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During the 1980s and 1990s, international medical graduates (IMGs) sought legal and educational measures aimed at obtaining licensure as physician associates/assistants (PAs). Proponents of IMGs asserted that their ethnic backgrounds and identification with their respective communities could increase access to care for some segments of the population and therefore should be permitted pathways to qualify as PAs. A variety of legal measures were introduced into state legislatures in at least five states and were firmly opposed and defeated by the PA profession. Recent attempts by IMGs to obtain licensure as PAs have occurred in Puerto Rico and Arizona. In their haste to address healthcare access and satisfy various constituencies, state legislators and regulatory boards fail to recognize established professional norms. This is occurring as medical organizations are examining alternative pathways for state licensure of physicians who have completed training and/or practiced outside of the United States. PA organizations, particularly state chapters, must be vigilant in upholding qualifications for practice and licensure standards, and state PA organizations must work to convince legislators to avoid using PA professional regulations to solve a workforce issue that is essentially an issue of physician medical education remediation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the attitudes and prevalence of academic/clinical rank among practicing physician associates/ assistants (PAs) in different specialties and geographic locations. Methods: We surveyed PAs in clinical practice with a bias toward hospital/academic-based clinicians. The survey was a modified instrument to evaluate perceptions, attitudes, barriers, and prevalence of academic rank. Results: Overall, 65% of respondents indicated academic/ clinical rank opportunities were of interest, but 60.8% noted that they were not eligible to hold rank in their institutions. Nearly 55% indicated a desire to hold rank, but 81.9% of respondents did not hold rank. The survey response rate was 22.9%. A lack of departmental emphasis was a common barrier to rank. Conclusions: Clinically practicing PAs clearly have a desire or interest in academic/clinical rank, but barriers persist. Further development of opportunities to hold academic/ clinical rank with mentorship may improve PA careers and propel professional advancement and parity. [ABSTRACT FROM AUTHOR]

Objective: 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. Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Myanmar might be the most recent country to graduate its first class of physician assistants (PAs). The country has a history of medics serving in underserved areas, but graduated its first six PAs in 2020, after a 5-year training program. These clinicians will care for a largely rural population, who live in areas of unreliable infrastructure and security. The PA profession in Myanmar aims to reduce maternal mortality, graduate 75 PAs by 2029, and improve access to healthcare in remote regions. [ABSTRACT FROM AUTHOR]

Objective: Developing competencies for interprofessional collaboration, including understanding other professionals' roles on interprofessional teams, is an essential component of medical education. This study explored resident physicians' perceptions of the clinical roles and responsibilities of physician assistants (PAs) and NPs in the clinical learning environment. Methods: Using a constructivist grounded theory approach, semistructured interviews were conducted with 15 residents in one academic setting. Transcripts were analyzed using an iterative approach to inductive coding. Results: Participants typically perceived Pas' and NPs' roles as being "like a resident," less commonly as independent clinicians, and rarely as collaborators. Barriers to understanding PA and NP roles and perceiving them as collaborators included the lack of preparatory instruction about PAs and NPs, the hierarchical structure of medical education, and inadequate role modeling of interprofessional collaboration. Conclusions: This study suggests that barriers in the clinical learning environment and the structure of medical education itself may impede residents' learning about PAs and NPs and how to collaborate with them. [ABSTRACT FROM AUTHOR]

Background: Physician assistants (PAs) and NPs have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. Purpose: To evaluate the workforce patterns of PAs and NPs working in nephrology over the past decade. Methods: Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. Results: Surveys of nephrology practitioners show the evolution of the dialysis-focused practitioner to one encompassing all aspects of nephrology: hospital, ICU, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. Conclusions: PAs and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population. [ABSTRACT FROM AUTHOR]

Background: Many communities face a shortage of qualified endoscopists. Training physician assistants (PAs) to perform colonoscopies can expand the availability of colorectal cancer screening. This study examined screening colonoscopy metrics and quality indicators among gastroenterologists, supervised PAs, and gastroenterology fellows. Methods: Consecutive patients undergoing average-risk screening colonoscopy were stratified into one of three groups by endoscopist type. Procedure and pathology reports were reviewed for the technical performance and quality metrics of the providers. Results: PAs performed comparably to gastroenterologists in technical performance and quality metrics, and demonstrated higher cecal intubation rates than their gastroenterologist colleagues. Comparisons of attending physicians and PAs grouped by years of experience also did not show notable differences in performance. Conclusions: In a supervised practice, PAs performed on par with their gastroenterology colleagues on established colonoscopy quality indicators. Following proper training, PAs can be employed in the provision of screening colonoscopy. [ABSTRACT FROM AUTHOR]

