Diversity of PA cohorts during the evolution to an entry-level master's degree.

OBJECTIVE: This study evaluated the racial and ethnic diversity of physician associate/assistant (PA) graduating cohorts during the profession's transition from a standard undergraduate degree to an entry-level master's degree. METHODS: Using all existing program reports from the Physician Assistant Education Association (1985-2019), we explored potential associations between changes in tuition, degree types offered, and racial/ethnic makeup of graduating cohorts. RESULTS: We observed a strong negative association between Black students and graduates versus increasing tuition and the rise of master's level programs. CONCLUSIONS: More equitable opportunities for joining the PA profession may be needed.

Physician Assistants/Associates With Doctoral Degrees: Where Are They Now?

PURPOSE: The impact of holding a doctoral credential by clinically practicing physician assistants/associates (PAs) remains unknown. The purpose of this study was to investigate practice patterns and describe demographic characteristics of PAs who have terminal doctoral degrees. METHODS: This was a secondary analysis of data obtained from the 2021 Salary Survey of the American Academy of PAs. A total of 13,865 PAs responded to the survey for an estimated response rate of 13.3%. We examined the relationships between holding a doctoral degree, demographic characteristics, and work-related variables. Descriptive bivariate statistics and chi-square tests were used for data analysis. RESULTS: Most of the PAs (93.6%) with doctoral degrees were older than 30 years and self-identified as female (55%). There were higher proportions of non-White individuals among those with doctorates compared with general PA population. Of the PAs holding doctoral degrees, 90.4% were primarily clinicians and 9.6% were primarily educators. Physician assistants/associates with doctoral degrees were employed with their current employer longer than PAs without doctoral degrees. Most of the PAs with doctoral degrees held informal or formal leadership and had an annual salary above the median (62.3%) compared with PAs without doctoral degrees (40.0%). CONCLUSION: There are statistically significant differences in practice patterns and demographic factors between PAs with and without doctoral degrees. Physician assistants/associates with doctoral degrees were older, were male, and held leadership positions. Taken together, holding a doctoral credential may improve upward mobility at workplaces. Qualitative studies are warranted to further understand the motivation and impact of holding a doctoral credential among clinically practicing PAs.

PA Scholars: What Drives and Inhibits Success?

PURPOSE: The full expression of an educator includes scholarship, yet many physician assistant (PA) educators are not published. Several barriers unique to PA education are often cited to explain this phenomenon. However, some in the PA profession have become prolific writers despite working in the same environment. In this study, authors strove to understand what motivated these productive faculty by posing 2 research questions: (1) What are the drivers of success for high-performing PA scholars and (2) how do high performing PA scholars overcome barriers? METHODS: A qualitative study using a constructivist, grounded theory approach explored the experiences and motivation of PA-credentialed educators who published >5 peer-reviewed articles and whose body of work achieved an h-index of >3. RESULTS: High-performing scholars valued scholarship as a creative outlet and a rewarding pursuit. Scholars achieved a sense of fulfillment in their work. Research and writing were described as protective against burnout. Participants viewed barriers differently than other educators. Barriers were acknowledged, but participants developed strategies to overcome obstacles. Mentorship was seen as crucial to success. A nuanced understanding of PA research and the characteristics associated with high-performing PA scholars emerged. The study identified developmental stages associated with the formation of a scholar. CONCLUSION: Progression from prescholar to mature scholar has important implications for initiatives designed to increase scholarship and provides evidence to support the claim that scholarship positively affects job satisfaction, personal well-being, and talent retention.

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.

Characteristics of Hybrid Learning Among Health Professions Programs: A Mixed-Methods Study.

PURPOSE: To characterize current trends in hybrid education within the physician assistant (PA) profession, specifically program design, drivers, and outcomes in comparison with physical therapy hybrid education. METHODS: This was a mixed-methods study involving secondary data analysis and focused interviews with stakeholders to triangulate the data. RESULTS: Compared with traditional PA programs, hybrid programs have similar admission requirements, higher cost of tuition, larger class size, and higher attrition rate than national mean. Physician Assistant National Certifying Exam outcome data are in line or slightly lower than national scores. Technological advancements and need for faculty/learner flexibility by time and location are frequently cited driving forces. CONCLUSIONS: There is a growing trend toward hybrid education among health professions. Other than cost, attrition rate, and immersion experiences, characteristics of hybrids are similar to traditional programs. It is relevant for PA educators to understand how this educational design may shape the future of PA graduates. Long-term impact should be evaluated with future studies.

Thinking Outside the Box: Advancing Clinical Education in an Era of Preceptor Shortage.

ABSTRACT: The expansion of health professions educational programs has led to an acute shortage of available clinical training sites. Rapid growth in the number of medical schools, physician assistant (PA) programs, and advanced nurse practitioner (APRN) programs, all of which share a need for similar types of clinical training experiences, has increased competition for clinical training sites and placed new challenges on educational institutions. Solutions are urgently needed to increase the quantity and quality of supervised clinical practice experiences as well as to ensure diversity among preceptors and geographical clinical sites. This article identifies key barriers to securing sufficient clinical training sites, notes emerging trends, and presents potential innovations through stakeholder collaboration for enhancing clinical training across health professions.

