Revisiting California's Supervising Physician-to-Physician Assistant Ratio Requirement: An Urgent Call to Action.

California like many other states is facing a severe shortage of primary care physicians and access to primary care is uneven across the state. It is well documented that California has the highest number of designated primary care health professional shortage areas in the country. Although physician assistants (PAs) and nurse practitioners (NPs) are estimated to make up a large portion of California's primary care workforce by 2030, outdated and unnecessary statutory requirements such as the physician-to-PA supervision ratio requirement represent a practice barrier in expanding access to care. Other states have either eliminated or revised their physician-to-PA supervision ratios in favor of expanding access to health care services. Therefore, this editorial represents a call for coordinated actions from local and state entities to address California's outdated physician-to-PA supervision ratio requirement. NPs are mentioned briefly as they have achieved a pathway to full practice authority in California.

An Evaluation of the Postgraduate Physician Assistant/Associate and Nurse Practitioner Orthopedic Surgery Fellowship and Residency Websites in the United States.

Background Although considerable research on physician fellowship training program websites has demonstrated critical deficiencies in accessibility and content, there is no published study regarding the website content of physician assistant/associate (PA) and nurse practitioner (NP) orthopedic surgery postgraduate residency/fellowship programs in the United States. Therefore, this study aims to conduct a web-based content analysis to assess the available information on program websites and identify the potential areas for improvement. Methods The methodology for this study was replicated from prior research on graduate medical education (GME) websites. Twenty-two PA and joint PA/NP orthopedic surgery postgraduate residency/fellowship training program websites were assessed between August and September 2022. The criteria comprised 17 items related to postgraduate education and recruitment content. All program websites were evaluated for pertinent content relevant to prospective applicants applying to orthopedic surgery residency/fellowship programs. Descriptive statistics were performed. Results Out of the 22 PA and joint PA/NP orthopedic postgraduate websites evaluated, all had a functional website link. Only one orthopedic surgery postgraduate website met all 17 criteria. All program websites assessed contained program descriptions and contact information. Other information present on websites included program admission requirements 95% (21/22), salary/benefits 77% (17/22), interview requirement 73% (16/22), faculty listing 68% (15/22), journal club 59% (13/22), program objectives/goals 59% (13/22), and acceptance process 54% (12/22). Less than half of the program websites contained the following information: listing of current PA/NP postgraduate trainees, sample rotation schedule, orientation activities, curriculum, wellness/well-being strategy, graduation and research requirements, and link to program handbook. However, accredited PA orthopedic surgery program websites contained more content relevant to prospective applicants than non-accredited programs. Conclusion This is the first study to provide a detailed analysis of PA and joint PA/NP postgraduate orthopedic surgery residency/fellowship program websites. Not surprisingly, there is a wide variation in the available content on these websites. Study results provide further evidence to support the urgent need to improve program website content for prospective applicants.