P. Eugene Jones

Workweek restrictions and specialty-trained physician assistants: potential opportunities.

The increasing use of physician assistants (PAs) in surgical settings is part of a continuing trend of PA specialization, and many graduate medical education (GME) programs in teaching hospitals have hired PAs to augment physician housestaff duties. PAs have been shown to be effective in these roles by contributing to the continuity of care and enhancement of resident educational experiences. One strategy for educating and training specialty PAs to help augment perioperative surgical workforce needs for acute and critically ill patients is PA postgraduate training programs, which are typically offered as formal 1 year experiences following entry-level PA education and based on the GME model. Many academic health centers (AHCs) are well positioned to host such educational programs by collaborating with PA educators to develop additional surgical postgraduate training programs. We propose a model to produce an increased supply of specialty-trained PAs to serve as permanent hospital-based clinicians who could enable surgical residency training programs to meet critical resident education and operative experience needs by providing team-oriented and physician-supervised perioperative care.

A Comparison of Behavioral and Multiple Mini-Interview Formats in Physician Assistant Program Admissions

Purpose: The interview remains a widely used tool in health professions program admissions. The purpose of this study was to compare the use of a behavioral interview format with the multiple mini‐interview format in measuring desired noncognitive behaviors. Methods: This dual cohort, observational, comparative study used a polytomous ratingscale model to analyze the results from two homogeneous groups of physician assistant (PA) program applicants (total N = 176). One group (n = 93) participated in two 20‐minute behavioral interviews conducted by two raters per interviewee. The behavioral format included questions related to past behaviors and performance as a way to identify latent professionalism characteristics. The second group (n = 83) completed ten separate 7‐minute stations with one rater per station. Each of the mini‐stations assigned a specific topic and/or task to be completed. The score distributions related to applicant performance and station difficulty were plotted using Rasch analysis software. Results: The behavioral interview format and multiple mini‐interview had similar model fit. The behavioral interview did not adequately measure differences in applicant characteristics. In contrast, the multiple mini‐interview measured more variation in noncognitive traits and identified better matching of station difficulty and person ability. Conclusions: In this study the multiple mini‐interview format was a more reliable admissions tool in detecting latent professionalism attributes among PA program applicants. The multiple mini‐interview format appeared to measure professional potential and organizational fit better than the behavioral interview format. A larger study across several programs may provide additional support for these findings.

Physician Assistant Faculty Retirement Intentions

Purpose: To collect and analyze data from a national sample of physician assistant (PA) educators to determine their retirement intentions and the potential need for faculty workforce replacement. Methods: Inclusion criteria resulted in an eligible sample of 1,030 faculty. Participants received an individually addressed e‐mail containing a link to a Web‐based survey, followed by a group thank you and reminder request sent 4 weeks later. Descriptive and comparative cross‐tabular analyses were performed. Results: Completed surveys were obtained from 445 faculty, for a response rate of 43%. Gender variability was noted in several categories, and of particular concern was the finding that although 45% of female respondents would ideally like to retire under age 62 (compared to 23% of males), 27% of females age 55 or older felt they could never afford to retire (compared to 8% of similar‐aged males). The most important personal retirement decision factor was assurance of a satisfactory income (88%), and the most important academic decision factor was classroom contact with students (55%). The option to retire early if offered was something that a plurality (42%) of faculty were uncertain about. Conclusions: Although this study reflects strong faculty concern for personal health and financial status prior to considering retirement, it also suggests the need for education in terms of financial and health benefits planning and the need to examine the gender differences in many response categories. There does not appear to be a large cohort of faculty on the verge of retirement. Some findings have implications for PAEA annual conference content planning.

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

&NA; 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.

Doctoral Degrees for PAs: Questions and Issues

The notion of doctoral degrees in the physician assistant (PA) profession is emerging as a controversial and polarizing subject. This topic has surfaced in part due to health professions seeking greater levels of status and acceptance and in part due to changing conceptualizations of doctoral-level education. As an indication of the growing interest surrounding this issue, Maj. Leonard Gruppo, PA-C, in this issue of Perspective, calls for the award of a clinical doctoral degree to PAs who complete postgraduate specialty training programs. While some in the profession may regard such a degree as a marker of academic and professional advancement, there are a number of significant questions related to doctoral education in the PA profession that should be addressed. (Clinically oriented professional doctorate degrees for PAs should be distinguished in these discussions from the more traditional academically oriented doctoral degrees obtained by PA educators. Such degrees, and the need for faculty to be prepared with them, are discussed elsewhere in this journal.) The emerging discussion about doctoral degrees for PAs stems from the inflationary spiral of credentials, diplomas, and certificates that health professions have pursued over the past century. 1 Medicine was the leader in the development of professional degrees in the early part of the 20th century, followed by law and several other professions. These professions sought to establish themselves among others by setting the doctoral degree as the entry-level credential awarded. Most of these doctoral degrees were typically regarded as “professional” doctorates, as opposed to the traditional academic type, which typically required production of a thesis that represented an original inquiry into a topic in the field. By tradition, receipt of a doctoral degree “implies recognition of the candidate as an equal by the university faculty under which he or she has studied.” 2 In the dependent clinician role that is the cornerstone of PA practice, the physician-PA team relationship may be undermined if clinical PAs perceive their doctoral degrees to be equal to the MD or DO degree. In some sense, a clinical doctorate already exists for PAs—it is called an MD or a DO. But, it may be argued, most of the health professions have opted to select a professional doctorate, one based on the ability to provide clinical services, as the preferred type of entry-level credential. Often such degrees include a substantial portion of clinical courses and experiences and do not require a thesis. Most, if not all, of the health care professions that are regarded as equivalent in status to the PA profession have now established their entry-level credential on the doctoral level: over the years, podiatry, audiology, physical therapy, optometry, and pharmacy have moved to award a professional practice-based doctorate. Nursing has announced that it will now move toward requiring the doctor of nursing practice (DNP) for all advanced practice nurses, with an implementation deadline date of 2015. 3

