but adapted to PA-specific factors: age, gender, race, geography, job availability, compensation (12:07).
- Evolving Data Collection:
- The team is continually expanding survey instruments for future, more nuanced research (13:08).
5. Survey and Data Analysis Methods
- Recently Certified Module:
- Research Evolution:
- Original work began during the pandemic, but was updated to use fresher, more representative data from 2023.
6. Findings on Debt and Demographics
- 12% Graduated Debt-Free:
- The vast majority begin practice with debt (16:24).
- Higher Debt Correlates:
- Higher debt among older graduates, Hispanic and African American PAs, those in the West, and those who hadn’t found a job yet (16:54).
- Quote — Andre ([16:54]):
“This finding is certainly concerning because PAs from these groups... are more likely to provide care in underserved populations and also working primary care.”
7. Does Student Debt Drive Specialty Selection?
- Primary Care Incentives:
- Loan repayment programs like the National Health Service Corps are a major attraction for PAs choosing primary care (18:20).
- Quote — Andre ([18:20]):
“PAs who chose primary care, they frequently mentioned the National Health Service Corps Scholarship Program, which can significantly reduce or even eliminate educational debt.”
- Quote — Andre ([18:20]):
- Public Service Loan Forgiveness and non-profit employment (e.g., hospitals, community health centers) are cited by PAs in both primary and non-primary care specialties.
- Loan repayment programs like the National Health Service Corps are a major attraction for PAs choosing primary care (18:20).
8. Other Influences: Work-Life Balance, Passion, and Flexibility
- Top Motivators:
- Passion for a specialty is the most cited reason for selection (19:45).
- Quote — Andre ([19:45]):
“Passion for the specific specialty was a common theme, particularly in the open ended comments.”
- Quote — Andre ([19:45]):
- Work-life balance, compensation, cost of living, fellowship opportunities, geographic preferences, and the unique PA capacity to change specialties all play significant roles.
- Strategies range from choosing primary care for scholarships/loan forgiveness with future plans to change fields — or the reverse: entering higher-paying specialties to pay off debt, then shifting to passion specialties like primary care.
- Passion for a specialty is the most cited reason for selection (19:45).
9. Fellowship Decisions and Employer Implications
- Debt’s Effect on Further Training:
- Debt can push new PAs toward immediate employment over pursuing fellowships, depending on job opportunities and location requirements (22:25).
- Employers can be competitive by offering higher starting salaries, sign-on bonuses, and loan repayment options.
10. What Can Educators and Employers Do?
- Pipeline Starts Early:
- Exposure to primary care, positive clinical experiences, and incentives for preceptors during PA training encourage entry into shortage specialties (24:45).
- Retaining and Attracting PAs:
- Foster strong team support, flexible scheduling, and competitive compensation packages.
11. Future Research Directions
- Addressing Gaps:
- NCCPA aims for research that identifies gaps in education/workforce and informs advocacy (27:04).
- Current focus areas: PA leadership, educator shortages, work-life balance, PAs in mental health — all important for improving PA workforce sustainability.
Notable Quotes (with Timestamps & Speaker Attribution)
-
On Data Collection:
"NCCPA has been collecting data on board certified PA since 2012. ... We utilize the data to monitor the PA workforce composition and growth, conduct research, and advocate for our profession."
— Mirella (04:52) -
On Changing Demographics of Debt:
"The percentage of new graduate PAs with more than $100,000 in debt rose from 51.9% in 2013 to 63.6% in 2022."
— Podcast Host (08:37) -
On Factors Associated With Higher Debt:
"Older age, Hispanic ethnicity, African American race, residing in the western US region, and not having accepted a position ... were associated with higher educational debt."
— Andre (16:54) -
On Passion for Specialty:
"Passion for the specific specialty was a common theme, particularly in the open ended comments."
— Andre (19:45) -
On Primary Care Incentives:
"PAs who chose primary care, they frequently mentioned the National Health Service Corps Scholarship Program, which can significantly reduce or even eliminate educational debt."
— Andre (18:20) -
On Early Primary Care Exposure:
"For PA educators to introduce primary care and the benefits ... really early in their training ... When students have that really good experience in primary care, they're more likely to consider it as they're looking for jobs."
— Alicia (24:45)
Timestamps for Key Segments
| Timestamp | Segment Description | |-----------|------------------------------------------------------------------------| | 01:36 | Research team backgrounds; how they joined NCCPA | | 04:52 | How NCCPA collects and uses workforce data; invitation to collaborate | | 08:37 | Shocking statistics on increasing educational debt | | 09:13 | Research gaps and rationale for focusing on PA specialty choice | | 12:07 | Designing the study, incorporating multifactorial influences | | 13:51 | Overview of the Recently Certified PA module and data analysis | | 16:24 | Major findings: only 12% of new PAs are debt-free | | 16:54 | Debt disparities by age, race, region; concerns with underrepresented groups | | 18:20 | Impact of loan repayment programs on specialty choice | | 19:45 | Work-life balance, passion, and other factors in specialty selection | | 22:25 | Effect of debt on decision to pursue further training or fellowship | | 24:45 | How educators/employers can encourage entry into shortage specialties | | 27:04 | Future NCCPA research priorities and current studies |
Memorable Moments
-
Myth-Busting:
Several participants recount how even they were unaware of NCCPA’s vast research and data collection until becoming involved—pointing to widespread misunderstandings about the profession’s gatekeeping body (07:44). -
Resourceful PAs:
The research reveals PAs are adept at navigating debt: combining scholarships, loan forgiveness, and flexible specialty pathways to align career and financial goals (18:20). -
Passion Still Central:
Despite debt and burnout concerns, most new PAs cite genuine passion as the leading driver in selecting a specialty (19:45).
Conclusion
This episode gave an in-depth look at the complex and nuanced relationship between educational debt and specialty choice among physician assistants. While debt is a significant consideration—shaping choices and influencing who works where—personal passion, job availability, compensation, and flexibility are all important. Loan repayment programs and positive primary care experiences play crucial roles in attracting PAs to underserved specialties. The NCCPA continues to support data-driven advocacy and education for the profession, and future research promises even deeper insights into workforce sustainability.