Whither the PA doctorate?

ABSTRACT: New perspectives have been brought to bear in the discussion of the topic of the physician associate/assistant (PA) doctoral degree in general and the entry-level PA doctorate in particular. Both the Physician Assistant Education Association (PAEA) and the American Academy of Physician Associates (AAPA) have sought and supported formal research investigations into the question. Evidence from studies shows that perceived benefits and risks are strongly influenced by the lens of the various stakeholders; that most PAs believe that the master's degree is enough for clinical practice; and that most clinical PAs and PA students are not in favor of an entry-level doctorate. Lessons learned from other healthcare professions that have transitioned to a clinical doctorate only marginally serve as a model for the PA profession. PA organizations need to fully own and embrace the task of leading the discussion and reaching a definitive conclusion in the determination of PA doctoral education. Failure of the PA profession to act decisively on the doctoral degree question would essentially default this decision to colleges and universities, which tend to have a vested economic interest in new types of degrees.

Physician assistant/associate retirement intent: seeking the exit ramp.

BACKGROUND: Retirement patterns for American physician assistants/associates (PAs) are in flux as the first substantial cadre trained in the 1970s makes their retirement choices. The growing and aging of the US population is increasing the demand for healthcare services. At the same time, provider retirement can decrease patient access to care, disrupt continuity of care and lead to poorer health outcomes. Knowing PA intentions to retire and the retirement patterns can be useful to health system employers and workforce policymakers. The purpose of this study was to investigate the retirement patterns of PAs within the United States. We investigated their characteristics, career roles, and intent to depart from clinical practice. METHODS: Drawing on the National Commission on Certification of Physician Assistants (NCCPA) 2020 health workforce data (N = 105,699), the associations of demographics (age, gender, US region, and years certified), and practice attributes (specialty and practice setting) of clinically active PAs were assessed with intending to retire in the next five years. Analyses for this national cross-sectional study included descriptive statistics, Chi-square, and Fisher's Exact test, as appropriate. A p-value of 0.05 or less was considered statistically significant for all analyses where a comparison was made. RESULTS: Overall, 5.8% of respondents indicated that they intend to retire within five years. We detected significant differences (all p < 0.001) on intentions to retire by age group, gender, US region, years certified, specialty, and practice setting. Respondents 70 years and older compared to those 60-69 were more likely (66.5% vs. 48.9%), males compared to females (8.8% vs. 4.4%), those who have been certified for more than 21 years compared to 11-20 years (25.6% vs. 4.0%), PAs practicing in family medicine compared to dermatology (7.7% vs. 3.4%) and those in the federal government practice setting compared to rural health clinic (13.6% vs. 9.8%) reported they were more likely to retire in the next five years. CONCLUSIONS: Our study provides a comprehensive snapshot of PA retirement intentions using a robust national dataset. Among the most important factors associated with intent to retire in this study were older age and duration of PA career. Most PAs are remaining clinically active into their seventh decade-suggesting that they are integrated into medical systems that value them and they, in turn, value their role.

Assessing demand for doctoral-prepared PA faculty: a five-year longitudinal study.

PURPOSE: Many health profession programs have transitioned to doctoral credentials. While a master's degree is the terminal degree for the physician assistant (PA) profession, there is increasing discussion regarding the doctoral degree as the PA terminal credential in US higher education.This study examines trends, demand and economic opportunities for doctoral prepared PA faculty; specifically, assessing to what extent PA faculty employers prefer doctoral credentials. METHODOLOGY: This longitudinal retrospective observational study assessed commonly required/preferred academic credentials in PA faculty job postings. Data from 2014 to 2020 was obtained from the labor analytics firm Burning Glass Technologies (BGT) and other academic job search engines. Data on current PA faculty and program directors were obtained from Physician Assistant Education Association (PAEA) survey reports. Wage gap analysis was performed to gain additional insight for the supply and demand of PA educators with a doctoral degree. RESULTS: Of the 612 unique job ads posted from 232 PA programs between 2014 and 2020, approximately 38.9% (238) stated a preference or requirement for a doctoral degree. Nearly half of the postings for program directors and leadership positions preferred candidates with doctorates. There was a correlation between tenure eligibility positions (20.1%) and preference/requirement for doctoral credentials. PAEA survey data (2014-2019) revealed approximately 24% PA faculty and 45-48% of program directors held a doctoral degree with Doctor of Philosophy (PhD) as the most frequently held doctorate. No significant difference existed in wages for faculty with or without doctoral degree. CONCLUSIONS: Based on a national sample of PA program job ads, there is a preference for doctoral-prepared PA educators and the demand for these candidates is greater than market supply. Our analysis has implications for individual faculty career planning, employers and the PA profession as it debates transition to a terminal doctoral credential. Further studies should assess the impact of doctoral credentials on PA education by examining measurable outcomes.

Developing and evaluating an instrument to assess perceptions of an entry-level physician associate doctoral degree.

