Physicians working with physician assistants and nurse practitioners: perceived effects on clinical practice.

Physicians in the United States are increasingly working with physician assistants (PAs) and nurse practitioners (NPs), but little is known about how they perceive working with PAs and NPs affects their clinical practice. We used a new national survey to examine physicians' perceptions of working with PAs and/or NPs on their patient volume, care quality, time use, and workload. Among our analytical sample of 5823 physicians, 59% reported working with PAs and/or NPs. Most reported that PAs and NPs positively affected their clinical practice. Among several findings, physicians working in medical schools and with higher incomes were more likely to indicate that PAs improve their clinical practices in all 4 aspects, while being in specialties with higher women's representation was associated with lower ratings for working with PAs. Native Hawaiian and Pacific Islander physicians and those with higher incomes were more likely to signify that NPs improved their clinical practices in all 4 aspects. These findings provide valuable insights, from the physicians' perspective, on care delivery reform.

The Influence of Patient Care, Shadowing, and Volunteer Experience on Diverse Applicant Matriculation Into Physician Assistant/Associate Programs.

PURPOSE: To better understand factors contributing to low matriculation rates for health professions students from backgrounds underrepresented in medicine (URiM), this study examined the influence of healthcare-releated preadmission experiences on physician assistant/associate (PA) program matriculation. METHODS: We analyzed data from the Centralized Application Service for PAs 2018 to 2019 admissions cycle to compare characteristics of non-URiM and URiM PA program applicants and matriculants. The primary focus was on preadmission healthcare-releated experiences. To control for the strong influence of grade point average (GPA) on the likelihood of matriculation, we divided applicants into 2 groups: those with GPA < 3.6 (the median GPA for matriculants) and those with GPA ≥ 3.6. Analyses consisted of descriptive statistics and logistic regressions. RESULTS: Our sample consisted of 25,880 PA program applicants. Higher proportions of URiM compared with non-URiM applicants identified as first-generation college students (39.3% vs. 19.9%) or indicated economic disadvantage (32.3% vs. 12.5%). Overall, higher proportions of URiM compared with non-URiM applicants reported no patient care experience (24.3% vs. 17.9%), no shadowing (31.7% vs. 21.7%), or no volunteering (32.2% vs. 26.9%). Among all applicants with GPA < 3.6, reporting any type of experience was associated with increased odds of matriculation. Among URiM applicants with GPA ≥ 3.6, patient care experience did not influence odds of matriculation (odds ratio [OR] = 1.22, P = .23), whereas shadowing was associated with twice the odds (OR = 2.01, P < .001). CONCLUSIONS: Although academic metrics are known to predict PA program matriculation, we found that preadmission experiences also play a role. The study findings suggest that lack of experience hours may hinder URiM student access to PA education.

Impact of COVID-19 on student perceived stress, life satisfaction, and psychological flexibility: examination of gender differences.

Objective: To identify stress management practices and examine the impact of the COVID-19 pandemic on well-being among male and female physician assistant (PA) students. Participants: Participants included 1,239 students from nine PA programs who matriculated pre-pandemic, acute pandemic, or post-acute pandemic. Methods: Measures included questions about stress management practices and validated instruments assessing perceived stress, life satisfaction, and psychological flexibility. Data were analyzed for differences based on year and gender. Results: Exercise (91.6%), yoga (54.6%), meditation (34.3%), and journaling (32.5%) were commonly reported stress reduction practices. Newly matriculated PA students adjusted to the COVID-19 pandemic differently based on gender. Pre-pandemic, men and women reported similar levels of perceived stress and psychological flexibility, but female students reported higher life satisfaction. Post-acute pandemic, however, female students reported higher perceived stress and lower psychological flexibility. Conclusions: Wellness resources may be strengthened by approaches that account for differences based on gender.

Central Application Service for Physician Assistants Fifteen-Year Data Report 2002-2016.

PURPOSE: This study highlights trends in available physician assistant (PA) applicant and matriculant data over the first 15 years of the Central Application Service for Physician Assistants (CASPA) service (2002-2016). This study expands knowledge identified in the CASPA 10-year data report. METHODS: This was a retrospective analysis of CASPA data from all CASPA-participating PA programs between 2002 and 2016. Central Application Service for Physician Assistants staff verified all applicant academic information. In addition, beginning in 2007, the online CASPA admissions portal linked matriculant data with applicant data. RESULTS: During the first 15 years of the CASPA service, there was a 194% increase in the number of CASPA-participating programs (from 68 to 200) and a 409% increase in the number of total applicants. Several trends identified in the CASPA 10-year report persisted, including increasing grade point averages among applicants and matriculants and lower matriculation rates among underrepresented minority applicants and applicants who reported economic disadvantage. CONCLUSION: This 15-year comprehensive analysis of the CASPA data will benefit the profession by providing historical information that faculty and policymakers can use as a basis for developing and evaluating future admissions policies and practices.

