Physician Assistant Profession Research Articles

Physician Assistants in Ophthalmology: A National Survey

To evaluate the scope of practice and training of current physician assistants (PAs) in ophthalmology and gauge their interest in further training and involvement in ophthalmology. Cross-sectional survey study. An anonymous survey on vision and ocular care in the PA profession was administered to PAs in ophthalmology within the American Academy of Physician Assistants member database. All survey questions were optional. A total response rate of 47/94 (50.0%) was obtained. Respondents reported an average of 9.8 years (SD= 9.0) of experience as a PA in ophthalmology. Over half of the respondents (59.5%) did not have previous experience in vision and ocular health before becoming a PA. Most respondents (79.5%) reported that they are able to provide their primary clinical responsibilities for ophthalmic care independently. In addition to providing clinical ophthalmic care, many of the respondents have duties that involve consenting patients for ophthalmic surgery and procedures (62.5%) and assisting in ophthalmic surgery and minor procedures (65.0%). Only a minority of respondents independently perform procedures, such as intravitreal injections (23.1%) and minor lid procedures (38.5%). Most respondents reported interest in additional training in providing vision and ocular care (69.0%), in continuing their career as a PA in ophthalmology (87.5%), and in joining a specialty organization for PAs in ophthalmology (88.1%). The PAs participating in this survey provide a range of clinical and some procedural ophthalmic care. The development of formal PA postgraduate training programs in ophthalmology may expand the pool of PAs qualified to practice ophthalmology.

Mentoring for Success in Physician Assistant Profession Pipelines.

Mentoring for Success in Physician Assistant Profession Pipelines.

"A PCMH mind and a PCMH heart": Patient, faculty, and learner perspectives on collaborative care in an interprofessional team-based training programme.

Providing high-quality primary care in patient-centred medical homes (PCMHa) requires competencies that can only be provided by interprofessional (IP) education. The benefits of collaborative training have been documented for learners, but less is known about the perceptions of the clinical professionals who train the learners or the patients receiving IP primary care. This investigation compared stakeholder attitudes about IP education, training, and providing collaborative care prior to developing a new IP training programme. We conducted five focus groups at a large general internal medicine training practice. Learner and faculty groups included participants from medicine, psychology, pharmacy, and physician assistant professions; three patient groups were held to obtain perspectives on receiving health care from IP trainees. We used inductive analysis to identify themes across the three stakeholder groups. We identified seven convergent themes across all three stakeholder groups: (a) team engagement, (b) technology in care delivery, (c) cost of care, (d) involving patients in learning, (e) time constraints, (f) scope of practice, and (g) autonomy/interdependence. Each group emphasized the need to define and communicate team members' roles. Learners anticipated high-quality IP interactions, and patients noted the benefits of receiving care from well-supervised trainees. Faculty struggled to navigate the training needs of diverse learner groups and to integrate PCMH mandates focused on documentation with authentic patient-centred care. This is the first reported data comparing perceptions about IP training and care across these three stakeholder groups. Results suggest the need to clarify scope of practice, define professional roles, and bridge gaps between teaching PCMH principles and subsequently providing high-quality health care. Results inform faculty development needs in learning ways to train learners across professions and outline ways to structure interactions with patients.

Strength in Differences? The Importance of Diversity to Students When Choosing a Physician Assistant Program

Physician assistant (PA) programs are the linchpin of endeavors to increase the diversity of the PA profession. Key to this role is understanding whether students from various backgrounds value certain program attributes differently. The current study investigated whether PA students' demographic characteristics were associated with their likelihood of having considered program diversity, and the importance they placed on program diversity when selecting a program to attend. In 2017, 3882 recently matriculated PA students provided key demographic information (ie, gender, race, and ethnicity) and indicated whether they had considered student body and faculty diversity when choosing PA programs to attend. Those who had considered a factor then reported how important it was to them for their program to have that attribute. The current study investigated whether students' demographic characteristics were associated with their likelihood of considering PA program diversity and their subsequent ratings of the importance of program diversity. Female, Asian, and underrepresented racial and ethnic minority students, compared with male and non-Hispanic white students, were significantly more likely to consider program diversity when choosing PA programs to attend and rated program diversity as being more important. Program diversity is a greater concern for female and racial and ethnic minority students when selecting PA programs to attend. Less diverse programs could potentially increase their appeal to minority students by highlighting opportunities to connect with communities of color outside of the PA program and by prioritizing the recruitment of minority faculty.

