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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]

Introduction: In the coming decades, demographic change will dramatically increase health care needs, especially for general practitioners (GPs). However, there is a shortage of young primary care physicians, with signs of (impending) underuse already becoming apparent in rural and structurally weak areas. Innovative care concepts are needed to counteract this development and ensure the future of primary care. In addition to medical assistants (MFA), academically trained physician assistants (PAs) could be considered for more demanding delegation tasks and be involved in direct patient care under the responsibility of a physician in the practice team. In England, the Netherlands and the USA, PAs have been a part of the health care systems for many years., Research Questions: 1) What are the potentials for delegation/possibilities for PAs working in primary care practices in contrast to medical assistants? 2) What structural requirements are necessary to regularly integrate PAs in primary care practices?, Methods: After preliminary interviews with PA experts and primary care researchers and practitioners (n=29), four expert interviews (n=4) with GPs and PAs were performed in a case analysis in order to elicit experiences with PAs in family practice. Based on this, three focus groups were conducted with GPs and practice staff (n=15) to discuss the extent, the need and the willingness to delegate physician services to PAs, as well as existing barriers. After transcription, analyses were performed using qualitative content analysis according to Mayring., Results: The participants acknowledged the potential to reduce physician workloads and showed a high willingness to delegate tasks. Practical examples suggest that a clearly defined delegation of medical tasks to PAs, e.g. participation in infection consultations, is possible after only a few weeks working in family practices. Thus, the cooperation between GPs, PAs and medical assistants can be successful. Uncertainties exist regarding the legal possibilities and limits of delegation as well as the current and future financial reimbursement of PAs., Discussion: The legal and financial framework for the utilization of PAs in ambulatory care should be reliably clarified as well as transparently communicated so that the considerable potentials of delegating tasks to academically trained staff, e.g. PAs, especially in the GP sector, can be exploited in the future., Conclusion: Participation of PAs in the GP team could be key to overcoming the often threatening or already existing under-provision of medical care in structurally weak regions., (Copyright © 2023. Published by Elsevier GmbH.)

Background: Physicians in Germany are overburdened. Delegation of tasks to Physician Assistants (PA) is one way of providing relief. Although PA work in Germany since 2012, few data are available. We studied advantages and disadvantages from those physicians point of view, who cooperate with PA since years, as well as working conditions, satisfaction and duration of work processes of PA., Method: Semi-quantitative cross-sectional survey on a course of PA graduates and the physicians they work with since three years. Retrospective analysis of patients´ waiting time and duration of stay in an emergency department., Results: Physicians were very satisfied with PA and reported a high degree of relief from workload. PA were highly satisfied with their job. Processing time in the emergency department was not longer when a PA was involved in patient care., Conclusion: Physicians are satisfied with PA as they are relieved from a heavy workload. More data on effectiveness and efficiency of PA in Germany are needed., Competing Interests: Tanja Meyer-Treschan, Barbara Veltjens, Nabeel Farhan und Julia Siegmüller sind oder waren hauptberuflich an Fachhochschule tätig, welche den Studiengang Physician Assistance anbieten. Ann Kathrin Stegemann, Julia Sebastian und Sarah Hatwich haben Physician Assistance studiert und arbeiten als Physician Assistants. Martin Beiderlinden und Ralf Siepe haben als Ärzte Physician Assistants in ihr Team integriert. Alle Autoren sind daher daran interessiert, das Berufsbild der Physician Assistants in das deutsche Gesundheitswesen erfolgreich einzubinden. Andere Interessenkonflikte, besonders im Sinne finanzieller Abhängigkeiten, bestehen nicht., (Thieme. All rights reserved.)