Teaching Provider Wellness and Physician Assistant Student Well-Being.

PURPOSE: The purpose of this novel study was to determine whether any association exists between student well-being and physician assistant (PA) program approaches to teaching provider health and well-being (provider wellness). METHODS: Data were sourced from 3 PA Education Association surveys. Data from the 2019 Matriculating Student and End of Program Surveys (EOPS) were analyzed to compare student-reported well-being across 6 measures. Next, data from the 2019 Didactic Curriculum Survey were assessed and matched to the 2019 EOPS data. Finally, generalized estimating equation models were used to assess the independent effects of course structure, mode of instruction, and contact hours on well-being scores among end-of-program students (within one month of graduation). RESULTS: While levels of well-being were generally favorable, except for "level of social activity" ( P = .20), across measures, graduating student levels of well-being ( P < .05) were statistically significantly lower than matriculating student levels of well-being. No associations were found between levels of student well-being and whether programs reported teaching or not teaching provider wellness. Some aspects of instruction (eg, contact hours) were inconsistently associated with various well-being measures. CONCLUSION: In this study, no consistent associations between approaches to teaching provider wellness and various measures of student well-being were identified. Further research is needed to determine what approaches to promoting wellness are effective.

Wellness in Physician Assistant Education: Exploring Mindfulness, Well-Being, and Stress.

PURPOSE: The current study examined stress reduction activities most commonly used by matriculating physician assistant (PA) students to better understand how students are approaching self-care and management of stress. In particular, the study examined levels of mindfulness and well-being to understand how these relate to various stress reduction approaches at the time of matriculation. METHODS: Newly matriculated students at 9 PA programs located across the nation were surveyed (n = 294). Validated survey instruments assessed levels of mindfulness and general well-being. Stress reduction activities were also assessed. Univariate and multivariate analyses were used to examine levels of mindfulness and levels of well-being to see how these relate to various stress reduction approaches. RESULTS: The survey response rate was 72%. Nearly one-third of respondents (32%) identified meditation as one of their stress reduction activities, and more than half (53%) reported having participated in mindfulness practice at least once in the past year. Sixty-four percent of students reported awareness of mindfulness practices, while only 16% reported frequent practice within the year prior to matriculation. When looking at variables of interest, decentering and psychological flexibility were significant in accounting for student-reported perceived stress and life satisfaction. CONCLUSION: PA students are likely receptive to mindfulness-based interventions that have the potential to improve well-being and reduce stress. There is opportunity for programs to incorporate reliable and structured training within curricula that effectively increases levels of mindfulness and, in doing so, can lead to improvement in perceived stress and life satisfaction. Further research may assist educators in the development of strategies to promote student and clinician wellness.

Structural racism, health disparities, and opportunities for PA practice.

ABSTRACT: Social determinants of health are rooted in structural racism. The healthcare community has long recognized the existence of significant race- and ethnicity-related health disparities. Yet pervasive disparities persist despite ongoing calls for institutions and healthcare professionals to promote health equity by addressing bias, discrimination, and social determinants of health. All PAs must take responsibility for the various ways in which we may unwittingly reinforce racism in our profession, and must shift our focus from treating the effects of racism to preventing them.

Comparing the Effectiveness of Virtual and In-Person Delivery of Mindfulness-Based Skills Within Healthcare Curriculums.

