Institutional sponsorship, student debt, and specialty choice in physician assistant education.

Physician assistant (PA) educational programs emerged in the mid 1960s in response to health workforce shortages and decreasing access to care and, specifically, the decline of generalist physicians. There is wide diversity in the institutional sponsorship of PA programs, and sponsor ship has trended of late to private institutions. We analyzed trends in sponsorship of PA educational programs and found that, in the past 15 years, there were 25 publicly sponsored and 96 privately sponsored programs that gained accreditation, a 3.84:1 private-to-public ratio. Of the 96 privately sponsored programs, only seven (7.3%) were located within institutions reporting membership in the Association of Academic Health Centers, compared to eight of the 25 publicly sponsored programs (32%). In 1978, a large majority (estimated 43 of the 48 then-existing PA programs) received their start-up or continuing funding through the US Public Health Service, Section 747 Title VII program, whereas in 2012 there were far fewer (39 of 173). The finding of a preponderance of private institutions may correlate with the trend of PAs selecting specialty practice (65%) over primary care. Specialty choice of graduating PA students may or may not be related to the disproportionate debt burden associated with attending privately sponsored programs, where the public-to-private tuition difference is significant. Moreover, the waning num ber of programs participating in the Title VII grant process may also have contributed to the overall rise in tuition rates among PA educational programs due to the loss of supplemental funding.