Objective: To elucidate the types of patients cared for by-physician assistants (PAs), specifically older adults and those with complex medical conditions. Methods: A nationwide survey was sent to PAs asking about their practice demographics, including the complexity of their patients and the types of treatment they provide; 676 responded. Results: Less than 2% of PAs specialize in geriatrics but 92.1% of PAs see patients over age 6.5 years. Most PAs see patients with conditions associated with aging, including hypertension (85.8%) and osteoarthritis (82.1 %) as well as those with three or more comorbidities (54.8%) or who are medically complex (52.8%). Conclusions: Although few PAs work exclusively in geriatrics, most PAs are providing medical care for older adults and patients with complex healthcare needs. PAs should be considered to fill healthcare needs that will continue to exist when caring for this patient population. [ABSTRACT FROM AUTHOR]

Background: Physician assistants (PAs) often have been embedded in academic medical centers to help ensure an adequate patient care workforce while supporting compliance with work-hour restrictions for residents and fellows (also called trainees). Limited studies have explored the effect of PAs on trainee learning. This qualitative study explored, from the perspective of physician faculty and PAs, how PAs working in the clinical learning environment can enhance or hinder trainee learning. Methods: Using purposive sampling, 12 PAs and 12 physician faculty members in one US teaching hospital were selected for semistructured interviews. Data collection and analysis were characterized by an iterative process. Data analysis was informed by principles of conventional content analysis. Results: Participants identified various ways in which PAs may affect trainee learning, intrinsically linked to the roles PAs assume in the clinical learning environment: clinician, teammate, and clinical teacher. Trainee learning may be enhanced because learning time can be optimized by having PAs in the clinical learning environment. Trainees can learn about PAs and how to collaborate with them, and PAs can enculturate and provide clinical instruction to trainees. Trainee learning may be hindered if learning opportunities for trainees go to PAs, trainees feel intimidated by experienced PAs, or trainees become too dependent on PAs. Conclusions: Our findings demonstrate enhancements and hindrances to trainees' learning linked to three key roles PAs perform in the clinical learning environment. These findings can inform how PAs are integrated into teaching services. Further investigation is needed to understand how PAs can balance their professional roles to foster effective collaborative practice and learning. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been exceptionally disruptive to healthcare delivery, exposing the strengths and weaknesses of our healthcare system. Though systems will continue to improvise in the short term to provide essential patient care, thoughtful consideration should be given to a long-term approach to improve healthcare delivery. Policy makers, legislators, and healthcare system leaders have the opportunity to reflect on lessons learned during this time and update outdated and detrimental restrictions affecting healthcare providers who have been vital to the pandemic response. This article focuses on lessons learned about the use of physician assistants and NPs, who have been readily deployed during this time. [ABSTRACT FROM AUTHOR]

Objective: This study investigated how professional development benefits offered by employers directly correlate to self-perceptions of leadership potential, committee involvement, and career satisfaction among physician assistants (PAs). Methods: A retrospective analysis of the 2015 AAPA National Survey and 2016 AAPA Salary Survey explored the associations between the aforementioned variables. Bivariate correlations were used to evaluate the associations between variables. Results: Self-perceived leadership attributes were found to be mildly and positively correlated with the number of committees a PA was involved in (P <.001; correlation coefficient (CC) = 0.245). Of the investigated factors, only leadership potential was significantly correlated with career satisfaction (P ≤.001; CC = 0.059). The proportion of professional development fees, memberships, and expenses covered by employers had no bearing on career satisfaction (P =.438). Conclusions: Irrespective of the benefits received, PAs were satisfied with their careers. Intrinsic rewards may have a greater positive association with career satisfaction than extrinsic benefits alone. [ABSTRACT FROM AUTHOR]

For decades, public concerns about a shortage of physicians led federal and state policy makers to pursue policies to increase the number of medical graduates. In response, the number of medical schools increased dramatically over the past decade. By 2016, the United States produced more new physicians than ever before. Expanding medical school enrollments, however, were not matched by a corresponding increase in the number of physicians choosing primary care. To date, few policy makers questioned the conventional wisdom that more is better when it comes to the supply of primary care physicians. Instead, policy makers should consider alternative approaches to increase access to patient-centered primary care. [ABSTRACT FROM AUTHOR]

Objective: We investigated the proportion of encounters that were interrupted during family-centered rounds in the pediatric intensive care unit (PICU) to determine whether the use of a physician assistant (PA) significantly affected the proportion of interrupted encounters. Methods: We evaluated 2,657 rounding encounters in our 24-bed regional referral unit. The duration of each rounding encounter and total rounding duration were recorded. The presence or absence of a PA during each rounding encounter, the occurrence of an interruption, and other potential predictors of interruptions were recorded. Results: The presence of a PA during PICU rounds was significantly associated (P <.001) with a 35.4% lower likelihood of an interruption. Conclusions: Family-centered rounds in the PICU are less likely to be interrupted when a PA is present. PAs help physicians and improve rounding efficiency by safely and effectively handling certain interruptions. [ABSTRACT FROM AUTHOR]