Purpose: To promote well-being, healthcare education programs have incorporated mindfulness-based skills and principles into existing curriculums. Pandemic-related restrictions have compelled programs to deliver content virtually. Study objectives were to determine (1) whether teaching mindfulness-based skills within physician assistant (PA) programs can promote well-being and (2) whether delivery type (virtual vs. in-person) can impact the effectiveness. Methods: During this 2-year study, a brief mindfulness-based curriculum was delivered to incoming first-year students at six PA programs, while students at two programs served as controls. The curriculum was delivered in-person in year one and virtually in year two. Validated pre- and post-test survey items assessed mindfulness (decentering ability, present moment attention and awareness, and psychological flexibility) and well-being (perceived stress and life satisfaction). Results: As expected, coping abilities and well-being were adversely impacted by educational demands. The mindfulness-based curriculum intervention was effective in increasing mindfulness and life satisfaction, while decreasing perceived stress when delivered in-person. Virtual curricular delivery was effective in decreasing perceived stress but not improving life satisfaction. Over half of the participants receiving the curriculum reported positive changes on mindfulness measures with approximately 14-38% reporting a change of greater than one standard deviation. Changes on mindfulness measures explained 30-38% of the reported changes in perceived stress and 22-26% of the changes in life satisfaction. Therefore, the mindfulness curriculum demonstrated statistically significant improvements in measures of mindfulness and mitigated declines in life satisfaction and perceived stress. Conclusion: Mindfulness-based skills effectively taught in-person or virtually within PA programs successfully promote well-being.

Medical Assistant Psychological Safety Linked to Leader Inclusiveness in Ambulatory Care Settings.

OBJECTIVES: Studies in hospitals show that leader behaviors and power distance between healthcare professionals influence psychological safety (PS). However, little research on PS in outpatient settings exists. The main objective of this study was to explore factors that influence the PS of medical assistants (MAs) working in ambulatory care. METHODS: A cross-sectional web-based survey consisting of items to assess PS and factors known to influence PS was distributed nationally to certified medical assistants (CMA) who obtained certification from the American Association of Medical Assistants. To evaluate relationships between variables, bivariate analyses and ordinary least squares regression were conducted on responses from those working in ambulatory care. RESULTS: From the 54,196 email addresses contacted, 7,467 individuals (13.8%) responded to one or more survey questions; of them, 4,674 reported working in ambulatory care. Similar to research involving other types of healthcare professionals, results showed that leader inclusiveness meaningfully predicted variation in PS (R2 = 0.21, p < 0.001). Power distance (as conceived in this study) was not associated with PS. CONCLUSIONS: This study adds to a growing body of literature showing that supportive leader behaviors positively impact PS. Greater attention to leadership development in health professions educational programs should be considered.

Assessing the Economics of an Entry-Level Physician Assistant Doctoral Degree.

PURPOSE: An entry-level doctoral degree for the physician assistant (PA) profession has been a perennial issue since the master's degree approval in 2000 and the 2009 release of the Clinical Doctorate Summit Report. Many PA counterparts have transitioned to required or optional doctoral degrees for entry into practice. Although the PA profession has not adopted an entry-level doctorate, postgraduate doctoral programs have proliferated. This study's aim was to compare the cost of post-PA doctoral degrees to the estimated cost of an entry-level PA doctorate. METHODS: Cost of a post-PA doctoral degree was obtained from data on 15 postgraduate doctoral programs associated with PAEA member programs. Historical, aggregated data on PA program characteristics were collected from PAEA Annual Program Survey reports to estimate costs for an entry-level doctorate and to propose a likely model. For comparison, educational program data from health professions that have transitioned to entry-level doctorates were assessed. RESULTS: The average cost for postgraduate PA programs is significantly higher than the projected add-on cost for an entry-level PA doctorate, which ranges from $5,731 to $15,563. Directors of post-PA doctorate programs report that enrollments are generally near or at capacity. CONCLUSIONS: Implementation of an entry-level doctorate by accredited PA educational programs has the potential for significant economic and chronological advantages over postgraduate doctoral programs.

How organizational culture influences holistic review: a qualitative multiple case study.

Studies primarily involving single health professions programs suggest that holistic review in admissions can increase underrepresented minority (URM) representation among admitted students. However, data showing little improvement in the overall proportion of URMs in many health professions, despite widespread use of holistic review, suggest that relatively few programs using holistic review admit substantial proportions of underrepresented minorities. Therefore, more research is needed to understand factors that facilitate holistic review practices that successfully promote diverse student enrollment. The literature suggests that a supportive organizational culture is necessary for holistic review to be effective; yet, the influence of culture on admissions has not been directly studied. This study employs a qualitative, multiple case study approach to explore the influence of a culture that values diversity and inclusion ('diversity culture') on holistic review practices in two physician assistant educational programs that met criteria consistent with a proposed conceptual framework linking diversity culture to holistic admissions associated with high URM student enrollment (relative to other similar programs). Data from multiple sources were collected at each program during the 2018-2019 admissions cycle, and a coding manual derived from the conceptual framework facilitated directed content analysis and comparison of program similarities and differences. Consistent with the conceptual framework, diversity culture appeared to be a strong driver of holistic admissions practices that support enrolling diverse classes of students. Additional insights emerged that may serve as propositions for further testing and include the finding that URM faculty 'champions for diversity' appeared to strongly influence the admissions process.