Integrating Oral Health: Physician Assistant Education in 2017.

This study describes the inclusion of oral health in physician assistant (PA) education programs in 2017. A 2014 study found that 78% of responding programs (n = 98 of 125) had integrated this content into their curriculum. The current study represents a partnership between the National Interprofessional Initiative on Oral Health, the Center for Integration of Primary Care and Oral Health, and the PA Leadership Initiative in Oral Health. The PA profession was one of 14 health professions surveyed to assess the quantity and quality of oral health integration, including barriers to and facilitators of change. An electronic cover letter explaining the research purpose was emailed to all US PA education program directors along with a link to a web-based survey. Most questions were followed by predefined response options; some questions offered an opportunity to include narrative responses or comments. There was greater inclusion of oral health curriculum in 2017 than in 2014, for both the number of programs including oral health education and the breadth of their curriculum. Efforts to equip PA faculty to integrate oral health core clinical competencies into their curriculum should continue, because existing strategies appear to be sustainable and effective in expanding oral health content across PA programs.

Commentaries on health services research

Commentaries on health services research

Minority Physician Assistant Faculty: A Phenomenological Assessment of Factors Leading to Retention in the Faculty Role.

Improving racial and ethnic diversity in the physician assistant (PA) profession is important to providing better care for underserved communities. The recruitment and retention of minority PA faculty is one aspect of helping to attract and retain a more diverse student body. Previous research has indicated that minority status is associated with the increased attrition of PA faculty but has not provided insight into the specific factors involved in the retention or attrition of minority PA faculty. The purpose of this qualitative research study was to describe the experience of minority PA faculty through a critical race theory lens. We used a phenomenological approach using structured interviews of minority PA faculty. Better understanding of the experience of minority PA faculty might lead to improved efforts at recruiting and supporting a more diverse faculty workforce. We conducted 13 interviews of PA faculty representing a variety of underrepresented minorities, geographic regions, types of schools, and stages of their careers. Major themes that emerged across the participants' experiences included opportunities for success in the form of both internal and external support systems and mentorship. As a corollary, barriers to the retention of minority PA faculty including a lack of institutional support, gaps in mentorship, and lack of a solid support network were cited.

How McMaster is Fulfilling the Need for Physician Assistants in Canada

The Physician Assistant (PA) profession has been growing over the past decade in Canada, and McMaster University was the first institution in Ontario to establish a PA program in 2008. The PA profession occupies a niche in the health care field and is needed to extend physician services contributing to the improvement of patient care. McMaster’s PA Education Program (PAEP) fosters collaboration and problem-based learning (PBL) in order to provide students with skills that are transferable to the workplace. McMaster’s PBL approach arms graduates with lifelong learning skills that are practical in a clinical setting. The following interviews with PAs provide a more comprehensive understanding of the development of the PA niche and proffer a glimpse into how McMaster’s PAEP equips its graduates with practical skills, which will allow them to excel in the workforce.

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.

Physician Assistant Educator Competencies.

The rapid expansion of physician assistant (PA) programs over the past decade has led to a shortage of experienced PA faculty. This has prompted many faculty development initiatives to help provide the skills needed by new faculty making the jump from clinical practice to academia. Faculty development is a key necessity in health professions education because many of the professionals attracted to the educator role are primarily trained as clinicians. Although this issue has been extensively evaluated by our colleagues in medical, nursing, and health education and various faculty development interventions have been implemented, this has not been done in the PA profession. In an effort to correct this, the Physician Assistant Education Association assembled a task force of experienced PA educators and charged them to evaluate the literature on faculty competencies in health professions education and to develop a set of PA educator competencies to help codify the essential knowledge, skills, attitudes, and behaviors that faculty need to be successful in their academic roles.The task force met its charge by engaging in an extensive review of the literature, developing a competency framework and proposed competencies, and soliciting the input of a diverse panel of experts in PA education to vet the proposed competencies. Using the insights and recommendations from the expert panel, the task force refined the competencies-resulting in the framework of PA educator competencies presented in this document.