The unprecedented surge in physician assistants (PAs) and NPs in the ED developed quickly in recent years, but scope of practice and practice patterns are not well described. Methods: We conducted two cross-sectional electronic surveys of the American College of Emergency Physicians' council. Survey construction was informed by interviews and evaluated with validity and reliability studies. Univariate analyses to establish associations also were performed. Results: Most councilors' departments employ PAs and NPs (72.4% of 163 responses). Supervisory requirements varied greatly among respondents for the same emergency severity index (ESI) level. Regardless of experience level, NPs were reported to use signifi cantly more resources than PAs; chi-square(4) = 105.292, P < .001 for less-experienced PAs or NPs; chi-square(4) = 120.415, P < .001 for more experienced PAs or NPs. Conclusion: Councilors reported great variation in PA and NP scope of practice. The results also suggest that new graduate PAs may be more clinically prepared to practice in the ED than new graduate NPs. [ABSTRACT FROM AUTHOR]

Clinicians are increasingly becoming familiar with the value of limited, focused point-of-care ultrasonography (POCUS) to help answer discrete clinical questions. Ultrasound education is being taught in medical schools and physician assistant (PA) and PA postgraduate programs nationwide. This article introduces five basic POC ultrasound scans that can easily be mastered by practicing PAs. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed whether using physician assistants (PAs) for fracture follow-up during nonoperative management of pediatric forearm fractures was associated with an increased risk of malunion. Methods: The study was a retrospective review of charts of 141 children under age 18 years who were treated nonoperatively in the division of orthopedics over 12 months for forearm fractures. The effect of type and number of follow-up providers on risk of malunion was determined and controlled for fracture type, location, and initial angulation. Logistic regression, Fisher exact test, and Cochran-Armitage trend test were used to analyze the data, with P < .05 indicating statistical significance. Results: Using strict criteria, malunion was identifi ed in 42 (30%) of 141 patients. Follow-up provided by even up to four PAs did not increase malunion risk. Transfer of care between two attending physicians increased malunion risk, independent of fracture characteristics. Conclusion: The involvement of even multiple PAs during follow-up management of nonoperatively treated pediatric forearm fractures is not associated with an increase in the risk of malunion. These findings are consistent with previous published works that highlighted the safe and valuable role PAs can play in the management of common fractures. [ABSTRACT FROM AUTHOR]

Objectives: Understanding the PA primary care workforce is an initial step toward greater use of primary care PAs in new healthcare delivery models. This study sought to describe primary care PA practice as it compares with PA practice in other specialties. Methods: Data from two 2015 national American Academy of Physician Assistants surveys were analyzed using descriptive statistics. Statistically significant differences between primary care and specialty PAs were assessed using tests of column proportions and tests of column means. Results: Compared with PAs in specialties, primary care PAs were older, saw more patients per week, and spent less time consulting with physicians. In addition, higher percentages were Hispanic, had a record of military service, and had plans to leave their specialty or retire. Conclusions: Primary care PAs appear to possess unique strengths; however, challenges to maintaining a primary care PA workforce are substantial. [ABSTRACT FROM AUTHOR]

The history of how PAs in the United States were first granted practice authority under the medical practice acts of the various states and territories begins in the 1960s with an imaginative way to circumvent the moratorium on licensure of new healthcare occupations in place at the time, while allowing the requisite flexibility for the new profession to take hold and thrive. In the subsequent decades, separate licensure for PAs was required and adopted. Despite the enormous success of the PA profession over its first 50 years, challenges remain. [ABSTRACT FROM AUTHOR]

National health workforce supply and demand models help predict requirements built on individual annual productivity assumptions. Dual employment rarely is addressed, yet in 2015, about 13.5% of certified physician assistants (PAs) reported two or more clinical positions. Of PAs working two positions, 44% reported the main reason was to supplement earnings, followed by role variety. The mean number of hours worked by all certified PAs was 40.7 per week and the average number of patients was 75. Dual-employed PAs averaged more than 51 hours and 97 patients per week. This new finding reveals an added dimension to provider productivity statistics requiring refinements to annual output calculations. [ABSTRACT FROM AUTHOR]

