Physician Assistant Practice Research Articles

Physician Assistant Training, Collaboration, and Practice Act Legislation: Perspectives From Practicing Physician Assistants.

This study examines training, experience, and collaborative practices of physician assistants (PAs) with employment experience and their perspectives on practice act legislation. Mixed method study with quantitative and qualitative data. One hundred eighty participants completed the survey. During clinical employment, 81.05% of respondents reported physicians participated in training. However, supervising physicians trained only 43.46%; 56.54% reported being trained by nurse practitioners (NPs), PAs, and/or other physicians. Onsite collaboration with physicians was reported by 87.2%. Supervising physician involvement was reported by 67.3%, and of these, 59% collaborated with PAs, NPs, and/or other physicians as well. One-third collaborated only with NPs, PAs, and/or other physicians. Daily/weekly collaboration with a supervising physician was reported by 78.89% in their first position and 54.87% in their current/most recent position; 77.22% collaborated with NPs, PAs, and/or other physicians in their first position and 71.68% in their current/most recent position. Most (64.44%) felt PAs should not be legally required to have physician supervision. Most (76.12%) felt care quality would not decrease if supervision were lifted. Most (74.44%) agreed that PAs are hired less frequently than NPs in states where physician supervision is required for PA but not NPs. Findings suggest that team-based practice is already the current structure of PA clinical training and collaboration with PAs receiving significant support from physicians who are not supervising physicians and other nonphysician practitioners. Establishing oversight at the practice level is supported by this practice structure. Determining effects of practice act legislation on employment training, collaboration, and hiring practices warrants further research.

The prevalence of ultrasound curricula in a sampling of U.S. physician assistant programs and recommendations for common ultrasound objectives: A national survey.

An increasing number of practicing physician assistants (PAs) are using ultrasound (US) in clinical settings. However, a lack of US learning objectives for PA students limits the optimal integration of this imaging modality in PA curricula. This study surveyed PA program directors across the United States to create a list of US learning objectives for PA students and to gauge their attitudes toward integrating US into anatomy curricula. Thirty-one of the 280 PA program directors responded to the survey. While 87% of participants reported that their institution includes ultrasound in its curriculum, 71% disagreed that the state of the use of ultrasound throughout their PA curriculum is fine and needs no modification. Based on the responses of the survey participants, this study categorized US learning objectives into high, medium, low, and no agreement for integration in PA curricula. As over half of the learning objectives (73%, 43/59) had high agreement for inclusion in curricula, this study demonstrates an opportunity for educators to include US in PA curricula.

A National Survey of Perspectives of Physician Assistants in Academic Plastic and Reconstructive Surgery

Background: Physician assistants (PAs) are an essential part of the healthcare team who improve access and efficiencies in patient care. A better understanding of the impact and current utilization of PAs in plastic and reconstructive surgery is needed. The purpose of this national survey was to evaluate the role and scope of practice of PAs in academic plastic surgery, as well as characterize current trends of PA utilization, compensation, and perceived value from a PA perspective. Methods: A voluntary, anonymous 50-question survey was distributed via SurveyMonkey to practicing PAs at 98 academic plastic surgery programs. The survey included questions about employment characteristics, involvement in clinical research and academic work, structural organization, academic benefits, compensation, and position held. Results: Ninety-one PAs from 35 plastic surgery programs completed the survey and were included (overall program response rate = 36.8%, participants response rate = 30.4%). Practice environments included outpatient clinics, the operating room, and inpatient care. Most commonly, respondents supported multiple surgeons as opposed to one surgeon’s practice. For 57% of respondents, compensation is based on a tiered system that accounts for specialty and experience. The reported mode base salary range corroborates national averages and most reported annual bonuses based on merit. The majority of respondents felt valued in their role. Conclusions: Through this national survey, we provide granularity as to how PAs are utilized and compensated in academic plastic surgery. We offer insight into the overall perceived value from a PA perspective that helps define the role and will ultimately help strengthen collaboration.

Moral Distress, Organizational Climate, and the Risk of Burnout Among Physician Assistants in Oncology.

Moral distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care. This study was initiated to explore associations between MD, burnout, and the organizational climate (OC) for oncology physician assistants (PAs). A national survey of oncology PAs was conducted to explore the associations between MD, OC, and burnout. The Nurse Practitioner-Primary Care OC Questionnaire was revised for oncology PAs to assess OC for PA practice. MD and burnout were assessed using the Measure of MD-Healthcare Professionals (MMD-HP) and the Maslach Burnout Inventory. One hundred forty-six oncology PAs are included in the analysis. PAs were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical oncology (73%), with mean age 41.0 years. The mean MMD-HP score for oncology PAs was 71.5 and there was no difference in MD scores on the basis of oncology subspecialty, practice setting, practice type, or hours worked per week. PAs currently considering leaving their position because of MD had significantly higher mean scores on the MMD-HP compared with those not considering leaving their position (108.2 v 64.8; P = .001). PAs with burnout also had significantly higher mean scores for MD compared with PAs without burnout (97.6 v 54.3; P < .001). A negative relationship between OC for PA practice and MD was only found for the PA-administration relations subscale, whereas all subscales were negatively associated with burnout. This study demonstrates that the risk of professional burnout increases significantly with increasing levels of MD. Additional research exploring the relationship between MD and burnout is needed.

