Creating a Physician Assistant Workforce That Represents All Communities  

As a physician assistant (PA) student at the University of Utah, I will soon become a member of the one of the fastest growing health care professions in the United States. Yet, I am one of very few Black PA students not only in Utah, but nationally. According to a recent study, only 3.5% of recent PA graduates were members of underrepresented racial and ethnic groups (Black, American Indian/Alaskan Native, Native, Native Hawaiian, or Pacific Islanders), and only 6.4% were Hispanic. By comparison, nearly 25% of the US population are members of racial and ethnic minority groups and 19.5% are Hispanic, and these percentages are growing. 

We need a more racially and ethnically diverse PA workforce to reflect the US patient population. But despite the significant increase in the number of PA graduates, there has been a steady decrease in Black graduates. Black representation began its decline as many PA programs transitioned to masters-level programs. According to the Physician Assistant Education Association (PAEA), 38 physician assistant schools had zero Black graduates and 16 schools had zero Hispanic graduates from 2019 to 2021.   

Representation Improves Outcomes  

Research shows that concordance between the race and ethnicity of the patient and provider improves health outcomes. But patients of color seeking racially concordant clinicians struggle to find them. Today, I wonder if my family in rural Mississippi would have had better outcomes if they had seen health care providers from their community who looked like us. Members of my extended family have fallen through cracks in the health care system multiple times. In his hometown, there are a lack of health care providers, and everybody has to travel up to 75 miles to reach primary care services in Natchez, Mississippi. Seeing my cousin constantly overcome these barriers with providers, only to be diagnosed with late-stage leukemia, was devastating.  

In Mississippi, the state with the largest share of African-Americans in the US at 37.8% in 2023, only 5.75% of PA recent graduates identified as Black. This is an alarming discrepancy. According to the Mississippi State Department of Health, the state continues to rank last, or close to last, in almost every leading health outcome. In 2021, the Mississippi State Department of Health found that 74% of adults report either being overweight or obese, which increases the risk for chronic conditions. There is an opportunity for clinicians of color to help Mississippi improve residents’ health.  

Source: Health Care Workforce Diversity Tracker. Fitzhugh Mullan Institute for Workforce Equity. The George Washington University and Social Mission Alliance. https://www.gwhwi.org/diversitytracker.html  

Recruiting and Retaining More PA Students of Color 

Despite these opportunities, in 2024, the Supreme Court rejected race-based affirmative action in admissions. Some states have also banned other efforts to improve equity, diversity and inclusion in higher education. Utah’s HSB 261, which banned diversity, equity, and inclusion offices, has significantly impacted my life as a student in Salt Lake City. (The Trump administration’s executive order ending federal support for DEI grants and contracts was blocked by a federal judge in February and then lifted in March but legal challenges continue.) 

Still, there are steps that state governments can take. Costs of attendance represents a major barrier to attending health professions schools for studies of color in particular. By offering in-state tuition to undocumented students and racially and ethnically underrepresented students, public colleges and universities could reduce barriers to attendance for such students who live in the state but have not established residency.  

And universities can increase efforts for PA student retention. Some solutions include data collection to identify students at risk of dropping out; increasing student engagement with campus life; assisting with non-tuition expenses such as childcare and room and board; and increasing academic support services. My own sense of financial insecurity distracts me from my education. And my insecurities were worsened by the closure of spaces like the Black Cultural Center at the University of Utah, which was once a source of support.   

Initiatives like the Empowerment, Diversity, Growth, and Excellence in Physician Assistant Education, or EDGE-PA at Drew University are proactively working to fill these voids. For example, the EDGE program is able to create an equitable landscape in PA education with targeted support and resources for underrepresented groups. In 2022, the Department of Education created the Post-Secondary Student Success Program (PSSP), which allocated $4.5 million to 10 historically black colleges and universities, minority-serving institutions, and community colleges; in 2024, the PSSP allocated almost $37 million to seven schools, including Portland State University and Jarvis Christian University in Texas. More schools and students can benefit from these types of initiatives—and rather than turning away from this work, the federal government should expand these programs.  

The federal government should also increase funding to at least the recommended annual level of $67 million for the Area Health Education Center (AHEC) program. AHEC supports the Health Resources and Services Administration Bureau of Health Workforce goals of increasing diversity among health professionals, broadening the distribution of the health workforce, and improving delivery in rural and underserved areas.  

There are multiple ways to increase racial and ethnic diversity in the PA workforce. Health professional schools have a duty to train a representative workforce that will improve health outcomes for our diverse and aging population. Likewise, the federal and state governments should ensure that public money is supporting the creation of such a workforce to help ensure all patients have equal opportunities for a long, healthy life.