Donald M. Pedersen

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).

Marketplace Demand for Physician Assistants: Results of a National Survey of 1998 Graduates

Introduction: The marked increase in the numbers of annual PA graduates over the past five years, coupled with the continuing output of new physicians and the significant expansion of other nonphysician professions, have raised questions regarding the current and future marketplace demand for PA graduates. There is a need to gather data on the initial employment experiences of PA graduates. Methods: We conducted a national cross‐sectional survey of 1998 PA graduates using a mailed questionnaire to assess their experiences in searching for initial PA employment and perceptions of market demand. A random sample of 1,500 subjects were administered a questionnaire comprising three categories: demographics, initial employment experiences, and perceptions of marketplace demand. In the perception portion of the study, 10 statements were posed to participants to assess their views of their search for initial employment and perceptions of the marketplace demand for PAs in their region. Results: Of respondents (N = 723), 66% were women; the mean age was 32 years; the range of ages was 21‐59 years; 14% were racial/ethnic minorities. Nearly all in the sample were eligible for employment as PAs. Of 723 who responded to the survey, 715 actually sat for the PANCE exam, and 697 (96.4%) passed. A strong majority, 664 (92%) of respondents, had found employment as a PA by the time they completed the survey; of the 664 positions held, 600 (90.3%) were full‐time positions. Respondents attended a mean of 3.18 job interviews, and received an average of 2.07 job offers. A majority of respondents, 539 (81.1%) of those who had secured jobs either full‐time or part‐time, secured employment within the first 8 weeks after graduation. Only 8%, or 57 respondents, indicated that they were not employed as PAs, 47 of whom had passed the PANCE. Responses varied considerably according to region (APAP Consortium regions) and by state. While respondents tended to be somewhat dissatisfied with the number of job offers presented to them (mean rating 2.5), they appeared to be more satisfied with the salary level (mean 3.4) and benefits (mean 3.5) of the position they accepted. Conclusions: The vast majority of 1998 PA graduates found employment as a PA— most of these within 8 weeks after graduation. This finding is identical to that observed in our survey of 1997 graduates. There were 91.8% (664 of 723) employed as PAs at the time of the survey among 1998 PAgraduates, versus 92.2% (657 of 712) reported in a survey of 1997 PA graduates. There appeared to be a perception, in particular among respondents on the east and west coasts, that the PA job market was not strong. Respondent perceptions revealed dissatisfaction with the number of job offers presented to them (mean rating of 2.5), disagreement with the notion that there were plenty of jobs (mean rating of 2.40), and disagreement with the idea that the job market is strong (2.06). Further study of the initial experiences and marketplace perceptions of recent PAgraduates should continue in a time of a fast and vastly changing medical care environment.

Rainforest Physician Assistants--The Papua New Guinea Health Extension Officer: An International Physician Assistant Analogue.

The physician assistant (PA) profession is one approach to addressing access to health care globally. This cadre has a potential role in providing health care and expanding training capacity in the developing world. Ultimately, the skill set and training of PA-type personnel is more likely to be the nearand mid-term solution to health worker shortages, particularly in low-income areas. This article discusses a lesserknown PA analogue, the health extension officer (HEO) of Papua New Guinea (PNG), and the country’s collaboration with a US PA program. This article also provides thoughts on the direction of the PA analogue profession. One of the unique aspects of the PA concept is that it is adaptable to the specific health needs of other nations. Although the PA profession is most developed in the United States, the concept of “an assistant or extender to the doctor” is not unique to the United States. Dating back to at least the 1600s under various titles, nonphysician clinicians (NPCs) exist across the globe. The Russian “feldsher,” the French “officier de santé,” and the Puerto Rican “practicante” are some examples. More current types include nurse practitioner, registered clinical officers (RCOs), tecnicos medicos, and, like in PNG, HEOs. Nonphysician clinicians can be critical to the health care of a country where there may be few doctors to provide health care. For example, in some sub-Saharan African nations, the number of NPCs equals or exceeds the number of physicians. There is a wide variety in the types of NPCs in these African countries. Nonphysician clinicians can be classified by title, basic entrance requirements, years of preservice education, internship, and scope of practice. Standardization of the PA analogue role is challenging, and there is no current World Health Organization category for PAs. Academic competencies and training programs for the PA-like clinician may be different in various countries, depending on the needs of the country. US PAs are often distinguished by their physician–PA relationship, where PAs exercise autonomy in medical decision making with physician supervision. Nonphysician clinicians, like PAs, evolvewhen the health care needs and resources of the country require them. The goal is to improve access to health care, along with the appeal of reduced cost and length of training. In PNG, HEOs are the rural health providers.

