Venetia L. Orcutt

Assessing the Value of Dual Physician Assistant/Public Health Degrees

&NA; The popularity of dual physician assistant/master of public health degree programs continues to increase within US physician assistant (PA) education. The advantages and disadvantages of pursuing dual degree training have not been fully explored in the PA literature. Potential advantages of dual training include broadening of the students perspective on health and health care beyond the “one provider, one patient” medical model, increased training in evaluation and use of the medical literature, increased skill in assessing community factors that affect the health of patients, enhanced expertise in health care administration or policy, and improved prospects for future roles as PA faculty members. Potential drawbacks include increased duration and expense of PA/MPH education, student burnout due to prolonged training, and the lack of jobs that explicitly use both halves of the PA/MPH training.

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.

Physician Assistant Specialty Choice: A Factor Analysis

Purpose: The purpose of this study was to identify factors related to physician assistant (PA) graduates’ specialty choice. Methods: A web‐based cross‐sectional study of PAs graduating between 2007 and 2009 was conducted (N = 12,128). Factor analysis was performed on 897 useable survey responses. The cohort profile resembles that of recent AAPA census data regarding demographic and specialty choice distribution. Results: Principal component factor analysis of perception items identified five factors that explained 52.6% of the response variance. Factors included personal satisfaction, intellectual challenge, patient care commitment, image of primary care, and professional satisfaction. The influence items analysis yielded five factors, explained 45.2% of the variance, and included practice environment, nature of patient care, lifestyle, employment opportunities, and risk aversion. These factors parallel previous findings of Hauer, et al. Conclusions: Identification of factors affecting specialty choice should provide an enhanced understanding to organizations as they explore strategies to increase recruitment and expansion of the primary care workforce.

The Evolution of Physician Assistant Faculty

INTRODUCTION As described by Hammond, the first educators of future physician assistants (PAs) emerged from the established medical education community and demonstrated a wide variety of backgrounds.1 Their noted determination to succeed, boundless energy, creativity, and commitment to respond to the needs of society proved to be the key to early success for the profession. In this issue, Cawley provides an abbreviated history of PA education, including a more detailed description of those early educators and leaders among PA program faculty, so this will not be repeated here. By the 1980s, acceptance of the PA profession by the medical community had grown, and a shift within the PA education community was emerging as more clinical PAs joined its ranks. The culture of PA programs began to move toward a student-centered approach and the embodiment of the service values upon which the profession was founded.1 This change from virtually no “PA” PA educators during the first decade of program existence to many was demonstrated in the Association of Physician Assistant Programs’ First Annual Report on Physician Assistant Educational Programs in the United States, 1984-85. The report noted that approximately one half of all program positions were then (in 1985) occupied by PAs.2 The increase in the number of PA programs during the 1990s resulted in the PA education community numbering over 1,000 as of 2007. These 21st century PA educators continue to exhibit the same characteristics valued in the original educators: determination, commitment, and innovation. Traversing the expectations of traditional academic life while maintaining their service orientation continues to challenge those who have chosen to enter the ranks of PA faculty. Before these challenges are considered, a profile of this community of educators is in order.

Exploring physician assistant data sources.

Objectives:To assess four physician assistant (PA) proprietary datasets and inform researchers about data quality for addressing healthcare policy and workforce questions. Methods:The quality of datasets was assessed by experienced researchers. Descriptive analysis included overview, collection methodology, variables, and availability. Assessment included each datasets strengths and limitations. Results:Datasets from the American Academy of Physician Assistants, National Commission on Certification of Physician Assistants, Physician Assistant Education Association, and Optum Provider360 Database include overlap in variables reflecting organizational mission and/or design. Attributes include variables for validation; limitations were lack of public use files, requirements for specific data requests or data purchase. The datasets do not have unique identifiers and cannot easily be linked. Conclusions:The PA datasets contain variables of interest but are limited in scope. Better data collection and shared platforms could further the understanding of PA workforce characteristics and contributions to American healthcare. Researchers await more comprehensive, longitudinal, linked, and publicly available datasets.

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.

Advanced Practice Providers in U.S. Urology: A National Survey of Demographics and Clinical Roles

Introduction: Projections suggest a significant shortage of urologists coupled with an increasing burden of urological disease due to an aging population. To meet this need, urologists have increasingly partnered with advanced practice providers. However, to this point the advanced practice provider workforce has not been comprehensively evaluated. Understanding the impact of advanced practice providers on the urology workforce is essential to maximize collaborative care as we strive for value and quality in evolving delivery models. Methods: A 29‐item, web based survey was administered to advanced practice providers identified by the AUA (American Urological Association), UAPA (Urological Association of Physician Assistants) and SUNA (Society of Urologic Nurses and Associates), querying many aspects of their practice. Results: A total of 296 advanced practice providers completed the survey. Advanced practice nurses comprised 62% of respondents while physician assistants comprised the remaining 38%. More than two‐thirds of the respondents were female and median age was 46 years. Only 6% reported having participated in formal postgraduate urological training. Advanced practice providers were evenly divided between institutional and private practice settings, and overwhelmingly in urban or suburban environments. The majority of advanced practice providers practice in the ambulatory setting (74%) and characterize their practice as general urology (72%). Overall 81% reported performing procedures independently, with 63% performing some procedures considered to be of moderate or high complexity. Conclusions: Advanced practice providers are active in the provision of urological care in many roles, including complex procedures. Given future workforce needs, advanced practice providers will likely assume additional responsibilities. As roles shift we must ensure we have the necessary educational and training opportunities to equip this vital part of our workforce.

The Expanding Role of Advanced Practice Providers in Urologic Procedural Care

OBJECTIVE To understand the role of Advanced Practice Providers (APPs) in urologic procedural care and its change over time. As the population ages and the urologic workforce struggles to meet patient access demands, the role of APPs in the provision of all aspects of urologic care is increasing. However, little is currently known about their role in procedural care. MATERIALS AND METHODS Commonly performed urologic procedures were linked to Current Procedural Terminology (CPT) codes from 1994 to 2012. National Medicare Part B beneficiary claims frequency was identified using Physician Supplier Procedure Summary Master Files. Trends were studied for APPs, urologists, and all other providers nationally across numerous procedures spanning complexity, acuity, and technical skill set requirements. RESULTS Between 1994 and 2012, annual Medicare claims for urologic procedures by APPs increased dramatically. Cystoscopy increased from 24 to 1820 (+7483%), transrectal prostate biopsy from 17 to 834 (+4806%), complex Foley catheter placement from 471 to 2929 (+522%), urodynamics testing from 41 to 9358 (+22,727%), and renal ultrasound from 18 to 4500 (+24,900%) CONCLUSION: We found dramatic growth in the provision of urologic procedural care by APPs over the past 2 decades. These data reinforce the known expansion of the APP role in urology and support the timeliness of ongoing collaborative multidisciplinary educational efforts to address unmet needs in education, training, and guideline formation to maximize access to urologic procedural services.

Expansion of Physician Assistant Education.

Abstract Physician assistant (PA) educational programs were created in the 1960s to prepare a new type of health care practitioner. Physician assistant programs began as experiments in medical education, and later, they proved to be highly successful in preparing capable, flexible, and productive clinicians. The growth of PA educational programs in US medical education—stimulated by grants, public policy, and anticipated shortages of providers—has gone through 3 distinct phases. At present, such programs are in the midst of the third growth spurt that is expected to continue beyond 2020, as a large number of colleges and universities seek to sponsor PA programs and attain accreditation status. Characteristics of these new programs are described, and the implications of the current expansion of PA education are examined.

Improving communication and interviewing skills: a community-based approach.

No abstract available.