Background: In Germany, the coverage of officially recommended vaccinations for the elderly is below a desirable level. It is known that advice provided by General Practitioners and Physician Assistants influences the uptake in patients ≥60 years. Therefore, the predictors of advice-giving behavior by these professions should be investigated to develop recommendations for possible actions for improvement. Methods: We conducted a postal cross-sectional survey on knowledge, attitudes and advice - giving behavior regarding vaccinations in the elderly among General Practitioners and Physician Assistants in 4995 practices in Germany. To find specific predictors, we performed logistic regressions with non-advising on any officially recommended vaccination or on three specific vaccinations as four separate outcomes, first using all participants, then only General Practitioners and lastly only Physician Assistants as our study population. Results: Participants consisted of 774 General Practitioners and 563 Physician Assistants, of whom overall 21 % stated to have not advised an officially recommended vaccination in elderly patients. The most frequent explanation was having forgotten about it. The habit of not counselling on vaccinations at regular intervals was associated with not advising any vaccination (OR: 2.8), influenza vaccination (OR: 2.3), and pneumococcal vaccination (OR: 3.1). While more General Practitioners than Physician Assistants felt sufficiently informed (90 % vs. 79 %, p < 0.001), General Practitioners displayed higher odds to not advise specific vaccinations (ORs: 1.8-2.8). Conclusions: To reduce the high risk of forgetting to advice on vaccinations, we recommend improving and promoting standing recall-systems, encouraging General Practitioners and Physician Assistants to counsel routinely at regular intervals regarding vaccinations, and providing Physician Assistants with better, tailor-made information on official recommendations and their changes. [ABSTRACT FROM AUTHOR]

Introduction: Against a background of falling staff levels, rising care needs and the expectation that health care assistants (HCAs) are to be more actively involved in the provision of health care in the future, job satisfaction plays an important role in motivating HCAs to pursue the profession over the long term., Question: How satisfied are HCAs with various aspects of their work and what socio-demographic factors have an influence on job satisfaction?, Methods: The data analysed was obtained from six different research projects (2011-2017). In all the projects, the job satisfaction of HCAs was surveyed using a standardised seven-step Warr-Cook-Wall questionnaire. The analysis of the 10 items was carried out both descriptively and using ordinal regression analysis to identify predictors., Results: Total of 2,371 HCAs were satisfied with their job situation (mean 5.2± 1.6), whereby satisfaction was lowest with regard to salary (mean 3.73± 1.9) and employee recognition (mean 4.76± 1.8). HCAs that had completed additional training to become specially qualified Health Care Assistants in the Family Practice (VERAH) or Non-physician Practice Assistants (NPA) (n=452) were more satisfied in their jobs in almost all respects, compared to health care assistants that had no additional qualification (n=1,676) (mean 5.67± 1.4 vs. 5.16± 1.5, p ˂ 0.00). Overall satisfaction was positively influenced by higher age, qualification as a VERAH/NPA, higher workload, and urban location of the practice., Conclusion: Measures to raise the attractiveness of the profession of HCA might include an increase in possibilities to undergo additional training, appropriate remuneration and adequate employee recognition. In this way, the largest occupational group in outpatient care could be provided with a satisfactory professional future., (Copyright © 2021. Published by Elsevier GmbH.)

Background: Physicians in training are major contributors to the German health care system. After graduation from medical school, physicians in training qualify for a certain specialty. The workload of physicians in training in Germany is so high that they have expressed their need for support. One opportunity to support physicians in training is by delegating tasks to physician assistants (medical assistants qualified by a specific course of study, graduated from universities of applied sciences). However, there is a lack of knowledge about the qualification of physician assistants and the conditions which allow support of physicians in training by physician assistants in Germany., Methods: Based on a focused internet search, this paper describes the development of the profession physician assistance in Germany and the currently offered graduation courses including their duration and qualification requirements. Furthermore, we present available recommendations for the content of physician assistants' education and characterize conditions for the support of physicians in training by physician assistants., Results: In Germany, physician assistance has been an academic discipline since 2005, the profession is, however, still quite seldom. Qualification requirements and the duration of education are determined by the universities. The aim is to qualify students for several competencies, which enable physician assistants to perform tasks of physicians under delegation. The conditions for delegation to physicians in training and to physician assistants are quite similar, resulting in partly comparable practice. Major differences relate to the so called "physician reservation" or physicians' core area, both of which define tasks that may only be carried out by physicians., Discussion: Integrating physician assistants into a medical team means supporting the specialists by delegating tasks, thus reducing the workload of all physicians in the team, including physicians in training. Currently, there are no data on and no outcomes of the performance of physician assistants in Germany., Conclusion: In everyday practice, health care delivered by physician assistants and by physicians in training is similar, at least as regards activities and tasks that do not need physician supervision., (Copyright © 2021. Published by Elsevier GmbH.)

