Contribution Of Physician Assistants Research Articles

A cross-sectional survey of German PA employment and workforce entry.

The contribution of physician assistants (PAs) to the German healthcare workforce has increased significantly since their introduction in 2005. From five training programs, the number has increased to the current 18, with 560 PAs awarded the PA bachelor of science degree as of 2020. Despite the growth, researchers lack systemic and reliable empirical data that provide insight into the German PA educational and professional profile. The German University Association Physician Assistant (DHPA) undertook the first nationwide cross-sectional survey on PAs in Germany to understand the German PA movement. This survey aimed to describe German PAs' entry into the profession and PA educational and job satisfaction. PA alumni of all universities affiliated with the DHPA and all subscribers of the Facebook online social media platform PA Blog were invited to complete an online questionnaire. Of the 282 PAs who completed the survey, 77% were female and under age 25 years. Almost all (94%) were employed, predominantly as PAs (91%, 241 of 265), although some held other positions. Most worked full time (87%), with some citing child-care needs as reasons for part-time employment (n = 21). Few reported unemployment (1.4%, 4 of 282). Eighty-two percent said they would probably or very likely choose the same course of study again. Most employed participants found the inclusion of frequent rotations between didactic and clinical training in PA programs beneficial. However, a small number of participants (26.8%) agreed that German PA programs' didactic and clinical teaching objectives were well aligned. German PAs have a high level of satisfaction with their profession and report low unemployment. Improvement in the alignment of didactic and clinical educational objectives to improve academic qualifications and satisfaction emerged as an area of research.

The contributions of physician assistants and nurse practitioners in primary health care

The contributions of physician assistants and nurse practitioners in primary health care

Commentaries on health services research

Box 1Obtaining a medical appointment with a PA or an NP in the United States is not difficult. After a half-century of development and deployment, about 200,000 PAs and NPs are clinically active in the 56 US jurisdictions. Not surprisingly, their presence is greatest in the ambulatory setting, where 98% of medical care takes place. Of an estimated 1.2 billion annual ambulatory visits, almost 20% are managed by a PA or NP.1 Perhaps more important is the duration in time. PAs and NPs have been present in American society for three generations. Many patients are seeing a PA or NP as a health professional who can take a history, order appropriate tests, arrive at a diagnosis, develop a treatment plan, and prescribe an appropriate regimen. In the end, like most of us, what patients want is to have their needs met, and they are largely indifferent as to who delivers it. Commentary by Roderick S. Hooker REFERENCE 1. Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2006. National health statistics reports; No 8. Hyattsville, MD: National Center for Health Statistics. 2008.Box 2Although the idea of a systematic review of the roles and contributions of PAs in primary care is appealing, this paper fails to deliver. The authors perpetuate inaccurate information, such as the proportion of PAs in active primary care practice. Coplan showed that no more than a third of American PAs work in primary care.1 The fundamental error: inappropriate criteria for the selection of articles to be analyzed. Specifically, only 46 papers from the US literature were deemed worthy of inclusion, a number that is misleadingly low. The authors use definitions of general practice/family medicine proposed by the European Region of the World Organization of Family Doctors rather than conventional US definitions, which resulted in distortion of the findings and/or the exclusion of relevant papers. In addition, many of the papers analyzed are old. The major inaccuracy: The paper's abstract states, “half of PAs are reported to work in primary care.” Closer examination of this figure reveals that these percentages come from old reports (circa 1991 or older). Systematic reviews by others have used wider selection criteria, employed a more consistent framework, and therefore contain more useful and accurate information.2 Commentary by James F. Cawley REFERENCES 1. Coplan B, Cawley JF, Stoehr JD. Brief report: physician assistants in primary care: trends and characteristics. Ann Fam Med. 2013;11(1):75–79. 2. Hooker RS, Everett CM. The contributions of physician assistants in primary care systems. Health & Social Care in the Community. 2012;20:20–31.Box 3This financial modeling study is what medical and PA students with higher debt obligations may want to consider when entertaining a family medicine career. Working in a nonprofit facility or medically underserved area may put the PA or medical school graduate ahead in the loan debt game. The Association of American Medical Colleges (AAMC) study of 384 debt scenarios included living in high- or medium-cost areas and incorporated various loan forgiveness and loan repayment strategies. In the end, student debt may be a significant limiting factor in career choice and specialty for newly minted PAs.1 A matrix of interest rates and student loan decisions requires the consideration of numerous personal factors such as housing, living expenses, spousal income, level of retirement income, and even anticipated children. Whether crushing debt will affect the choices for PAs and physicians alike remains an area in need of study. Commentary by Jennifer M. CoombsBox 4REFERENCE 1. Student loan debt affects generations of Americans. US News and World Report. http://www.usnews.com/education/blogs/student-loan-ranger/2012/10/03/student-debt-affects-generations-of-americans. Accessed July 2013.