Physician Assistants' Training and Self-Perceived Competencies to Work with Survivors of Intimate Partner Violence.

The purpose of this research was to assess physician assistant (PA) education and training on the diagnosis, management, and treatment of survivors of intimate partner violence (IPV), as well as perceived current vs. desired skills in tasks related to the management and treatment of IPV. Participants in 2 studies included a convenience sample of attendees at an annual PA conference (study 1) and PAs in the United States who were randomly selected to be administered an online survey related to their PA practice (study 2). In 2 studies, PAs reported low perceived competence to treat and manage patients who are survivors of IPV. More than half of the respondents (51.2%) had received training to work with survivors of IPV. Almost 3 in 5 indicated that they felt adequately prepared, and almost 3 in 10 regularly asked patients about IPV. Gaps between current and desired perceived skills to treat and manage survivors of IPV were larger among PAs who had previous training related to IPV compared with PAs with no prior training. Guidance for PA educators may improve PA education and increase competencies among new PAs. Without more substantial guidance from an accrediting body, PA programs are left responsible for implementing IPV curriculum. Professional associations as well as constituent and specialty organizations that provide continuing medical education have an equally important role in strengthening skills and abilities among PAs.

The PA profession in Israel: A half-decade perspective.

Implementation of physician assistants (PAs) in EDs throughout Israel began in May 2016. The profession is now showing some progress but at a relatively slow rate. This article provides an overview of Israel and its healthcare system, and describes the implementation, deployment, education, training, and scope of practice of PAs in Israel, plus recent developments and suggestions for advancing the profession.

Ordering Characteristics Predictive of Noncontrast CT Head Positivity in the Emergency Department

Recent decades have seen a steady increase in noncontrast head CT utilization in the emergency department with a concurrent rise in the practice of physician assistants (PAs) and nurse practitioners (NPs). The goal of this study was to identify ordering and patient characteristics predictive of positive noncontrast head CTs in the ED. We hypothesized NP/PAs would have lower positivity rates compared to physicians, suggestive of relative overutilization. We retrospectively identified ED patients who underwent noncontrast head CTs at a single institution: a nonlevel 1 trauma center, during a 7-year period, recording examination positivity, ordering provider training/experience, and multiple additional ordering/patient attributes. Exam positivity was defined as any intracranial abnormality necessitating a change in acute management, such as acute hemorrhage, hydrocephalus, herniation, or worsening prior findings. 6624 patients met inclusion criteria. 4.6% (280/6107) of physician exams were positive while 3.7% (19/517) of NP/PA exams were positive; however, differences were not significant. Increasing provider experience was not associated with positivity. Attributes with increased positivity were patient age (p < 0.001), daytime exam (p < 0.05), and indications regarding malignancy (p < 0.001) or focal neurologic deficit (p=0.001). Attributes with decreased positivity were indications of trauma (p < 0.001) or vertigo/dizziness (p < 0.05). We found no significant difference in rates of exam positivity between physicians and NP/PAs, even accounting for years of experience. This suggests increasing utilization of head CTs in the ED is not due to the increasing presence of NP/PAs, and may be reflective of general practice trends and clear diagnostic algorithms leading to head CT.

The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage.

James F. Cawley, MPH, PA-C, is a visiting professor and scholar-in-residence at the Physician Assistant Leadership and Learning Academy, University of Maryland Baltimore, in Baltimore, Maryland. He is also a professor in the School of Physician Assistant Practice at Florida State University in Tallahassee, Florida, as well as professor emeritus in the Department of Prevention and Community Health, Milken Institute School of Public Health, at The George Washington University in Washington, DC. Correspondence should be addressed to: James F. Cawley, MPH, PA-C, Physician Assistant Leadership Learning Academy (PALLA), Graduate School, University of Maryland Baltimore, 620 West Lexington Street, Baltimore, MD 21201; Email: [email protected] The author declares no conflict of interest.

Evaluating liability in the supervising physician, PA, and employer relationship.

Emerging case law demonstrates that physicians who collaborate with physician assistants (PAs), as well as the entity that employs the physician and PA, are facing allegations of liability. The allegations of liability arise from the actions of the PA, inaction of the physician, and failure to meet the regulatory requirements for the oversight of PA practice. In some instances, the physician and employer struggle to meet the complex state regulatory requirements that govern the relationship(s) between the PA and the physician. A review of case law demonstrated that courts generally assign liability for the actions of the PA to the PA, but liability to the physician and employer for failure to meet the statutory requirements for oversight of the PA. All stakeholders must use the lessons learned from case law to mitigate physician and employer liability.

