Financial analysis of PA lifetime earnings and debt.

ABSTRACT: This economic analysis of physician assistant/associate (PA) career earnings sought to assess the increasing effect of student debt, its potential effect on job selection, and whether such financial obligations may influence graduates to select higher-paying specialties. The model was a 30-year-old newly graduated PA who begins working in family medicine. A simulation included wages, student debt, national household expenditures, and real estate statistics. The scenario consisted of a high and middle cost of living in two geographic areas, a family of four, and an average life expectancy. Using a validated economic program, a series of calculations produced the financial effect on moderate-income levels and expenditures based on median PA earnings. On the deficit side is education debt, loan repayment, financing a house, college for children, retirement, and discretionary spending. Weighted variables were used to maximize the sensitivity effect of the simulation. A Monte Carlo probabilistic program predicted the likely outcome of income, expenses, inflation, and investments. Furthermore, the lifetime earnings of a PA who retires at age 67 years and lives to age 85 years falls in the 75th percentile of income of all Americans. The conclusion is that a full-time PA career in any clinical role is as economically rewarding as it is satisfying.

Financial analysis of PA lifetime earnings and debt.

ABSTRACT: This economic analysis of physician assistant/associate (PA) career earnings sought to assess the increasing effect of student debt, its potential effect on job selection, and whether such financial obligations may influence graduates to select higher-paying specialties. The model was a 30-year-old newly graduated PA who begins working in family medicine. A simulation included wages, student debt, national household expenditures, and real estate statistics. The scenario consisted of a high and middle cost of living in two geographic areas, a family of four, and an average life expectancy. Using a validated economic program, a series of calculations produced the financial effect on moderateincome levels and expenditures based on median PA earnings. On the deficit side is education debt, loan repayment, financing a house, college for children, retirement, and discretionary spending. Weighted variables were used to maximize the sensitivity effect of the simulation. A Monte Carlo probabilistic program predicted the likely outcome of income, expenses, inflation, and investments. Furthermore, the lifetime earnings of a PA who retires at age 67 years and lives to age 85 years falls in the 75th percentile of income of all Americans. The conclusion is that a full-time PA career in any clinical role is as economically rewarding as it is satisfying.

PAEA End of Rotation™ Exams Accurately Identify Students at Risk of Physician Assistant National Certifying Exam Failure.

PURPOSE: Physician Assistant Education Association (PAEA) End of Rotation™ exams are used by programs across the country. However, little information exists on the predictive ability of the exams' scale scores and Physician Assistant National Certifying Exam (PANCE) performance. The purpose of this study was to evaluate End of Rotation exam scores and their relationship with poor PANCE performance (PPP). METHODS: In an IRB-approved, multi-center, multi-year study, associations between PAEA End of Rotation exam scale scores and PANCE scores were explored. A taxonomy of nested linear regression models with random intercepts was fit at the program level. Fully adjusted models controlled for year, timing of the exam, student age, and gender. RESULTS: Fully adjusted linear models found that 10-point increases in End of Rotation exam scores were associated with a 16.8-point (95% confidence interval [CI]: 14.1-19.6) to 23.5-point (95% CI: 20.6-26.5) increase in PANCE score for Women's Health and Emergency Medicine, respectively. Associations between exams did not significantly vary (P = .768). Logistic models found End of Rotation exam scores were strongly and consistently associated with lower odds of PPP, with higher exam scores (10-point increase) associated with decrements in odds of PPP, ranging between 37% and 48% across exams. The effect estimate for the Emergency Medicine exam was consistently stronger in all models. CONCLUSIONS: PAEA End of Rotation exam scores were consistently predictive of PPP. While each End of Rotation exam measures a specialty content area, the association with the overall PANCE score varied only by a change in odds of low performance or failure by a small percentage. Low End of Rotation exam scores appear to be consistent predictors of PPP in our multi-center cohort of physician assistant students.

Crafting a Profession: Moving From Innovative Model Programs to a Successful National Profession.