Integration of the first physician assistants into Israeli emergency departments \u2013 the physician assistants\u2019 perspective

BackgroundA new role of Physician Assistant (PA) was introduced into Emergency Departments (ED) in Israel in 2016, as part of a larger effort to improve the quality of service in the EDs. When the new role was introduced, there was a fair amount of uncertainty about whether it would succeed, in light of ambivalence on the part of many ED nurses, and lack of clarity among ED directors about the necessity of a PA role, and about the extent to which PAs would be allowed to take on professionally meaningful tasks.The first class to train PAs was run by the Ministry Of Health between May 2016 and August 2017, with 34 PA trainees participating. 17 out of 24 EDs across Israel partook in the integration of the new PAs. This study assessed how this initial phase of integration is proceeding, from the perspective of the PA trainees themselves.MethodsNew PA trainees were surveyed at the beginning and end of their training. Likert scale responses were collected (using a scale of 1 to 6). Respondents were asked about difficulties in their previous profession, their motives for choosing the PA profession and their expectations for the new position. The follow-up survey included additional questions about their clinical activities. Descriptive and correlational statistics were performed.ResultsIn the first survey, PA trainees reported that their main difficulties as paramedics were lack of options for professional advancement and burnout. New PA trainees had initially very high expectations for professional challenge, professional status upgrade, personal fulfillment, career prospects and an increase in wages (average mean score 5.7). In the follow-up survey there was a large drop in all of their ratings (average mean score 3.8).In the second survey, PA trainees reported spending the majority of their time evaluating, diagnosing and managing patients as opposed to preforming clinical procedures, such as inserting an IV, administrating medicine or applying casts. Despite their decreased expectations, they still felt that they were intellectually stimulated (5.3 average), given high levels of responsibility (4.8 average), and making significant contributions to the healthcare team and patients (average score of 5.5). All of the above were correlated with overall satisfaction. The main difficulties they reported were related to limited authority and further career advancement.ConclusionsThe new Israeli PA role has officially been launched in emergency medicine. The first group of PA trainees report a positive, productive integration, and overall satisfaction levels with their new career are high. However, the PA trainees reported having experienced some difficulties along the way, and there was a large decrease in their overall expectations from the new position during their first year on the job. Since the subject of limited authority was found to be a substantial difficulty for the new PA trainees, the Ministry of Health should explore this issue and create a uniform policy on it.

Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature

Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature

Postprofessional PA doctorates: A new era.

When I look into the future, it's so bright it burns my eyes.—Oprah WinfreyAs the physician assistant (PA) profession celebrated 50 years of solid growth, it also set the agenda for the future. At the American Academy of PAs' (AAPA's) 2017 conference, members of the House of Delegates un

The new Israeli PA.

Israel launched its new physician assistant profession with its first class of students, who were graduated in October 2017. The program is run by the Ministry of Health's Training and Development Department. This first course was focused on emergency medicine and the plan is to expand to anesthesiology and pathology in the near future.

Physician Assistant Educational Research: 50 Years On.

The physician assistant (PA) profession began as an experiment in medical education. Initial research on the PA profession was performed primarily by health service researchers and medical educators who sought to measure the impact of the introduction of early PAs into practice. The introduction of PAs, health care providers who shared the practice of medicine with physicians, was a revolutionary step in health workforce policy, and its impact became a relevant topic of investigation. Research has not been a high priority in many PA programs, and the amount of research on PA education has been limited. This article traces periods of activity and contributions in PA educational research over the past 50 years and discusses prospects for the future of research in PA education.

Crafting a Profession: Moving From Innovative Model Programs to a Successful National Profession.

The authors review the historical underpinnings of the physician assistant (PA) profession and the tumultuous social context at the time the PA profession was born. They explore the creation of "model" PA programs and the subsequent crafting of the PA profession through 2 distinct "quality control" procedures: the credentialing of PA programs (accreditation) and the credentialing of PA graduates (certification). These pillars of PA education and PA practice brought credibility to a fledgling profession in its early years and stand today as examples of the creative thinking and courage of the architects of a profession that, for the first time in American medical history, allowed someone, other than physicians, to practice medicine.

