A Three-Year Retrospective Analysis of the Economic Impact on Clinical Practice Sites Involved in Training Second-Year Physician Assistant Students

Purpose: To determine the financial implications of the involvement of second-year physician assistant (PA) students in the clinical practices of supervising primary care physicians from 1993‐1996. Method: Over 100,000 patient encounters, documenting level of involvement by the supervising physician, type of patient problem, and patient demographics were recorded on computer logging forms by second-year PA students from three consecutive second-year classes during their nine-month primary care preceptorships. Based on estimates of the costs and charges per patient visit, the financial contributions made by secondyear PA students to physician practices that participate in their training were calculated. Discounted was the total student amount contributed by “stage of practice” (level of involvement of the supervising physician), overhead costs, bad debt, and managed care contracting. Results: The data suggest that PA students contribute on average approximately $36,689 to each individual practice site over the course of their nine-month clinical experience. The amount contributed by the second-year PA students remained constant for each of the three classes involved. Each student saw an average of 6.42 patients per day, and the total amount attributable to the student portion of the joint product (supervising physician contribution plus the PA student contribution) amounted to $47,647 prior to discounting. Additionally, there was a statistically significant increase in the percentage of stage 4 (maximum PA student involvement) encounters by PA students over the course of the three-year study period. Conclusions: The involvement of a PA student in a clinical primary care practice is financially beneficial to the practice. The increasing percentage of stage 4 encounters over the study period may be due to the impact of managed care and its emphasis on productivity.