Background: Demographic change will lead to a serious shortage of doctors in the inpatient and outpatient sectors in the next years. To ensure that medical care is provided in the future, various models of medical assistant professions have been created in the past, both at state and federal level. Due to the diversity of these training courses, advanced training courses and study paths, it is becoming increasingly difficult to keep track of fields of application, focal points of activities, etc. METHOD: An analysis of the currently existing models and professions of physician assistants was carried out. The models considered are VERAH, AgnES zwei , EVA, MoNi, MoPra, OTA/ATA, CTA, ANP and PA., Results: VERAH, AgnES zwei , EVA, MoNi and MoPra carry out their activities in primary care. OTA/ATA, CTA, ANP and PA, on the other hand, are active in clinical inpatient care (PA also in outpatient care). All curricula show significant differences in entrance requirements, length of time and content. VERAH and AgnES zwei , EVA, MoNi and MoPra have the lowest entrance requirements and the shortest advanced training. VERAH and AgnES zwei focus on case management, while OTA/ATA or CTA training and ANP as well as PA studies focus on practical clinical use and the transfer of medical knowledge. While CTAs and OTAs/ATAs can work in the surgery field only and ANP mainly in the nursing field, PA can work both in the clinical and outpatient field., Conclusions: Due to the already existing doctors shortage, which will increase in the future, medical care can only be guaranteed by interprofessional team building. To this end, the professional associations and the associations of Statutory Health-Insurance physicians are called to develop appropriate models and remuneration.

Background: In Germany, a decreasing number of general practitioners (GPs) face a growing number of patients with multimorbidity. Whilst care for patients with multimorbidity involves various healthcare providers, the coordination of this care is one of the many responsibilities of GPs. The aims of this study are to identify the barriers to the successful coordination of multimorbid patient care and these patients' complex needs, and to explore the support needed by GPs in the care of multimorbid patients. Interviewees were asked for their opinion on concepts which involve the support by additional employees within the practice or, alternatively, external health care professionals, providing patient navigation., Methods: Thirty-two semi-structured, qualitative interviews were conducted with 16 GPs and 16 medical practice assistants (MPAs) from 16 different practices in Berlin. A MPA is a qualified non-physician practice employee. He or she undergoes a three years vocational training which qualifies him or her to provide administrative and clinical support. The interviews were digitally recorded, transcribed and analysed using the framework analysis methodology., Results: The results of this paper predominantly focus on GPs' perspectives of coordination within and external to general practice. Coordination in the context of care for multimorbid patients consists of a wide range of different tasks. Organisational and administrative obstacles under the regulatory framework of the German healthcare system, and insufficient communication with other healthcare providers constitute barriers described by the interviewed GPs and MPAs. In order to ensure optimal care for patients with multimorbidity, GPs may have to delegate responsibilities associated with coordinating tasks. GPs consider the deployment of an additional specifically qualified employee inside the general practice to take on coordinative and social and legal duties to be a viable option., Conclusions: The cross-sectoral cooperation between all involved key players working within the healthcare system, as well as the coordination of the whole care process, is seemingly challenging for GPs within the complex care system of multimorbid patients. GPs are generally open to the assignment of a person to support them in coordination tasks, preferably situated within the practice team.