Drugs in primary care that may alter COVID-19 risk and severity.

ABSTRACT: This article describes drugs used in primary care that could alter patients' risk for and severity of COVID-19. The risks and benefits of each drug class were differentiated according to the strength of evidence from 58 selected randomized controlled trials, systematic reviews, and meta-analyses. Most of the studies reported on drugs affecting the renin-angiotensin-aldosterone system. Other classes included opioids, acid suppressants, nonsteroidal anti-inflammatory drugs, corticosteroids, vitamins, biguanides, and statins. Current evidence has not fully differentiated drugs that may increase risk versus benefits in COVID-19 infection. Further studies are needed in this area.

Reasons clinical education directors intend to leave their jobs.

OBJECTIVES: The goals of this study were to characterize clinical coordinators compared to other Physician Assistant (PA) faculty, and investigate factors associated with intent to leave their position, institution, and academia in the U.S. METHODS: This was a secondary analysis of data obtained from the 2019 Physician Assistant Education Association (PAEA) Faculty and Directors Survey. We examined bivariate associations with faculty role and conducted multiple logistic regression to identify predictors of intent to leave among clinical directors. RESULTS: Clinical directors indicated an intention to leave their position more often than other faculty. Factors influencing intent to leave were a lack of satisfaction with professional development and moderate to high levels of burnout. Clinical directors with severe burnout had 27x the odds of intending to leave academia. CONCLUSIONS: Our results suggest why clinical directors intend to leave and underscore the need for professional development opportunities and faculty mentoring. Faculty-centered work arrangements are needed to reduce burnout among clinical directors.

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.

Accreditation in the Health Professions: Implications for Physician Assistant Education.

ABSTRACT: The accreditation process of health professions educational (HPE) programs is an essential ingredient in preparing a qualified healthcare workforce. Accreditation ensures that minimum standards are met by educational programs and contributes to pedagogical integrity, consistency, and academic policies and practices, leading to the desired quality of graduate outcomes. In this study, we analyzed key characteristics, policies, and practices for accreditation in 5 health professions to highlight emerging trends and discern implications for the physician assistant (PA) profession. There is growing evidence of movement toward outcome-based accreditation versus process-oriented accreditation and collaborative engagements between programs and the accreditors. Agencies are providing online discussion platforms and direct mentorship and, at the height of the coronavirus pandemic, offered virtual site visits. At an institution level, we observed a trend towards structured faculty development on accreditation, implementation of technology infrastructure for data collection, visualization and analysis, and the use of consultants for outsourcing certain elements of the accreditation process. There is a wide spectrum of approaches, from prescriptive to liberal, by the various accrediting agencies in enforcing compliance. A balance is desirable for the institutional-accreditor relationship to work effectively.

Academic leadership in physician assistant/associate medical education: a cross-sectional analysis of the association with doctoral degree, gender, and minority status.

BACKGROUND: There is a critical need for a diverse pool of academic leaders to increase the number and diversity of the medical workforce. Physician Assistant/Associate (PA) is a growing medical profession. Although the master's degree is the terminal degree for PAs, a growing number of PAs obtain a variety of doctoral degrees. However, there is no standardized training for academic PA leaders. The purpose of this study was to identify factors associated with PA academic leadership. Specifically, this study explored the following factors: doctoral degree credentials, gender and underrepresented minority status. METHODS: Using the 2019 Physician Assistant Education Association Faculty and Directors survey, we assessed the relationship between academic leadership groups [Program Director (PD), Academic Director (AD), and Clinical Director (CD)] doctoral degree, gender, and underrepresented minority in medicine (URIM) status. Multivariable logistic regression models were used to determine the predictors of being in a leadership role. Results with p < 0.05 were considered statistically significant. RESULTS: Of the 956 participants, 71% were female, 4% Hispanic, 86% White, 4% Black, 2% Asian, and 1% Native Hawaiian/Pacific Islander/American Indian/Alaska Native. Overall, 9% were URIM. Mean age was 45.6 (SD = 10.2) years. Average time in PA education was 2.9 years (SD = 1.4). Approximately 50% (n = 472) had a leadership role (PD-24%, AD-10%, CD-16%). Of all leaders, 68% were female, 9% were URIM, and 19% had a doctoral degree. Having a doctoral degree increased the odds of being a PD [AOR 2.38, CI [1.57-3.59], p = < 0.0001, AD and CD = non-significant]. More time in PA education increased the odds of being a PD [AOR 1.10, CI [1.07-1.12, p = < 0.0001] and AD [AOR 1.06, CI [1.03-1.09], p = < 0.0001], but not a CD. Gender and URIM status were not significantly associated with leadership roles. URIMs had doctorate degrees at higher rates than non-URIMs. CONCLUSION: PA academic leaders differ by doctoral degree attainment but not by gender and URIM status. URIM faculty are grossly underrepresented in the PA professorate, but disproportionately have doctoral degrees. Academic training opportunities for all PA academic leaders and strategies to increase URIM faculty are needed.

