Reasons for unsuccessful research submissions to JAAPA.

OBJECTIVE: PA authors face many barriers to publication and may benefit from additional transparency in the editorial decision-making process. This study examined the most common reasons for rejection of original research submissions to JAAPA. METHODS: Senior JAAPA editors conducted a thematic analysis of reviewer and editor comments and used these broad themes to classify the reasons for rejection of original research manuscripts submitted to JAAPA. RESULTS: From October 2015 through December 2018, 77 research manuscripts were submitted to JAAPA. Fifty-six manuscripts were rejected, resulting in an overall rejection rate of 73.7%. Common reasons for rejection included: methodologic issues (55.4%), content outside the journal's scope (42.9%), poor writing quality (17.9%), guideline nonadherence (3.6%), lack of novelty (3.6%), and author(s) declining to revise the manuscript (1.8%). CONCLUSION: The most common reasons for manuscript rejection can be overcome through research planning and manuscript preparation.

Primary care workforce paradox: A physician shortage and a PA and NP surplus.

OBJECTIVE: Primary care workforce projections continue to predict significant physician shortages. An oversupply of primary care physician assistants (PAs) and NPs also is predicted. This paradox calls into question the assumptions that underlie workforce projection models, which likely underestimate the primary care contributions of PAs and NPs. METHODS: Federally qualified health center data from the 2016-2019 Uniform Data System were used to calculate the number of clinic visits per full-time equivalent (FTE) physician, PA, and NP. Visits per FTE were compared across provider type to determine provider-specific productivity ratios. RESULTS: The combined PA and NP productivity ratio increased relative to physicians in each year, ranging from 0.85 in 2016 to 0.88 in 2019. Clinic visits per FTE for PAs and family physicians were nearly equivalent. CONCLUSIONS: Primary care workforce projection models should be reexamined to more accurately capture the productivity of PAs and NPs.

PA program characteristics and diversity in the profession.

OBJECTIVES: The primary objective of this study was to identify PA program characteristics that may be associated with higher or lower percentages of underrepresented minority students in PA programs. METHODS: Data from the Physician Assistant Education Association (PAEA) 2002-2003 and 2012-2013 annual surveys were analyzed. Bivariate correlation coefficients and multiple regression modeling were used to identify relationships between program characteristics and percentages of black and Hispanic students. RESULTS: The percentage of white matriculants in PA programs increased from 76.5% in 2002-2003 to 81.8% in 2012-2013; the percentage of black students decreased from 6.2% to 4.4%. Multiple linear regression revealed a modest negative relationship between master's degree and percentage of underrepresented minority students and a modest positive relationship between percentages of underrepresented minority employees and underrepresented minority students. CONCLUSIONS: Further research is needed to identify strategies to increase underrepresented minority participation in healthcare professions programs.

Research on the PA profession: The medical model shifts.

Physician assistant (PA)-focused research arose in response to the idea that an assistant to the busy physician could improve healthcare delivery. The process of answering questions about the profession has involved multiple approaches and various scholarly disciplines. In the course of this undertaking, what emerged were three stages of examination of PA behavior. The bibliographic span from this period contains about 2,400 studies that advance some notion of PA benefit to society. On the 50th anniversary of the PA profession, a question arises as to what research has shown. The answer is that PAs are providing care at significant levels of quality and quantity and their presence is enriching many challenges in healthcare delivery. In an era where demand for medical services is outstripping supply, the good idea born in the 1960s is emerging as a medical innovation domestically and globally.

Payment source and provider type in the US healthcare system.

Greater use of physician assistants (PAs) and nurse practitioners (NPs) to meet growing demand for healthcare in the United States is an increasingly common strategy to improve access to care and control costs. Evidence suggests that payment for services differs depending on the type of provider. This study sought to determine if the source of payment for a medical visit varies based on whether care is provided by a physician, PA, or NP. Data from the National Hospital Ambulatory Medical Care Survey (2006 through 2010) were analyzed. Physicians were proportionally more likely than NPs or PAs to provide care for medical visits compensated by private insurance or Medicare. Conversely, PAs and NPs were more likely to serve as providers of care for services with other payment sources such as Medicaid and out-of-pocket.

Ambulatory and chronic disease care by physician assistants and nurse practitioners.

As the US population increases and ages, more patients require care. A reengineered health care system relies on physician assistants and nurse practitioners; however, the extent to which they care for medical conditions is marginally known. We analyzed ambulatory visits by provider type and diagnosis focusing on chronic diseases to identify differences in patients seen by each type of provider. Both physician assistants and nurse practitioners attended 14% of 777 million weighted visits. Overall, diabetes and hypertension accounted for 2% to 4% of visits. The distribution of visits for chronic disease diagnoses appears to be similar for all 3 providers (physicians, nurse practitioners, and physician assistants). These findings may improve organizational efficiency in ambulatory systems.