Richard W. Dehn

Ambulatory and chronic disease care by physician assistants and nurse practitioners.

As the US population increases and ages, more patients require care. A reengineered health care system relies on physician assistants and nurse practitioners; however, the extent to which they care for medical conditions is marginally known. We analyzed ambulatory visits by provider type and diagnosis focusing on chronic diseases to identify differences in patients seen by each type of provider. Both physician assistants and nurse practitioners attended 14% of 777 million weighted visits. Overall, diabetes and hypertension accounted for 2% to 4% of visits. The distribution of visits for chronic disease diagnoses appears to be similar for all 3 providers (physicians, nurse practitioners, and physician assistants). These findings may improve organizational efficiency in ambulatory systems.

Physician Assistant Program Director Opinions Regarding the Importance of Faculty Research and Publication

Purpose: Over the last decade, rapid growth in the number of physician assistant (PA) programs has strained our professions ability to supply sufficient numbers of well‐prepared faculty members. As the profession shifts towards an entry‐level graduate degree, PA educators—generally recruited out of clinical practice—are feeling more pressure to be involved in traditional scholarship activities. The goal of this portion of a two‐part study was to elicit opinions from PA program directors regarding the importance of, and barriers to, successful publication by their faculty members. Methods: A written survey instrument on various issues surrounding research and publication by faculty members was administered to directors of all accredited PA programs in May 2002. Results: PA program directors rated their priorities for faculty duties in the following order: (1) classroom teaching, (2) service and administrative duties, (3) clinical practice, and (4) research and academic scholarship. Program directors felt that faculty should ideally spend about 15% of their time on research activities. The factors felt to have the largest detrimental effect on publication success were: lack of time due to teaching or other responsibilities, lack of training in research design, and lack of previous experience with successful publication. Creation of set‐aside time dedicated to research and writing was considered the most important factor for promotion of faculty scholarship. Conclusions: Although program directors consider research and publication to be compatible with institutional priorities and very important to the profession as a whole, these activities are generally given a lower priority than other faculty duties.

The Distribution of Physicians, Advance Practice Nurses, and Physician Assistants In Iowa

The geographical distribution of health care providers across populations is of interest to American health policy researchers. While population-to-provider ratios may indicate adequate availability of medical providers in the overall population, providers tend to be distributed in a way that results in a surplus of providers in some areas and a scarcity in others. One of the rationales for the founding of the physician assistant (PA) profession was to address a longstanding maldistribution of physicians. How this is being undertaken has not been well verified. We wondered whether one of the rationales for the development of PAs— rural deployment—was being realized. This study set out to answer the question of whether nonphysician clinicians are providing care in rural areas and at what rate. In many instances, the geographic distribution of PAs, compared to physicians and advance practice nurses (APNs), is not well known other than in terms of the number of providers by type licensed in individual states. Further investigation of this topic has been hampered by incomplete databases of health care professionals, methodological differences in data collection, and incomplete reporting, which make these professions all but incompatible for comparison. A lack of detailed geographical practice specificity within many data sets also hampers a comparison of the results. The geographical distribution of PAs and physicians in Iowa was last compared by Dehn and Asprey in 1995.1 This study illustrated that PAs were much more likely than physicians to practice in a primary care specialty, a smaller community, and in an underserved area. One of the shortcomings was that the comparison data sets were derived from survey data collected by different investigators using different methodologies at different times. In another example, Pedersen and colleagues calculated the productivity of PAs, physicians, and nurse practitioners utilizing survey data collected by a single investigator.2 One of the results of their study indicated that in Utah, 26% of PAs practice in the least populous counties, containing 23% of the state’s population. In 1995 the Iowa legislature mandated that the University of Iowa Office of Statewide Clinical Education Programs build and maintain accurate and detailed databases of health care professionals practicing in Iowa in order to study and track their distribution. These databases have been constructed and carefully maintained using data from multiple sources and provide a more reliable census record of health care professionals practicing in Iowa. Because the data is collected, compiled, and updated for all professions in a systematic manner, the database allows for valid comparisons between different health care professions. The Iowa data were obtained in November 2005 for physicians, BRIEF REPORT

Payment source and provider type in the US healthcare system.

AbstractGreater use of physician assistants (PAs) and nurse practitioners (NPs) to meet growing demand for healthcare in the United States is an increasingly common strategy to improve access to care and control costs. Evidence suggests that payment for services differs depending on the type of provider. This study sought to determine if the source of payment for a medical visit varies based on whether care is provided by a physician, PA, or NP. Data from the National Hospital Ambulatory Medical Care Survey (2006 through 2010) were analyzed. Physicians were proportionally more likely than NPs or PAs to provide care for medical visits compensated by private insurance or Medicare. Conversely, PAs and NPs were more likely to serve as providers of care for services with other payment sources such as Medicaid and out-of-pocket.

Surgical Graduates’ Perspectives on Postgraduate Physician Assistant Training Programs

2007 Vol 18 No 1 | The Journal of Physician Assistant Education INTRODUCTION Postgraduate physician assistant (PA) training programs, also called PA residency programs, have existed since 1971.1 The first surgical PA residency was started at the Montefiore hospital in the Bronx in 1971.2 Since 1971 the number of surgical postgraduate programs has expanded to 11 in 2007.2 No investigation has systematically examined the economic implications of these training programs for either the graduate or the employer. One study looked at postgraduate training and its effect on employment, earnings, and job responsibility of those graduating from a residency program in 2003.3 Other descriptive studies have examined the residency program director’s perspective on postgraduate training4 or the resident’s perspective.5 Most of the remaining literature in the PA journals consists of editorials regarding the need for these types of programs or the standardization of postgraduate training.

Physician Assistant Educational Research

INTRODUCTION As the physician assistant (PA) profession has evolved since the first PAs graduated in 1967, PA educational research has also evolved to address a changing set of questions. Early educational research focused on addressing big questions that were fundamental to whether the new profession could produce competent clinicians whom the medical establishment and the public would accept. In contrast, current educational research efforts are more likely to address questions concerning adjustments to the educational process, such as curriculum changes, admission processes, preparation of graduates for national certification, and aggregate descriptions of various aspects of PA education in the United States. The challenges awaiting PA educators in the profession’s early years in regard to studying their own program’s efforts and the resulting outcomes are vividly described in an essay by E. Harvey Estes Jr. published in 1993. This essay is worth quoting at some length:

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.

The development of varying physician assistant roles in the United States

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.

Do PAs change specialties during their careers

definitive, it does provide valuable insight into the mobility of the PA in the health care system. In a variety of specialties and practice settings, physician assistants bridge critical gaps in the US health care system. This study demonstrates that physician assistant mobility is not just a theoretical possibility but a reality and an opportunity that a majority of PAs exercise over the course of their careers.

Patient attitudes toward physician assistants

Research on patient satisfaction with physician assistants in rural primary care medical practices is lacking. This study attempted to determine patients’ satisfaction with family practice PAs in rural communities, assess patient perceptions of “comfort” with PAs in a range of hypothetical medial procedures, analyze patients’ reactions to PAs as a function of patient characteristics, and document perceptions of changes in medical practices after PAs are employed. Findings support reports that patients are highly satisfied with PA services and extend those observations to rural primary care practices. Reaction to PAs is more favorable among women, more favorable in patients with more education, and more favorable among those with greater contact with PAs. Hooker RS, Potts R, Ray W. Patient satisfaction: comparing physician assistants, nurse practitioners, and physicians. The Permanente Journal.