Thematic analysis of personal statements in physician assistant program admissions

Purpose: The written personal statement is widely used in health professions program admissions. The purposes of this study were to identify the common themes manifesting in the personal statements of physician assistant (PA) program applicants and to measure the odds of matriculation while controlling for other admission covariates. Methods: This study was a retrospective mixed‐method observational study of CASPA admissions data. From the aggregate pool of 14,682 CASPA applications in the 2009–2010 admissions cycle, we randomly selected a subset of 600 unique de‐identified applicants with complete application data. We coded the major themes and subthemes for each personal statement. We then performed maximum likelihood logistic regression analysis that compared the odds of matriculation based on the major themes and known cognitive admission variables. Results: We identified eight major themes including altruism and the desire to help people, challenges and hardships, experience, key accomplishments, personal characteristics, positive perception of PA career attributes, role models, and a religious or spiritual quest. The only major theme increasing the odds of matriculation was role models, specifically exposure to a PA role model. Grade‐point average far exceeded all other variables influencing the odds of matriculation. Conclusions: In this study, we found the personal statement to be an unreliable tool for predicting successful PA program matriculation.

The Doctoral Pipeline in Physician Assistant Education

Purpose: This study examined the intentions and motivations of PA faculty regarding the pursuit of doctoral education in 2003. Variables assessed included the characteristics of faculty and the educational programs they were pursuing, including type of program and degree awarded, delivery methods, and presence or absence of institutional support. Projections were made based on the anticipated dates of graduation. Methods: A 15‐item Web‐based survey was sent to PA faculty identified via the Association of Physician Assistant Programs (now the Physician Assistant Education Association) faculty directory. Results: The response rate was 66.8%, with 20% of these enrolled in doctoral study. Of those currently enrolled, 48% were pursuing a doctor of philosophy (PhD) degree, 80% had 10 years or less as PA faculty, 48% attended on campus, 80% expected project completion by 2006, and 21% reported no institutional support. Of the faculty not enrolled, 41% were investigating programs, 5% planned to submit applications in the next 6 months, and 3% anticipated enrollment in the next 6 months. Conclusions: The population of doctorally prepared PA faculty will nearly double by the year 2010, with the majority completing PhD degrees via on campus delivery. While a significant number of faculty are investigating programs, few anticipate enrollment in the near future, which would result in minimal growth in the number of doctorally prepared faculty beyond 2010.

An Investigation of Potential Criteria for Ranking Physician Assistant Programs

&NA; Masters degree‐level physician assistant (PA) programs have been ranked by U.S. News & World Report since 1998. While both the general idea of ranking PA programs and the particular process used have been criticized, there has been no formal study of PA education on the issue. We undertook a survey of PA program directors to identify program characteristics that would best objectify reputations. One hundred and twenty‐six program directors were mailed a 75‐item survey in the fall of 2000 and 95 responded (75%). The most notable aspect of the survey results was the lack of agreement on what PA program attributes should be measured. The greatest agreement was on faculty‐to‐student ratio, graduation rate, student attrition rate, and PA National Certifying Examination (PANCE) scores. Agreement was almost unanimous that program rank should not be a component of the accreditation process. In spite of the human need to compare and contrast, there is little agreement among PA program directors on the elements that should be used for a programs ranking. Without near‐unanimous support across PA programs for internally developing objective scores for PA ranking, we conclude this aspect of PA education will be left to outside agencies and organizations.

The Texas health workforce benefit of military physician assistant program veterans.

Purpose: Little is known about the benefits to society of the educational development of health personnel in the military who return to civilian life and continue their careers. The US Department of Defense has produced physician assistants (PAs) since the early 1970s, and PA training is now consolidated into one location in Texas as the Interservice Physician Assistant Program (IPAP). We studied redistribution of PAs upon service departure to determine if IPAP attendance had an effect on the Texas PA workforce. Methods: The Texas Medical Board dataset of licensed PAs was examined to identify program attended, practice specialty by supervising physician designation, practice location, and primary care or specialty care practice designation. Primary care was defined as family medicine, general pediatrics, or general internal medicine. All other designations were classified as specialty practice. Results: Of 6,016 licensed Texas PAs, 425 (7.0%) reported attending a military PA training program. Of the 254 PAs in full‐time civilian clinical practice, 148 (58.3%) reported practice in primary care settings, and 106 (41.7%) reported specialty clinical practice settings. Discussion: With the average military officer retirement age of 47 years and the 2010 average US retirement age of 64 years for men and 62 for women, an estimated 16 years of community workforce productivity is provided per veteran PA following completion of military service. We estimated over 47,000 outpatient visits are provided per PA following military service. The care provided can be measured as a positive return‐on‐investment of taxpayer‐provided education.

Physician Assistant Education: Will We Meet the Need?

&NA; Recent findings projecting an increased demand for PAs in the US workforce, coupled with a looming shortage of adequately prepared PA faculty and an already high faculty turnover rate, justify a discussion on how to approach these issues from the perspective of faculty preparation and development. Taking into consideration the current and projected growth rate of PA training programs, the increasing demand for PA faculty will result in an average of approximately one doctorally prepared PA faculty member per US program, at a time when most programs have either converted to or commenced with a masters degree curriculum. Until we have a better understanding of clinical PA roles and relationships, our curricular approach to educating PAs will remain based on anecdotal and empirical experiences derived from the medical school model. Doctoral programs in PA education would help define, clarify, and advance the PA profession by codifying the body of attributes, roles, and knowledge unique to the profession.