Background: Working conditions may not only impair the health of health care staff, but also the quality of delivered patient care. Evidence for this in relation to physician assistants remains limited despite the fact that they represent the largest professional group in German primary care and perform occupational tasks that are highly relevant to the quality of patient care. This study aimed to gain insights into the potential relationship of working conditions with the quality of care., Methods: Participants were recruited from a randomized sample of medical practices in and around the city of Düsseldorf (Germany) and with support from the medical health care staff association (VMF e.V.). In total, 26 qualitative in-depth interviews were conducted (11/2015-02/2016), transcribed and content-analyzed using MaxQDA., Results: The majority of participants expressed the view that working conditions impact on the quality of care. In particular, the quality of social interactions with patients and minor mistakes were alluded to in this regard., Conclusions: Working conditions of physician assistants are characterized by high demands. Their potential impact on the quality of social interactions with patients and the rate of minor mistakes highlights the relevance of preventive actions. Our findings may represent the starting point for further research into preventive measures., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: In all phases, patients are entitled to receive medical treatment according to medical specialist standards. This does not mean that patients necessarily have to be treated by a medical specialist. Operations performed by "beginners", e. g. assistant physicians, are permitted. However, there are increased liability risks, both for the specialist and the assistant physician. Furthermore, there are risks of criminal responsibility for causing bodily harm by negligence or negligent manslaughter., Objectives and Methods: This article portrays the requirements of civil liability and criminal responsibility concerning beginners' operations on the basis of cases and judgments of the Federal Court and the Higher Regional Courts in Germany. Additionally, the reception of the jurisprudence by the relevant legal literature will be discussed., Results: Jurisprudence and legal literature categorize breaches of duty of care. Assistant physicians can be subject to contributory negligence liabilities, while specialists can bear liabilities for negligent selection, organization or supervision. Responsible specialist and assistant physicians can protect themselves (and the patient) and avoid legal risks by only performing operations adequate to their educational level or by delegating operations to beginners and ensuring intervention by a specialist by supervision of the operation which is suitable to the assistant physician's level of education.

Background: In Germany, physician assistant (PA) is a comparatively young profession. The concept paper by the German Medical Association (BÄK) and the Federation of Statutory Health Insurance Physicians (KBV) from 2017 defines the new occupational profile in detail. In contrast, there is hardly any information on the day to day working life of a PA in Germany OBJECTIVE: The aim of this study was to map the employment reality of the PA graduates of the study program of the Baden-Wuerttemberg Cooperative State University Karlsruhe., Material and Methods: Graduates of the PA study program were interviewed using the web-based evaluation system EvaSys V7.1 (Electric Paper Evaluationssysteme GmbH, Lüneburg, Deutschland) in the spring of 2018. The information was evaluated descriptively., Results: The response rate was 70% (48 out of 69 graduates), 44 graduates were employed as a PA and 27 worked in a surgical department. The core tasks of the surgically active PA, which were often performed to varying frequency included assisting surgery and the performance of simple wound closures. In addition, activities in the areas of documentation, communication and information sharing were emphasized. The average salary of a surgical PA was 3718 €. This amount was rated by 44.4% as appropriate or very appropriate. The current occupational situation for 81.5% of the study participants was much better or better than expected before the start of their PA studies. Overall satisfaction was very high: 85.1% of the graduates were satisfied to very satisfied., Conclusion: The graduates' level of job satisfaction is remarkable. Many of the activities mentioned in the concept paper of the BÄK and KBV were carried out frequently or very frequently by the PA. Nonetheless, the PA profession has significant development potential, especially in the realm of surgical PAs.

There are currently many assistant professions in the German healthcare system which have either a more nursing or a more medical character. All these assistant professions have in common that as yet they do not require uniform training criteria but members of these professions undertake some aspects of medical activities. At the center lies the difficulty of more political than legal discussion on whether members of these assistant professions and also nursing personnel are allowed to or should undertake medical activities. This article illuminates the legal status quo.