Assessing and benchmarking equity, diversity, and inclusion in healthcare professions.

ABSTRACT: Healthcare professions are among the fastest growing careers in the United States, but the issues of equity, diversity, and inclusion remain a challenge. The percentage of underrepresented minority groups is disproportionately small despite many efforts to increase workforce diversity over the past several decades. As the demographics in our nation are rapidly changing, increasing racial, ethnic, and cognitive diversity is crucial to achieving a workforce with the capacity to provide accessible and equitable healthcare. Given the growing evidence that a diverse workforce improves healthcare outcomes, fosters unique perspectives (cognitive diversity), and helps to reduce health disparities, there is an urgent need to address perennial barriers such as structural racism, biases, and stereotypes. Educational institutions should be held accountable to integrate equity, diversity, and inclusion in all aspects of healthcare professions education and practice. This article discusses potential areas for innovation and opportunities that can be leveraged in assessing and benchmarking equity, diversity, and inclusion in healthcare professions. The ability to thoroughly assess the PA profession's culture in relationship to diversity, equity, and inclusion provides an opportunity to determine how well the profession is performing, and to strategically plan for what else need to be done.

An assessment of physician assistant student diversity in the United States: a snapshot for the healthcare workforce.

BACKGROUND: The Physician Assistant (PA) workforce falls short of mirroring national demographics mainly due to a lack of diversity in student enrollment. Few studies have systematically examined diversity across PA programs at the national level, and little is known about best practices for consistently graduating a diverse group of students. We descriptively characterized the extent to which PA programs are graduating a diverse group of students and identified top performing PA programs. METHODS: Data from the Integrated Postsecondary Education Data System (IPEDS) were used to calculate the number and proportion of racial or ethnically diverse graduates. The study sample included 139 accredited PA programs that had graduated a minimum of five cohorts from 2014-2018. Within each of the United States Census Divisions, programs were ranked according to the number and proportion of graduates who were underrepresented minority (URM) race, Hispanic ethnicity, and of non-white (URM race, Hispanic, and Asian). RESULTS: Amongst PA programs in the United States, a large disparity in the number and proportion of racial and ethnic graduates was observed. Of 34,625 PA graduates, only 2,207 (6.4%) were Hispanic ethnicity and 1,220 (3.5%) were URM race. Furthermore, a large number of diverse graduates came from a small number of top performing programs. CONCLUSION: Despite the abundance of evidence for the need to diversify the healthcare workforce, PA programs have had difficulty recruiting and graduating a diverse group of students. This study provides empirical evidence that PA programs have not been able to attain the level of diversity necessary to shift the lack of diversity in the PA workforce. Based upon this study's findings, the top performing PA programs can be used as role models to establish benchmarks for other programs. The results of this descriptive study are currently being used to guide a qualitative study to identify the top performers' strategies for success.

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.

A survey of implicit bias training in physician assistant and nurse practitioner postgraduate fellowship/residency programs.

BACKGROUND: There has been renewed focus on advancing inclusivity within organized medicine to reduce health disparities and achieve health equity by addressing the deleterious effects of implicit bias in healthcare and clinical outcomes. It is well documented that negative implicit attitudes and stereotypes perpetuate inequity in healthcare. The aim of this study is to investigate implicit bias training in postgraduate physician assistant (PA) and nurse practitioner (NP) education; describe delivery of content to trainees; and detail program directors' attitudes toward this type of training. Although there is research examining implicit bias training in physician residency education, there are no published studies on implicit bias training in postgraduate PA and NP postgraduate residency/fellowship programs. METHOD: A non-experimental, descriptive study was designed to obtain information via survey from members of the Association of Postgraduate Physician Assistant Programs (APPAP). RESULTS: The response rate was 41%. The majority of respondents (76%) felt that PA and NP postgraduate programs should include implicit bias instruction. Educational strategies used by PA and joint PA/NP postgraduate programs or their sponsoring institution to deliver implicit bias content to trainees include: implicit bias training modules (50%), facilitated group discussions (36%), invited speaker on implicit bias (33%), case studies on implicit bias (16%), and implicit association test (10%); however, 30% of postgraduate programs do not provide implicit bias training to PA and/or NP trainees. Barriers to implementing implicit bias training expressed by some postgraduate programs include: uncertainty in how to incorporate implicit bias training (16%); lack of strategic alignment with training program or sponsoring institution (13%); time constraints (10%); financial constraints (6%); lack of access to content experts (6%); and unfamiliarity with evidence supporting implicit bias training (6%). CONCLUSION: The present study sheds some light on the current state of implicit bias training in PA and joint PA/NP postgraduate residency/fellowship programs. While the majority of programs offer some sort of implicit bias training, there is a need to standardize this training in PA and joint PA/NP postgraduate education curricula using an actionable framework.