To What Degree? Considerations for the Pursuit of a Doctoral Degree by Clinical Physician Assistants

Clinical doctorate and other doctoral-level degrees have been increasingly considered by practicing physician assistants (PAs). Although doctoral programs and degrees vary, there are common factors that are helpful to consider when exploring doctoral education. This article outlines 5 key considerations for the PA who is exploring doctoral education.

The role of PAs in providing mental health care.

The prevalence of psychiatric and substance use disorders in the United States is rising and of growing concern. Because such behavioral conditions are widespread, one approach is to collaborate with various medical professionals to help offset this demand. To address this issue, the frequency and types of mental health conditions encountered by physician assistants (PAs) were assessed. The National Commission on the Certification of Physician Assistants Practice Analysis was examined for the types of mental health conditions encountered across the spectrum of medical and surgical practices. The findings reveal that, in 2015, at least 62% of PAs saw and evaluated mental health conditions and behavioral disorders at least weekly in their settings. These patient diagnoses were seen with variability based on the specialty of the PA. The highest percentage of cases reported by PAs were in psychiatry, followed by general internal medicine, emergency medicine, family medicine, and hospital medicine. With the profession projected to grow, recruiting, retaining, and integrating more PAs into mental health care is a suggested strategy for addressing national provider shortages.

Driving high-functioning clinical teams: An advanced practice registered nurse and physician assistant optimization initiative.

Rapid changes in the health care marketplace are driving health care systems to modify operations by which the advanced practice registered nurse (APRN) and physician assistant (PA) clinicians serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands resulting in high-functioning clinical teams. With the growing number of APRNs and PAs within a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these health care providers. Directors of the Advanced Practice Provider Best Practice Center developed an internal nurse practitioner (NP)/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service in which evaluations were conducted to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists. Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and over 200 individual NP/CNM/CNS and PA provider interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members. Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support. Several recommendations were presented to department leaders regarding NP/CNM/CNS/PA practice. Those departments who implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.

Driving high-functioning clinical teams: An advanced practice registered nurse and PA optimization initiative.

Rapid changes in the healthcare marketplace are driving healthcare systems to modify operations by which advanced practice registered nurses (APRNs) and physician assistants (PAs) serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands, resulting in high-functioning clinical teams. With the growing number of APRNs and PAs in a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these healthcare providers. Directors of the APP Best Practice Center developed an internal NP/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service which conducted evaluations to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists. Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and more than 200 individual NP/CNM/CNS/PA interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members. Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support. Several recommendations were presented to department leaders about NP/CNM/CNS/PA practice. Departments that implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.

The effects of demographics on physician assistant attitudes and openness towards interprofessional medical collaboration and education

Abstract Objectives Interprofessional medical collaboration is an approach to patient care that involves multiple health care specialists from varying fields coming together to solve difficult medical cases. The World Health Organization has reported that interprofessional collaboration is a key factor for the development of high-quality global health care. The Readiness for Interprofessional Learning Scale (RIPLS) is used to assess attitudes and openness towards interprofessional collaboration. This study aimed to assess the attitudes of physician assistants towards interprofessional collaboration and whether or not demographics affect attitudes and openness. Design and participants A modified RIPLS was used to evaluate 131 practicing physician assistants. Anonymous participants were able to access the questionnaire through SurveyMonkey during a six-month period in the Spring and Summer of 2017. Participants completed the RIPLS survey and answered demographic questions related to sex, age, and medical specialty field. Results Physician assistant scores reflected favorable attitudes and openness to interprofessional collaboration and education. There were no significant differences associated with any demographic category. Conclusions Results indicate that physician assistants have favorable attitudes and openness to interprofessional collaboration and education regardless of age, sex, or medical specialty field.

Physician assistant utilization in U.S. emergency departments; 2010 to 2017.