Background: Chronic (systolic) heart failure (CHF) represents a clinical syndrome with high individual and societal burden of disease. Multifaceted interventions like case management are seen as promising ways of improving patient outcomes, but lack a robust evidence base, especially for primary care. The aim of the study was to explore the effectiveness of a new model of CHF case management conducted by doctors' assistants (DAs, equivalent to a nursing role) and supported by general practitioners (GPs)., Methods: This patient-randomised controlled trial (phase II) included 31 DAs and employing GPs from 29 small office-based practices in Germany. Patients with CHF received either case management (n = 99) consisting of telephone monitoring and home visits or usual care (n = 100) for 12 months. We obtained clinical data, health care utilisation data, and patient-reported data on generic and disease-specific quality of life (QoL, SF-36 and KCCQ), CHF self-care (EHFScBS) and on quality of care (PACIC-5A). To compare between groups at follow-up, we performed analyses of covariance and logistic regression models., Results: Baseline measurement showed high guideline adherence to evidence-based pharmacotherapy and good patient self-care: Patients received angiotensin converting enzyme inhibitors (or angiotensin-2 receptor antagonists) in 93.8% and 95%, and betablockers in 72.2% and 84%, and received both in combination in 68% and 80% of cases respectively. EHFScBS scores (SD) were 25.4 (8.4) and 25.0 (7.1). KCCQ overall summary scores (SD) were 65.4 (22.6) and 64.7 (22.7). We found low hospital admission and mortality rates. EHFScBS scores (-3.6 [-5.7;-1.6]) and PACIC and 5A scores (both 0.5, [0.3;0.7/0.8]) improved in favour of CM but QoL scores showed no significant group differences (Physical/Mental SF-36 summary scores/KCCQ-os [95%CI]: -0.3 [-3.0;2.5]/-0.1 [-3.4;3.1]/1.7 [-3.0;6.4])., Conclusions: In this sample, with little room for improvement regarding evidence-based pharmacotherapy and CHF self-care, case management showed no improved health outcomes or health care utilisation. However, case management significantly improved performance and key intermediate outcomes. Our study provides evidence for the feasibility of the case management model., Trial Registration Number: ISRCTN30822978.

Background: The aim of this paper is to analyze psychosocial stress in the workplace among hospital doctors working in surgical fields in Germany with the aid of the demand-control model, the effort-reward imbalance model, and selected additional indicators., Methods: A written questionnaire was answered by a stratified random sample consisting of 1311 hospital doctors working in surgical fields in 489 hospitals in Germany. Validated instruments were used to make measurements according to the demand-control and effort-reward imbalance models., Results: The working conditions of about a quarter of the hospital doctors surveyed were characterized by an effort-reward imbalance. 22% of them have "job strain" according to the demand-control model, i.e., they are confronted with high demands, yet have a low degree of control. Residents and assistant physicians not occupying training positions were both found to have an especially high degree of psychosocial stress. Furthermore, about one-fifth of the hospital doctors surveyed thought about giving up their profession at least a few times per month. 44% of them considered that the quality of patient care was sometimes or often impaired by an excessive physician workload., Conclusion: An investigation of psychosocial stress in the workplace among hospital doctors in surgical fields in Germany indicates that this group suffers from more severe stress at work than other occupational groups. Such working conditions pose a threat to these physicians' own health and to the quality of the health care that they provide.

Aim: Bipolar hemiarthroplasty is frequently used in femoral neck fractures. There is only little evidence regarding differences in complication rates if the procedure is performed by either a junior or senior surgeon., Methods: 360 bipolar hemiarthroplasties were retrospectively investigated. Complication rates for junior and senior surgeons were evaluated as well as differences between daytime and nightshift surgery. We also assessed the duration of surgery for the two groups and its impact on the complication rate., Results: The average duration of the procedure was 67 minutes (23-194) with statistically significant differences between junior and senior surgeons (77 vs. 61 minutes, p < 0.001). Complications occurred in 27 (7.5%) of all cases. Postoperative infections were most frequently found (3.1% of all complications), followed by haematomas and dislocations of the implant (1.7% and 1.1 %, respectively). 25 patients required revision operations. More complications were found in cases performed by junior surgeons (9.56% vs. 6.25%). This difference was not significant (p = 0.248). During on-call duty we also observed more complications compared to daytime surgery (11% vs. 7%). There was no coherence between the duration of surgery and the incidence of complications., Conclusions: Bipolar hemiarthroplasty is a reliable treatment option for femoral neck fractures even when performed by a junior surgeon. The higher incidence of complications during nighttime surgery should be a reason to perform those cases that are not urgent during the daytime shift., (Georg Thieme Verlag KG Stuttgart New York.)