Holistic Admissions and Underrepresented Minorities in Physician Assistant Programs.

PURPOSE: The purpose of this study was to assess holistic review use in physician assistant (PA) programs and determine whether a relationship between holistic review and underrepresented minority (URM) matriculation exists. METHODS: Using data from the 2016-2017 Physician Assistant Education Association annual survey of PA programs, we examined the frequency of holistic review use across PA programs. Bivariate correlation analyses and binary logistic regression were used to examine relationships between holistic review practices and program percentages of first-year underrepresented racial and ethnic minority students. RESULTS: Most PA programs (169/219 [77.2%]) reported using holistic review, and its use modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.16, 95% confidence interval [CI] = 0.02-0.30) or Hispanic (rho = 0.20, 95% CI = 0.06-0.33). Using several holistic review elements related to program commitment to diversity modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.25, 95% CI = 0.10-0.39) or African American (rho = 0.20, 95% CI = 0.04-0.34). Additionally, the odds of a first-year student being an underrepresented racial or ethnic minority were slightly higher in PA programs using holistic review (OR = 1.56, 95% CI = 1.23-1.99 and OR 1.33, 95% CI = 1.09-1.62, respectively). CONCLUSIONS: PA program use of holistic review practices was modestly associated with percentage of URM students. Further research is needed to identify elements that are most effective.

The need for greater diversity in the PA profession.

Leading organizations committed to improving health and healthcare in the United States agree that a more diverse healthcare workforce is needed to combat widespread disparities affecting underrepresented minority and underserved populations. Until the 1990s, a higher proportion of underrepresented minorities entered PA programs than other healthcare professions programs, such as medical school. However, in recent years, the PA profession has struggled to increase diversity among its ranks. This article reviews the rationale for greater diversity in the PA workforce, discusses the obstacles that underrepresented minority students and PA educators face, and makes recommendations to address diversity. The PA profession's rapid growth presents an opportunity to expedite change through community outreach, sustained commitment to diversity, research, and policy change.

Burnout, job satisfaction, and stress levels of PAs.

OBJECTIVE: The main goal of this study was to assess burnout, job satisfaction, and stress to gain insight into the work lives of female and male PAs. METHODS: Data were obtained from the 2016 American Academy of PAs salary survey. Descriptive statistics were used to assess questions related to burnout, happiness, and stress and to compare responses by sex. RESULTS: Analysis revealed that, in general, PAs experience modest levels of burnout but are happy at work. More than half (55.6%) rated spending too many hours at work as an important contributor to stress. A higher percentage of female PAs than male PAs (32.2% versus 25.6%) have quit a job due to stress. CONCLUSIONS: Overall, PAs rate aspects of work life favorably. Further research on factors that contribute to the PA work experience may help inform interventions aimed at improving job satisfaction among healthcare professionals.

PA program characteristics and diversity in the profession.

OBJECTIVES: The primary objective of this study was to identify PA program characteristics that may be associated with higher or lower percentages of underrepresented minority students in PA programs. METHODS: Data from the Physician Assistant Education Association (PAEA) 2002-2003 and 2012-2013 annual surveys were analyzed. Bivariate correlation coefficients and multiple regression modeling were used to identify relationships between program characteristics and percentages of black and Hispanic students. RESULTS: The percentage of white matriculants in PA programs increased from 76.5% in 2002-2003 to 81.8% in 2012-2013; the percentage of black students decreased from 6.2% to 4.4%. Multiple linear regression revealed a modest negative relationship between master's degree and percentage of underrepresented minority students and a modest positive relationship between percentages of underrepresented minority employees and underrepresented minority students. CONCLUSIONS: Further research is needed to identify strategies to increase underrepresented minority participation in healthcare professions programs.

An Ecological Approach to Understanding Preventive Service Utilization Among the Underserved.

Preventive services have the potential to reduce health disparities; however, these services are underutilized, particularly among the underserved. Patients with low socioeconomic status and racial and ethnic minorities experience significant health disparities related to cancer and infectious and chronic diseases but face multilevel challenges accessing preventive care. The purpose of this article is to enhance understanding of preventive service utilization among underserved patients by providing an ecological framework that addresses factors at multiple levels that influence patient care. In addition to factors that directly impact the patient, the framework incorporates influences on the patient's experience of the health system.