The authors review the historical underpinnings of the physician assistant (PA) profession and the tumultuous social context at the time the PA profession was born. They explore the creation of "model" PA programs and the subsequent crafting of the PA profession through 2 distinct "quality control" procedures: the credentialing of PA programs (accreditation) and the credentialing of PA graduates (certification). These pillars of PA education and PA practice brought credibility to a fledgling profession in its early years and stand today as examples of the creative thinking and courage of the architects of a profession that, for the first time in American medical history, allowed someone, other than physicians, to practice medicine.

Board Review Course as Intervention: Impact on PANCE Performance.

PURPOSE: To analyze the effectiveness of an independent commercial 3-day Physician Assistant National Certifying Examination (PANCE)-Physician Assistant National Recertifying Examination (PANRE) board review course to improve first-time pass rates on the PANCE. METHODS: Data were extracted from academic files at 2 universities over 2 years. In the first year (2014), the universities had not implemented a requirement for participation in a commercial board review course. In the second year (2015), both universities required participation in the course. There were 116 students at Idaho State University and 85 students at the University of Utah. RESULTS: Multiple regression analyses with PANCE score as the outcome variable were conducted with number of days to PANCE, number of practice tests, location of review course, Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) II performance, first-time PANCE pass rates, and first-time PANCE scores. After controlling for demographics, PACKRAT II scores, and students' home university, the study found that participation in the board certification course did not seem to affect student performance on the PANCE (R change = 0.000, p = .728). Post hoc analysis revealed a significant main effect for number of tests (F(3,94) = 3.35, p = .022, (Equation is included in full-text article.)= 0.097). Although not statistically significant, differences between on-site and off-site attendance may be of practical significance. CONCLUSIONS: There were no significant differences in PANCE performance of PA students who participated in a program-sponsored board review course and the performance of those who did not participate the previous year. We offer suggestions for future research to maximize the utility of a board review course.

The changing physician assistant profession: a gender shift.

The physician assistant (PA) movement originally served as an avenue for male veterans to transition into the civilian workforce. After a half-century of development, the profession in the United States is now predominantly female and nonveteran. Using archival data and other resources, this article documents the influences on gender and age shifts in the PA profession with related policy perspectives. Now entering its sixth decade, the profession continues to evolve as demand for PA services outpaces supply.

What do we know about retired physician assistants? A preliminary study.

Retirement generally means the complete end of employment. Retirement is a new phenomenon for physician assistants (PAs), as those trained in the 1970s exit their careers. To better understand retirement patterns of PAs, we undertook a survey in 2011 using a national database. A cadre of 625 respondents met the criteria of being retired and living; the mean age of PA retirement was 61 years (range 47-75 years). Duration of a PA career was 29 years on average (range, 10-40 years). Forty-three percent of respondents retired from family/general medicine and 11% from emergency medicine. Almost all reported receiving Social Security and Medicare; most had some form of a pension. Fewer than one-fifth retired for health reasons. When asked about the timeliness of retiring, 20% wished they had retired later in life; 4% of the men and 7% of the women thought they should have retired earlier; 74% of the men and 73% of the women said they had retired at the right time. Reasons for retiring varied widely. Approximately one-quarter reported volunteering in a medically-related capacity. We suggest that retirement is a concept undergoing evolution in American society and that PAs represent a health profession that reflects the complexity of this evolution.

Pandemic (H1N1) 2009 influenza in hospitalized children in Manitoba: nosocomial transmission and lessons learned from the first wave.