Physician Assistants (PAs) are widely used in United States (US) Emergency Departments (EDs). We sought to characterize ED PA utilization and practice characteristics in US EDs 2010-2017. A retrospective, secondary analysis of the 2010 to 2017 Center for Disease Control's National Hospital Ambulatory Medical Care Survey (NHAMCS) was performed. National estimates of ED visits involving PAs alone (PA), PAs with physician involvement (PA+), or physician only (PHYS) were analyzed for patient demographics and hospital characteristics. Between 2010 and 2017, an estimated 1 billion US ED visits occurred. 5.0% (95% confidence interval [CI] ±2.7%) of visits were seen by a PA, and 8.2% (±2.7%) by a PA+; 76.3% (±7.2%) by PHYS. No linear trends by year were identified in PA or PA+ visits. PA acuity was highest for semi-urgent/nonurgent (56.4%, ±10.7%). PA see the minority of ambulance arrival [5.8% (±1.3)] and admit less patients [1.7% (±0.7%)]. Less laboratory [53.3% (±10.2%) vs. 67.0% (±6.2%)] and radiographic [38.8% (±6.6%) vs. 51.6% (±4.6%) studies were performed during PA vs. PHYS visits. PA visits were most common for patients 25-44years old (yo) (32.9%, ±6.2%) and 15-24 yo (19.2%, ±3.7%). Most PA visits result in a length of stay (LOS) between 1 and 1.9h (32.9%, ±6.7%) compared to most PHYS visits resulting in a LOS >3h (40.3%, ±3%). From 2010 to 2017, no linear trends in US ED PA and PA+ utilization were identified. PHYS continue to see the majority of ED patients.

Can Medicine Be Cured? The Corruption of a Profession

James F. Cawley, MPH, PA-C, is a professor for the School of Physician Assistant Practice, Florida State University, Tallahassee, Florida, and professor emeritus, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University in Washington, DC. Correspondence should be addressed to: James F. Cawley, MPH, PA-C, Physician Assistant Practice, College of Medicine, Florida State University, 1115 Call Street, Tallahassee, Florida. Email: [email protected]

Shared Learning for Better Outcomes

Shared Learning for Better Outcomes

Using the Core Competencies for New Physician Assistant Graduates to Prioritize Admission Criteria for PA Practice in 2025.

In a fast-changing medical and educational environment, it is incumbent upon the physician assistant (PA) education community to periodically consider what the future practice environment might look like for our graduates. Changes in technology, regulation, reimbursement, health system economics, and health care delivery are among the many forces shaping the practice environment of the future. The 2018 Physician Assistant Education Association (PAEA) Presidents Commission reflected on what PA practice might look like in 2025 and used the Association's Core Competencies for New PA Graduates to consider what characteristics might therefore be required of the PA graduates who will practice in this future. We postulate that the future PA practice environment will require enhanced skills in such areas as interpreting technology-driven clinical data for patients and practices, consulting effectively with increasingly specialized members of health care teams, understanding population health and predictive analytics, and knowing how to access and critically assess new medical information. Working backward, we identify certain noncognitive attributes that will likely need to be prioritized in our admission processes and suggest some tools that can be used to assess them. These attributes include ethical responsibility, communication, critical thinking, situational judgment, and professionalism. As with all Presidents Commission articles, this piece is intended primarily to stimulate thought, dialogue, and future research. We encourage all faculty to participate in this dialogue, through the new PAEA Digital Learning Hub (https://paealearning.org/learn/digital-learning-hub/) and other channels.

Perceptions of the affordable care act by Physician Assistants

Objective: Implementation of the affordable care act (ACA) resulted in an increased number of insured individuals and a shortage of primary care physicians. Physician Assistants (PAs) are poised to address this shortage since the PA profession is grounded in teamwork exemplified by the Accountable Care Organizations supported by the ACA. This study assesses the perception of the ACA by PAs providing healthcare services during implementation of the ACA.Methods: In this repeated cross-sectional study, alumni from a Midwest PA program were surveyed in 2014, 2016 and 2018 on knowledge and perception of the ACA. Questions addressed the ACA impact on the PA profession and on patients’ access to healthcare.Results: During the initial four years of ACA implementation, the following increases in perception were seen: 1) 32% increase in positive outlook of healthcare; 2) 37% increase in positive influence on PA practice; 3) 30% increase in positive impact of practice autonomy; 4) 64% increase in positive impact for patients; and 5) 33% increase in patient access to care. Additionally, the inability to choose a provider increased by 18%.Conclusions: Over the last four years PAs have perceived positive effects pertaining to their practice and regarding the impact on their patients despite an increase in the inability to choose a provider. Inability to choose a provider may in part be due to the rising number of narrow-network plans. The findings of greater autonomy and increased compensation for PAs are contrary to physicians who perceive the ACA to decrease their autonomy and their compensation.

State-by-State Variations in PA Licensure: A Policy Analysis

ABSTRACTState licensure procedures for PAs (physician assistants) vary significantly, as does the average time necessary for states to process a PA license. This article discusses these variations and presents evidence that states with the highest number of extra requirements for PA licensure tend to have longer license processing times. It also includes an analysis showing that states with modernized PA practice laws (e.g., laws that allow PAs to practice to the full extent of their education and experience) tend to have fewer extra licensure requirements. Finally, this article discusses potential benefits of reducing extra PA licensure requirements, including mitigation of health care practitioner shortages without compromising patient safety and greater adoption of the Uniform Application (UA) for PAs.