BACKGROUND: Most health professions in the United States have adopted clinical or practice doctorates, sparking an ongoing debate on whether physician assistants/associates (PAs) should transition from a master's to a doctorate as the terminal degree for the profession. Although more studies are anticipated, there is no validated instrument assessing perceptions of various stakeholders regarding an entry-level PA doctoral degree. The objective of this study was to develop and evaluate a novel self-report measure to assess perceptions of an entry-level PA doctoral degree. METHODS: A multifaceted, mixed-methods approach was adopted. Based on a comprehensive literature review of the doctoral transition experiences in other health professions, an initial version of perceptions of an entry-level terminal PA doctoral degree scale (PEDDS) was generated. This scale was pilot tested with a group of PA faculty, students, and clinicians. Then, a cross-sectional survey consisting of 67 items was conducted with a national random sample of practicing PAs and PA students. Additionally, semi-structured interviews were conducted to ensure the validity of PEDDS. A principal component analysis (PCA) was conducted to reduce the number of items and reveal the underlying structure of PEDDS. RESULTS: The PCA confirmed 10 factors of PEDDS consisting of 53 items as the best-fit factor structure with adequate internal consistency of subscales. Those factors include a) expected positive impact on the PA profession, b) expected impact on prerequisites, (c) expected impact on the student preparedness as PA faculty and educators, (d) expected impact on the student preparedness as clinicians, (e) expected impact on accreditation and certification, (f) expected impact on curriculum, (g) expected impact on PA educators, (h) expected positive impact on diversity, (i) expected negative impact on the PA profession, and (j) expected impact on the student competency. CONCLUSIONS: The present study highlights the need to develop valid and reliable measurements to assess perceptions regarding the transition to the entry-level doctorate across health professions. This study could be used to guide further discussion of the entry-level doctorates for PAs and other health professions by bridging the gap of existing literature related to valid, reliable, and standardized measures on this topic.

American health workforce policy and PAs: A brief history.

ABSTRACT: Health workforce policy in the United States from the mid-1970s has been strongly influenced by perceptions of the adequacy of the physician supply and its relationship to physician assistants/associates (PAs) and NPs. During the 1980s, a series of inaccurate reports by the federal government mistakenly warned of an impending physician surplus and shaped policy decisions for decades. In spite of perceptions of a physician surplus, the PA profession expanded rapidly in the 1990s. Projections of the adequacy of the physician supply changed to a shortage in the first decade of this century and the PA component of the healthcare workforce continued to expand. During the past decade, the Association of American Medical Colleges has employed microsimulation modeling expertise to project the extent of physician shortages, an effort that initially failed to incorporate the contributions of PAs and NPs in the workforce. Although current projection models include the contributions of PAs and NPs, the substitution ratios used are notably low. Specifically, PA and NP productivity effort was set roughly at one-quarter to one-half that of the physician. PAs and NPs make up a substantial contingent within the US healthcare workforce and should be included fully in future workforce projection estimates. This article provides policy recommendations for the advancement of PA contributions to the delivery of medical care.

The PA profession in the 1990s.

ABSTRACT: History is rarely linear, and nowhere is this more evident than the US physician assistant/associate (PA) movement (1965-2021). The 1990s stand out as pivotal years for the PA profession, marked by advances that shaped the profession, experiments in primary care delivery, sex equity, the Balanced Budget Act, and national policy errors in predicting a physician surplus. Rapid growth followed program expansion, doubling from 57 in 1993 to 120 by 1999. By the end of the decade, all states had advanced PA-enabling legislation with broad-based prescribing. During this era, PA-focused research moved from descriptive to predictive, an official journal emerged in 1988, the Accreditation Review Commission on Education for the Physician Assistant became independent, and the American Academy of Physician Associates helped shape federal health policy. Also during this period, the profile of PAs shifted from older males to younger females with important sociological implications in leadership and career development. Notable milestones included national recognition of PAs as Medicare-eligible providers, direct commissioning in the military, and employment surges in the Veterans Health Administration and US Public Health Service. Not least of all this was a time of role shifts toward specialized medicine and surgery.

A physician assistant entry-level doctoral degree: more harm than good?

BACKGROUND: As most health professions in the United States have adopted clinical or practice doctorates, there has been an ongoing debate on whether physician assistants (PAs) should transition from a master's to a doctorate as the terminal degree. The authors examined perceived risks, benefits and impact of transitioning to an entry-level PA doctoral degree. METHODS: A multi-prong, mixed-methods approach was used that included a literature review and collecting quantitative and qualitative data using a survey and interviews. Bivariate analysis and binomial logistic regression were performed to evaluate relationships between perceptions/perspectives on an entry-level PA doctoral degree and the anticipated impact of it causing more harm than good to the PA profession. Deductive content analysis was used to analyze the qualitative data. RESULTS: Of 636 PA clinicians and students (46% response rate), 457 (72%) disagreed that an entry-level PA doctoral degree should be required. More than half of the respondents (54%) agreed that it should be offered but not required and 380 respondents (60%) agreed that an entry-level doctoral degree would cause more harm than good. Race, educational attainment, occupation, and length of practice as a PA were significantly associated with having a perception of causing more harm. There was strong positive association between the perception of a doctoral degree causing more harm with expectations of having a negative impact on the availability of clinical training sites (OR = 4.39, p < .05). The most commonly cited benefits were parity with other professions and competitive advantage, whereas the perceived risks were increased cost for education, decreased diversity in the profession, and negative impact on the PA/physician relationship. CONCLUSIONS: The major takeaway of our study was that perceived benefits and risks are strongly influenced by the lens of the stakeholder. While the majority of PAs and students appear to be not in favor mainly due to the potential harm, the proportion of those in favor is not insignificant and their views should not be ignored. Addressing concerns with key stakeholders could help the PA profession to transition to a doctoral degree with minimal adverse impact.