OBJECTIVE: To review the experiences at Winnipeg Children's Hospital (WCH) during the 2009 influenza season, with an emphasis on nosocomial transmission and infection prevention and control responses. DESIGN: A case series of patients admitted to WCH who had laboratory-confirmed cases of influenza between January 1 and July 31, 2009, with a comparison of patients with seasonal influenza and those with pandemic (H1N1) 2009 influenza; a review of the impact of infection prevention and control modifications on nosocomial transmission. PATIENTS AND SETTING: A total of 104 inpatients with influenza, 81 of whom had pandemic (H1N1) 2009 influenza, were reviewed at a large Canadian pediatric tertiary care center. RESULTS: There were no differences in risk factors, presentation, or outcome between patients with seasonal influenza and those with pandemic (H1N1) 2009 influenza. There were 8 nosocomial cases of pandemic (H1N1) 2009 influenza. Excluding patients with nosocomial cases, mean length of hospital stay was significantly shortened to 3.7 days for individuals who had pandemic (H1N1) 2009 influenza and who received empiric oseltamivir on admission to the hospital, compared with 12.0 days for patients for whom treatment was delayed (P = .02). Treatment with oseltamivir of all patients with suspected cases of influenza and prompt modifications to infection control practices, including playroom closures and enhanced education of visitors and staff, terminated nosocomial transmission. CONCLUSIONS: Infection with pandemic (H1N1) 2009 influenza virus resulted in a substantial number of hospitalizations of pediatric patients in Manitoba, including those with nosocomial cases, thereby stressing the capacity of WCH. Immediate therapy with oseltamivir on admission to the hospital resulted in a significantly reduced length of hospitalization. This, coupled with intensified infection prevention and control practices, halted nosocomial transmission. These strategies should be considered in future pandemic influenza or other respiratory viral outbreaks.

Factors associated with physician assistant practice in rural and primary care in utah.

Physician Assistants (PAs) have become an integral part of the United States (U.S.) health care system since the profession began in the late 1960s. PAs have been suggested as solutions to predicted physician shortages especially in primary care. This study examined the predictors of primary care and rural practice patterns of PAs in Utah. A cross sectional survey design was utilized. The outcome variables were practice specialty and practice location. The predictor variables were age, gender, number of years in practice, location of upbringing, and professional school of graduation. There was a response rate of 67.7%. The Utah Division of Occupational and Professional Licensing (DOPL) provided the list of licensed PAs in the state. Physician assistants who reported being raised in rural communities were 2.29 times more likely to be practicing in rural communities (95% CI 0.89-5.85). Female PAs had lower odds of practicing in a rural area (OR: 0.26; 95% CI: 0.10-0.66). Female PAs had lower odds of practicing in primary care versus their male counterparts (OR: 0.56; 95% CI: 0.33-0.96). Graduation from the Utah PA Program was more likely to result in primary care practice (OR: 2.16; 95% CI: 1.34-3.49).

Kinetic studies of unmodified individual Escherichia coli beta-galactosidase molecules in free solution.

Assays were performed on individual Escherichia coli beta-galactosidase molecules at 2 different concentrations of the substrate DDAO-beta-D-galactoside using a free zone capillary electrophoresis-based protocol with an in-laboratory-constructed instrument utilizing laser-induced fluorescence detection. In a typical run, 2 enzyme molecules were injected into the capillary. They were separated from each other by a brief period of electrophoresis and incubated on the capillary in the presence of the substrate. They were then mobilized on the capillary into a zone of substrate at a different concentration, re-incubated, and the product peaks mobilized past the detector . The relative change in activity as the concentration was increased differed between molecules, suggesting differences in Km. In a different experiment, the capillary was filled with on average 13 enzyme molecules per run, incubated, and the activities of the individual molecules determined. The shapes of the distribution curves of single molecule activities obtained at different concentrations of the substrate resorufin-beta-D-galactoside were indistinguishable, suggesting a homogeneous Km. To explain why individual enzyme molecules behaved as if they were heterogeneous with respect to Km but the population behaved as if it were homogeneous, theoretical Michaelis-Menten curves were constructed. The curves for populations with heterogeneous Km values were found to be indistinguishable from that of a homogeneous population.

Crystallization of beta-galactosidase does not reduce the range of activity of individual molecules.

By use of a capillary electrophoresis-based procedure, it is possible to measure the activity of individual molecules of beta-galactosidase. Molecules from the crystallized enzyme as well as the original enzyme preparation used to grow the crystals both displayed a range of activity of 20-fold or greater. beta-Galactosidase molecules obtained from two different crystals had indistinguishable activity distributions of 31,600 +/- 1100 and 31,800 +/- 1100 reactions min(-1) (enzyme molecule)(-1). This activity was found to be significantly different from that of the enzyme used to grow the crystals, which showed an activity distribution of 38,500 +/- 900 reactions min(-1) (enzyme molecule)(-1).