From the very beginning, popular media has played an essential role in driving public awareness and recognition of physician assistants (PAs) as major contributors to healthcare. But for PAs, popular media can be a double-edged sword. Over time, the roles of PAs have evolved from bit players to leading characters on television medical dramas. Even so, on some occasions, the roles of PAs have been marginalized and misrepresented. In the future, the PA profession will need to remain vigilant about how PAs are portrayed in the popular media and must learn how to use the full benefit of the media to promote the profession's diversity, flexibility, collegiality, and civic-mindedness. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Overweight and obesity compose a chronic disease process of epidemic proportions that presents on a continuum, likely affecting nearly two out of every three patients treated by physician assistants (PAs). However, meaningful and actionable definitions, including but not limited to anthropometric and clinical descriptors, are needed. The effective treatment of overweight and obesity requires an efficient and timely process of screening, diagnosis, evaluation of complications, staging, and clear algorithmic management. PAs are trained as primary care providers and can diagnose and treat overweight and obese patients regardless of practice setting and across the spectrum of the disease and patient's age. [ABSTRACT FROM AUTHOR]

This study sought to assess physician assistant (PA) wages, make comparisons with other healthcare professionals, and project their earnings to 2025. The Bureau of Labor Statistics PA employment datasets were probed, and 2013 wages were used to explore median wage differences between large employer categories and 14 years of historical data (2000-2013). Median wages of PAs, family physicians and general practitioners, pharmacists, registered nurses, advanced practice nurses, and physical therapists were compared. Linear regression was used to project the PA median wage to 2025. In 2013, the median hourly wage for a PA employed in a clinical role was $44.70. From 2000 to 2013, PA wages increased by 40% compared with the cumulative inflation rate of 35.3%. This suggests that demand exceeds supply, a finding consistent with similar clinicians such as family physicians. A predictive model suggests that PA employment opportunities and remuneration will remain high through 2025. [ABSTRACT FROM AUTHOR]

In response to increased demand for primary care services under the Affordable Care Act, the national network of community health centers (CHCs) will play an increasingly prominent role. CHCs have a broad staffing model that includes extensive use of physician assistants (PAs), nurse practitioners (NPs), and certified nurse midwives (CNMs). Between 2007 and 2012, the number of PAs, NPs, and CNMs at CHCs increased by 61%, compared with 31 % for physicians. However, several policy and payment issues jeopardize CHCs' ability to expand their workforce and meet the current and rising demand for care. [ABSTRACT FROM AUTHOR]

Medical anthropology is a subfield of anthropology that investigates how culture influences people’s ideas and behaviors regarding health and illness. Medical anthropology contributes to the understanding of how and why health systems operate the way they do, how different people understand and interact with these systems and cultural practices, and what assets people use and challenges they may encounter when constructing perceptions of their own health conditions. The goal of this article is to highlight the methodological tools and analytical insights that medical anthropology offers to the study of physician assistants (PAs). The article discusses the field of medical anthropology; the advantages of ethnographic and qualitative research; and how medical anthropology can explain how PAs fit into improved health delivery services by exploring three studies of PAs by medical anthropologists. [ABSTRACT FROM AUTHOR]

The public perceives nurses, pharmacists, and physicians as some of the most ethical professions, according to Gallup polling data. Physician assistants (PAs) have not been studied. This article describes a nationwide survey of PA students and evaluates the materials allowed for study purposes. The goal was to understand what factors influence a PA student’s decision to use nonsanctioned materials during their training. [ABSTRACT FROM AUTHOR]

Background: Most pediatric ED visits are for nonemergent problems. Physician assistants are well trained to manage these patients; however, their effect on patient flow in a pediatric ED is unknown. Objectives: To compare the effect on key pediatric ED efficiency indicators of extending physician coverage versus adding PAs with equivalent incremental costs. Methods: We used discrete event simulation modeling to compare the effect of additional physician coverage versus adding PAs on wait time, length of stay (LOS), and patients leaving without being seen. Results: Simulation of extended physician coverage reduced wait times, LOS, and rates of leaving without being seen across acuity levels. Adding PAs reduced wait times and LOS for high-acuity visits, and slightly increased the LOS for low-acuity visits. Conclusions: With restricted autonomy, PAs mainly benefitted the high-acuity patients. Increasing the level of PA autonomy was critical in broadening the effect of PAs to all acuity levels. [ABSTRACT FROM AUTHOR]

A census of physician assistants in the United States is necessary to help legislators make policy decisions about the profession. In 2013, a PA status analysis was undertaken using a novel data source derived from state licensure. The Provider 360 Database was probed for all licensed PAs, and 84,064 were identified. Duplicates, sanctioned, deceased, and dual-licensed were reconciled. In the aggregate, the mean age was 42 years (median 45; mode 32; range 22-74) and 75% of US licensed PAs were women. Statewide distribution per capita ranged from 60 per 100,000 in Alaska to 3.9 per 100,000 in Mississippi; the US mean was 26.8. The robustness of this database draws on active licensure data to identify clinically active PAs. Such refinements and details contribute to health workforce research such as census, modeling, retirement trends, and labor participation rates. [ABSTRACT FROM AUTHOR]