Physician Assistant Doctorate: A Ticket to Autonomy?

As the physician assistant (PA) profession celebrates 5 decades of practice, questions about the future direction of PA education and practice persist. Conversations regarding prescribing privileges have given way to debate about PA certification and the necessary level of PA education. Most PA programs already confer master's degrees, but there has been at times vigorous debate on whether or not the PA profession should join pharmacy (PharmD), physical therapy (DPT), and advanced practice nursing (DNP) and standardize education at the clinical doctorate level. The primary aim of this article is to provide historical perspective on the evolution of the PA educational degree and to discuss the potential association between credential and PA practice autonomy.

Physician Assistant Applicant Pool

The physician assistant (PA) profession's first attempt to characterize the applicant pool for PA education began with publication of the first Annual Report on Physician Assistant Educational Programs in the United States in 1985. The methodology used in the report was limited, however, in identifying the number of unique applicants to PA programs. Collecting accurate and reliable data on the profession's applicant pool was the primary motivator leading to initiation of the Central Application Service for Physician Assistants (CASPA) in 2001. In the past 15 years, CASPA has provided increasingly valuable data on the profession's applicant pool, allowing for accurate tracking and analysis of trends in the growth and changing demographics of those applying to PA educational programs. This special report presents a unique analysis of CASPA data that relates the competitiveness of entry into PA programs with that experienced by our colleagues in medicine, for both Doctor of Medicine (MD) and Doctor or Osteopathic Medicine (DO) schools. We present data reflecting the most notable changing demographics of the profession's applicant and matriculant pools in sex, age, grade point average, and health care experience. We use aggregate data of self-identified race descriptors to compare the contributions of PA, medical, and osteopathic medicine schools to the improvement of diversity within the health professions. To date, the applicant pool of PA programs seems to have kept pace with the expansion of existing programs and the development of new programs. This article poses serious questions for the profession to ponder, as the demographics of those entering PA education change and the number of PA graduates continues to grow.

Challenges of Clinical Education.

As we celebrate the 50th anniversary of the physician assistant (PA) profession and specifically PA education, think of the tens of thousands of clinical preceptors who were or currently still are involved in the education of PA students. The clinical phase of PA programs has become the rate-limiting issue in PA education. For decades, developing clinical education sites was relatively easy. Over the last decade, rapid expansion in medical, nurse practitioner, and PA education programs has resulted in greater challenges in obtaining necessary clinical training sites. This article attempts to address several of the current challenges in PA clinical education.

Founding of the Association of Physician Assistant Programs and the Organization's Central Role in the Development of the Physician Assistant Profession.

The Physician Assistant Education Association (PAEA) (formerly Association of Physician Assistant Programs [APAP]) was founded in 1972 by early PA program leaders to encourage collaboration and discussion among program leaders and faculty on a wide range of issues of mutual concern. This article addresses the founding of the organization, which continues to represent PA programs today. It addresses the important accomplishments of APAP during the 1972-1974 period and describes in detail the essential contributions of APAP and its leaders in developing the PA profession. Included are discussions of "the Role of the Registry of Physicians' Associates," which was incorporated into APAP; the sponsorship of "the First National Conference on New Health Practitioners" in collaboration with AAPA; the "Launching a Joint National Office" for APAP and AAPA in Washington, DC, in 1973; and "Places at the Table," which reviews the successful efforts of APAP leaders to gain inclusion of AAPA and APAP in the Joint Review Committee on Educational Programs for Assistants to the Primary Physician (JRC-PA) for accrediting qualified programs, the contribution of APAP leaders to the development of the first Certification Examination for the Assistant to the Primary Care Physician by the National Board of Medical Examiners (NBME) in 1973, leadership in the founding of the National Commission on the Certification of Physician Assistants (NCCPA) in 1974, and collaboration with the Association of American Medical Colleges (AAMC) in developing interdisciplinary education and training. It concludes with a summation of the legacy of APAP (PAEA's) formative years.