Human resources for health: a needs assessment of the Nepal health assistant - a physician assistant analogue?

InMarch2013, theUniversity ofUtah’sGlobal Partners, housed within the School of Medicine’s Department of Family and PreventiveMedicine, embarked on a needs assessment of the health assistant (HA)profession inNepal as a response toEarle Canfield’s request to the Physician Assistant Education Association (PAEA). Canfield, a US physician assistant PA working in Nepal, felt that the timing was right to connect his experience and contacts within Nepal with US PA educators to enhance health care in Nepal. Thirteen years earlier, he founded AmericanNepali Students and Women’s Education Relief (ANSWER), a nongovernmental organization that supports and educates hundreds of marginalized children in 120 Nepali schools and colleges. ANSWER educates in many disciplines including allied health professionals. During the construction of Nepal Health Care Cooperative’s (NEHCO’s) first of 5 regional hospitals in Kathmandu, Canfield considered that this health system might be an avenue by which rural health care could be simultaneously improved. Earle, with the assistance of American-trained PAs in Kathmandu, Krishna Gurung and Stephen Knoble, thought that, with little additional resources, a PA-styled training programcouldbe included. Problemsof caste, poverty, truncated education, and the shortcomings of ruralmedical care delivery in Nepal might be partly addressed by advancing the HA profession, which is similar to the US PA profession. In rural Nepal, there exists an acute need for adequately trainedandavailablehealth careworkers.HAs commonlywork in rural health posts and urban areas. Canfield requested assistance from theAmericanAcademyof PhysicianAssistants (AAPA) who referred the request to PAEA. In addition, he made an appointment with NEHCO administrator Dr Ram Prasad Shrestha who became amajor player and advocate for enhancing the HA profession in Nepal. Dr Shrestha was trained in Russia before medical schools existed in Nepal. As a highly regarded physician and surgeon, he had wide experience across Nepal in rural and urban settings with many administrative offices and clinical appointments, and was familiar with the HA program that predated Nepali medical schools. With his invaluable contacts and wide-ranging experience, Dr Shrestha had the capacity to be a champion for Canfield’s cause. After meeting with Canfield in May 2013 at the conference where he received the AAPAHumanitarian Award for his work in Nepal, Global Partners promoted the idea of Dr Shrestha for a US fact-finding visit to demonstrate the US model of the PA profession.

Educational debt: does it have an influence on initial job location and specialty choice?

Purpose: This study applied a quantitative design and analyzed the impact of educational debt on initial specialty and location choices for physician assistant (PA) graduates in Indiana. Methods: PAs who graduated between January 1, 2000, and December 31, 2010, and actively practice in Indiana were surveyed. Descriptive statistics and chi‐square analyses were performed to determine whether any significant relationships existed among practice specialty, location, and gender. Results: 157 participants (33%) responded to the survey and were considered in the final analysis. Males were more likely than females to be influenced by debt in choosing their specialty and the location of their initial job. A majority of PAs would have reconsidered rural practice if they had received federal and or state loan forgiveness for educational debt. Conclusion: This study provides evidence that debt may influence practice specialty and location choice. Further studies are needed to determine how gender might account for decisions to practice in certain specialties and location.

Remembering Our Past to Assure Our Future

2003 ¶ Perspective on Physician Assistant Education ¶ Volume 14, Number 2 The military cemetery at Fort Douglas in Salt Lake City, Utah provided the backdrop on a glorious July afternoon to recall the origins of the physician assistant profession. Nearly 200 individuals joined the faculty, staff, students, and alumni of the University of Utah’s physician assistant program on this hallowed site to unveil a tribute to combat medics and corpsmen and the role they played in the birth of the physician assistant profession. I’ve narrated the ceremonoy in the following pages. It is my hope you enjoy it as much as all who were able to attend. The Last Word ...