The effect of team-based care practice on productivity for family physicians.

ABSTRACT: About 60% of family physician practices employ PAs and/or NPs but gaps exist in the knowledge of the clinical effects on physician-PA and physician-NP teams. This review summarizes and comments on the significance of a recent report from the American Board of Family Medicine that compares the scope of practice of family physicians for family physicians practicing with either a PA, NP, or both.

Curriculum essentials of an entry-level PA doctoral degree.

OBJECTIVES: With increasing discussion of physician assistant (PA) doctoral education, investigation of curriculum essentials and competencies has become relevant. METHODS: We conducted a national mixed-methods study comprising a survey and semistructured interviews to capture stakeholders' views on essential curricular elements for PA doctoral education. RESULTS: If the PA profession decides to transition to a terminal doctoral degree, 75% of respondents indicated this would require new content, with half indicating it would require significant change to the curriculum, enhance PA educational rigor, and change the competencies of the new graduate. The majority of respondents favored a bridge program model and the Doctor of Medical Science (DMSc) as the degree title. CONCLUSIONS: Overall, respondents agreed that transition to an entry-level PA doctoral degree would affect various aspects of the curriculum. As the prospect of an entry-level PA doctoral degree gains further attention, additional debate on curriculum essentials and competencies is warranted.

Physician assistants in urgent care.

OBJECTIVE: To describe the characteristics of physician assistants (PAs) who practice urgent care. METHODS: Data from national surveys conducted by the American Academy of PAs (AAPA) between 1998 and 2016 were analyzed, comparing PAs who practice in urgent care, emergency medicine, and all other specialties. RESULTS: The percentage of PAs who work in an urgent care setting has nearly doubled in the last 10 years. PAs who work in urgent care see more patients and perform more minor surgical procedures than those in emergency medicine. They are less likely to be newly graduated PAs than those in emergency medicine. PAs in urgent care are less likely than other PAs to consult a physician about their patients in real time. CONCLUSION: The number of PAs practicing urgent care is increasing. More research is needed to further characterize PA practice in this specialty.

PAs in primary care: Current status and workforce implications.

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.

Analysis of 2011 physician assistant education debt load.

This study seeks to investigate how physician assistants (PAs) finance their education and to characterize the educational debt of PA students. Data from the 2011 American Academy of PAs (AAPA)-Physician Assistant Education Association Graduating Student Survey were used to explore the educational debt of PA students. The median total educational debt of a PA student graduating in 2011 was $80,000. Little financial assistance, other than student loans, is available to PA students. Eighty-five percent of PA students report owing some PA education debt amount, with 23% owing at least $100,000. This study provides a baseline look at PA student debt loads as a starting point for more detailed and robust research into new graduate specialty choices and PA career migration into other specialties. Further research is needed to explore the effect of student debt on students' specialty choices.

The GMENAC report and the PA profession.

The 1980 report of the Graduate Medical Education National Advisory Committee (GMENAC) predicted a surplus of physicians by 1990 and 2000. The report appeared to have a depressing effect on the growth of the PA profession in the early 1980s; in the 9 years following its release, no new PA programs were started and a number of existing programs closed. The GMENAC forecast proved to be inaccurate and the PA profession saw significant program growth in the 1990s and beyond. A lesson of GMENAC is that accurately predicting health workforce supply and demand is difficult.

Physician assistants in rural communities.

About 12% of all PAs work in rural settings, according to the 2013 Annual Survey of the American Academy of Physician Assistants. PAs in rural areas are more likely to practice in primary care specialties, have a wider scope of practice, and see patients who are uninsured or covered by Medicaid or Medicare. The positive effect of PAs on rural health has been demonstrated in extensive studies. PAs in rural areas are often the usual care providers for patients with chronic conditions, provide care that is cost effective and safe, and in certain cases increase access to care. Hiring a PA in a rural medical practice can have a salutary economic effect on the practice as well as the community.

Women, family medicine, and career choice: An opportunity cost analysis.

OBJECTIVE: This study compared the cost of physician versus physician assistant (PA) education for women practicing in family medicine. METHODS: Using 2013 salary survey data from both the Medical Group Management Association and the American Academy of PAs as well as other publicly available data sources, the authors compared the current net present value (NPV) of physician and PA training for women practicing in family medicine. RESULTS: Considering a base case scenario involving a 24-year-old woman, the NPV to become a family medicine physician was $2,015,000 compared with an NPV of $1,751,000 to become a family medicine PA. Alternative projections produced an NPV for PA training that slightly exceeded the NPV for family medicine physician training. CONCLUSIONS: For a woman practicing in family medicine, becoming a physician or a PA offers similar financial rewards.