Physician Assistant Faculty Perceptions Regarding Ongoing Self-assessment and Accreditation.

PURPOSE: While the processes of ongoing self-assessment and accreditation provide significant benefits to physician assistant (PA) programs, faculty members are often challenged by the required procedures and standards set by accreditation agencies. This study explored faculty perspectives regarding the processes of ongoing self-assessment and accreditation in PA programs. METHODS: A qualitative research design centered around semistructured interviews was used. A total of 26 participants were recruited, including PA program directors, associate program directors, directors of assessment and accreditation, past Accreditation Review Commission on Education for the Physician Assistant commissioners, accreditation consultants, deans, and PA Education Association leaders. DATA COLLECTION: Semistructured one-on-one interviews were conducted by 8 members of the research team through Zoom video conferencing. Data were collected until saturation was reached. DATA ANALYSIS: The interview recordings were transcribed and analyzed independently by 3 researchers. The transcripts were imported into NVivo, a qualitative data analysis software, for coding and inductive thematic analysis. RESULTS: Six emergent themes were identified under 2 major categories: facilitators and challenges. Facilitators for conducting continuous programmatic review and analysis include it takes a village, internal and external support, and sustained faculty development, whereas challenges are lack of knowledge and time, unclear expectations, and inflexibility. CONCLUSION: The study highlights factors associated with facilitating the ongoing self-assessment process. However, a number of challenges were also identified. The study suggests opportunities for intervention at the program, institution, and profession level.

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.

Advancing Physician Assistant Faculty Development: A New Model.

PURPOSE: The purpose of this article is to describe the development, implementation, and evaluation of an innovative physician assistant (PA) faculty development model. METHODS: The Maryland Physician Assistant Leadership and Learning Academy's (PALLA's) executive team developed a 10-month fellowship designed to build a skilled faculty pipeline. The fellowship framework was grounded in the PA educator competencies, the 3 pillars of academia, and the 5th edition Accreditation Standards for Physician Assistant Education. The self-perceived impact of the fellowship was evaluated through multiple surveys. RESULTS: Survey results show that all of the learning activities met fellows' expectations, and fellows indicated strong agreement in self-perceived achievement in meeting the fellowship outcome goals. CONCLUSION: Study results provide evidence that formal training increases self-perceived competence in clinicians transitioning to academia. PALLA can serve as a model for other states to ensure faculty capacity within PA education.

Examining the Gap: Compensation Disparities between Male and Female Physician Assistants.

BACKGROUND: Compensation disparities between men and women have been problematic for decades, and there is considerable evidence that the gap cannot be entirely explained by nongender factors. The current study examined the compensation gap in the physician assistant (PA) profession. METHODS: Compensation data from 2014 was collected by the American Academy of PAs in 2015. Practice variables, including experience, specialty, and hours worked, were controlled for in an ordinary least-squares sequential regression model to examine whether there remained a disparity in total compensation. In addition, the absolute disparity in compensation was compared with historical data collected by American Academy of PAs over the previous 1.5 decades. RESULTS: Without controlling for practice variables, a total compensation disparity of $16,052 existed between men and women in the PA profession. Even after PA practice variables were controlled for, a total compensation disparity of $9,695 remained between men and women (95% confidence interval, $8,438-$10,952). A 17-year trend indicates the absolute disparity between men and women has not lessened, although the disparity as a percent of male compensation has decreased in recent years. CONCLUSIONS: There remain challenges to ensuring pay equality in the PA profession. Even when compensation-relevant factors such as experience, hours worked, specialty, postgraduate training, region, and call are controlled for, there is still a substantial gender disparity in PA compensation. Remedies that may address this pay inequality include raising awareness of compensation disparities, teaching effective negotiation skills, assisting employers as they develop equitable compensation plans, having less reliance on past salary in position negotiation, and professional associations advocating for policies that support equal wages and opportunities, regardless of personal characteristics.

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.

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.

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.

What the IOM Report on Graduate Medical Education Means for Physician Assistants.

Graduate medical education (GME) is funded by taxpayers through Medicare subsidies that pay for physician residency training, primarily to teaching hospitals. The Institute of Medicine (IOM) recently conducted a study of US GME and issued a series of recommendations for future policy reform. This commentary examines the major elements of proposed reforms for GME and offers analysis of those that may pertain specifically to physician assistant education now and in the future.

Institutional sponsorship, student debt, and specialty choice in physician assistant education.

Physician assistant (PA) educational programs emerged in the mid 1960s in response to health workforce shortages and decreasing access to care and, specifically, the decline of generalist physicians. There is wide diversity in the institutional sponsorship of PA programs, and sponsorship has trended of late to private institutions. We analyzed trends in sponsorship of PA educational programs and found that, in the past 15 years, there were 25 publicly sponsored and 96 privately sponsored programs that gained accreditation, a 3.84:1 private-to-public ratio. Of the 96 privately sponsored programs, only seven (7.3%) were located within institutions reporting membership in the Association of Academic Health Centers, compared to eight of the 25 publicly sponsored programs (32%). In 1978, a large majority (estimated 43 of the 48 then-existing PA programs) received their start-up or continuing funding through the US Public Health Service, Section 747 Title VII program, whereas in 2012 there were far fewer (39 of 173). The finding of a preponderance of private institutions may correlate with the trend of PAs selecting specialty practice (65%) over primary care. Specialty choice of graduating PA students may or may not be related to the disproportionate debt burden associated with attending privately sponsored programs, where the public-to-private tuition difference is significant. Moreover, the waning number of programs participating in the Title VII grant process may also have contributed to the overall rise in tuition rates among PA educational programs due to the loss of supplemental funding.

Assessing the value of dual physician assistant/public health degrees.

The popularity of dual physician assistant/master of public health degree programs continues to increase within US physician assistant (PA) education. The advantages and disadvantages of pursuing dual degree training have not been fully explored in the PA literature. Potential advantages of dual training include broadening of the student's perspective on health and health care beyond the "one provider, one patient" medical model, increased training in evaluation and use of the medical literature, increased skill in assessing community factors that affect the health of patients, enhanced expertise in health care administration or policy, and improved prospects for future roles as PA faculty members. Potential drawbacks include increased duration and expense of PA/MPH education, student burnout due to prolonged training, and the lack of jobs that explicitly use both halves of the PA/MPH training.

Predictive modeling the physician assistant supply: 2010-2025.

OBJECTIVE: A component of health-care reform in 2010 identified physician assistants (PAs) as needed to help mitigate the expected doctor shortage. We modeled their number to predict rational estimates for workforce planners. METHODS: The number of PAs in active clinical practice in 2010 formed the baseline. We used graduation rates and program expansion to project annual growth; attrition estimates offset these amounts. A simulation model incorporated historical trends, current supply, and graduation amounts. Sensitivity analyses were conducted to systematically adjust parameters in the model to determine the effects of such changes. RESULTS: As of 2010, there were 74,476 PAs in the active workforce. The mean age was 42 years and 65% were female. There were 154 accredited educational programs; 99% had a graduating class and produced an average of 44 graduates annually (total n=6,776). With a 7% increase in graduate entry rate and a 5% annual attrition rate, the supply of clinically active PAs will grow to 93,099 in 2015, 111,004 in 2020, and 127,821 in 2025. This model holds clinically active PAs in primary care at 34%. CONCLUSIONS: The number of clinically active PAs is projected to increase by almost 72% in 15 years. Attrition rates, especially retirement patterns, are not well understood for PAs, and variation could affect future supply. While the majority of PAs are in the medical specialties and subspecialties fields, new policy steps funding PA education and promoting primary care may add more PAs in primary care than the model predicts.