Thailand International Elective (TIE): A Model Curriculum in International Health And Cross-Cultural Experience

The Journal of Physician Assistant Education | 2006 Vol 17 No 3 INTRODUCTION Physician assistants (PAs) are becoming well known on a global scale, with the creation in the last few years of new programs in England, Canada, the Netherlands, and elsewhere. Additionally, according to a survey by the PAEA International Affairs Committee (IAC), 50 counties have been identified where PA students had completed clinical rotations.1 It is important that students understand international health care issues, not only to work internationally, but also to effectively deal with an increasing number of foreign patients in US practice settings. The IAC survey also indicated that 68% of PA program respondents reported that they monitor and approve their international rotations similarly to their programs’ clinical rotations within the United States. The remaining 32% of programs, however, which showed a more laissez faire attitude, are a cause for concern, and their students could be placed at substantial risk if accreditation standards for clinical sites are not followed regarding clinical placements. After 8 years of experience placing PA students internationally for clinical experiences with variable results (based on student and preceptor rotation evaluations), the University of Utah Physician Assistant Program (UPAP) embarked on a comprehensive approach to preparing individuals to work internationally through its Thailand International Elective (TIE). The following precepts were considered while developing TIE:

The Clinical Use of Personal Digital Assistants by Physician Assistants and Physician Assistant Students in the Primary Care Setting

Purpose: Few studies have been published regarding the use of personal digital assistants (PDAs) as a medical reference by physician assistants (PAs) and PA students in family practice. The purpose of this study was to assess and compare the utilization of medical programs that can be referenced on PDAs by PAs and students in the state of Utah. Methods: An e‐mail survey was sent to a non‐randomized group of the 32 second‐year PA students and a randomized group of 40 certified PAs. We measured the percentage of students and PAs consulting medical PDA programs, the specific program(s) used by each group, the frequency of consultation, and the overall value of PDAs as perceived by the users. Specific medical programs are those that acted as clinical reference tools, allowing the PA (or student) to improve patient care. The medical program category was broken down into three areas: drug reference, clinical reference, and calculator programs. Results: Sixty‐eight percent of students and 70% of PAs responded. All students and 79% of PA respondents used a PDA daily for patient care. The drug referencing programs were by far the most popular. EPocrates was the most common program. Clinical reference programs and medical calculators were more popular; both were used with greater frequency by the students. Griffiths Five Minute Clinical Consult (5MCC) was the most popular clinical reference program and MedCalc the most popular medical calculator. Students also placed a greater value on the PDA medical programs, although the difference relative to practicing PAs was not statistically significant (p>.05). Conclusion: Results of this study indicate that the programs in each of the three program classes—drug reference, clinical reference, and medical calculator— were highly popular. The student group used the drug reference programs more frequently. Clinical reference programs were more popular with the students, who used them more frequently, but not daily. Both groups felt that, unlike the drug programs, the clinical and calculator programs did not require daily use. Students perceived the programs to be of more value in regards to improving patient care.

Designing and Implementing a New Course for Physician Assistant Students on the Arts and Medicine

&NA; The authors developed an 8‐hour course for first‐year physician assistant students, The Arts and Medicine, with the goal of helping them become more familiar with and appreciative of the role arts can play in the lifelong education of a physician assistant. Each of four 2‐hour sessions used the format of a theatrical play, with a musical overture. Act One divided into 2 or 3 scenes, an intermission (break), and Act Two, with 2 or 3 additional scenes. The course exposed students to literary, visual, and performing arts and used both lecture and group discussion methods. The course evaluation included a comparison of student pre‐ and post‐assessment of how they valued the course goal and asked students to assess whether the course met expectations as defined by them. Using a 4‐point scale (4=excellent), the overall course evaluation was 3.3. Based on the assessment of goals and expectations plus the overall rating, this course will continue to be offered.