The contribution of Physician Assistants in primary care: a systematic review

BackgroundPrimary care provision is important in the delivery of health care but many countries face primary care workforce challenges. Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as Physician Assistants (PAs). Objective: This systematic review aimed to appraise the evidence of the contribution of PAs within primary care, defined for this study as general practice, relevant to the UK or similar systems.MethodsMedline, CINAHL, PsycINFO, BNI, SSCI and SCOPUS databases were searched from 1950 to 2010. Eligibility criteria: PAs with a recognised PA qualification, general practice/family medicine included and the findings relevant to it presented separately and an English language journal publication. Two reviewers independently identified relevant publications, assessed quality using Critical Appraisal Skills Programme tools and extracted findings. Findings were classified and synthesised narratively as factors related to structure, process or outcome of care.Results2167 publications were identified, of which 49 met our inclusion criteria, with 46 from the United States of America (USA). Structure: approximately half of PAs are reported to work in primary care in the USA with good support and a willingness to employ amongst doctors. Process: the majority of PAs’ workload is the management of patients with acute presentations. PAs tend to see younger patients and a different caseload to doctors, and require supervision. Studies of costs provide mixed results. Outcomes: acceptability to patients and potential patients is consistently found to be high, and studies of appropriateness report positively. Overall the evidence was appraised as of weak to moderate quality, with little comparative data presented and little change in research questions over time.Limitations: identification of a broad range of studies examining ‘contribution’ made meta analysis or meta synthesis untenable.ConclusionsThe research evidence of the contribution of PAs to primary care was mixed and limited. However, the continued growth in employment of PAs in American primary care suggests that this professional group is judged to be of value by increasing numbers of employers. Further specific studies are needed to fill in the gaps in our knowledge about the effectiveness of PAs’ contribution to the international primary care workforce.

Physician assistants: friends or foes to doctors?

Joanne Ostler and colleagues evaluate the contribution of physician assistants in one mental health trust

The contributions of physician assistants in primary care systems.

Shortages of primary care doctors are occurring globally; one means of meeting this demand has been the use of physician assistants (PAs). Introduced in the United States in the late 1960s to address doctor shortages, the PA movement has grown to over 75,000 providers in 2011 and spread to Australia, Canada, Great Britain, the Netherlands, Germany, Ghana and South Africa. A purposeful literature review was undertaken to assess the contribution of PAs to primary care systems. Contemporary studies suggest that PAs can contribute to the successful attainment of primary care functions, particularly the provision of comprehensive care, accessibility and accountability. Employing PAs seems a reasonable strategy for providing primary care for diverse populations.

The Impact of Disruptive Innovations in Orthopaedics

The US healthcare system is currently facing daunting demographic and economic challenges. Because musculoskeletal disorders and disease represent a substantial and growing portion of this healthcare burden, novel approaches will be needed to continue to provide high-quality, affordable, and accessible orthopaedic care to our population. The concept of “disruptive innovations,” which has been studied and popularized by Harvard Business School Professor Clayton Christensen, may offer a potential framework for developing strategies to improve quality and control costs associated with musculoskeletal care. The introduction of mobile fluoroscopic imaging systems, the development of the Surgical Implant Generation Network intramedullary nail for treatment of long bone fractures in the developing world, the expanding role and contributions of physician assistants and nurse practitioners to the orthopaedic team, and the rise of ambulatory surgery centers are all examples of disruptive innovations in the field of orthopaedics. Although numerous cultural and regulatory barriers have limited the widespread adoption of these “disruptive innovations,” we believe they represent an opportunity for clinicians to regain leadership in health care while at the same time improving quality and access to care for patients with musculoskeletal disease.