High-Volume Hydraulic Fracturing and Human Health Outcomes: A Scoping Review.

OBJECTIVE: Examine extent of peer-reviewed literature exploring human health effects of hydraulic fracturing (HVHF). METHODS: A scoping review methodology was used to examine peer-reviewed studies published from 2000 through 2017 that empirically examine direct health impacts of hydraulic fracturing. RESULTS: Through September 2017, only 18 studies were found published in peer-reviewed journals that met our requirements for inclusion in the review. Most of these studies resulted in positive or mixed findings of health outcomes. CONCLUSIONS: The paucity of studies reflects the difficulty in drawing direct connections between HVHF and human health outcomes. Many health outcomes may take years to emerge, exposure often occurs in lightly populated rural areas with older, poorer, and sicker residents, and diagnosis is difficult without physician knowledge of prior exposure. Primary care providers should record thorough histories to help guide future treatment.

Strategies and perceived barriers to recruitment of underrepresented minority students in physician assistant programs.

PURPOSE: The purpose of this descriptive cross-sectional study was to identify the characteristics and effectiveness of recruitment strategies for underrepresented minorities (URM) and barriers to URM applicants to physician assistant programs. METHODS: A 108-question survey was e-mailed to 168 physician assistant programs; 36 partial and 67 fully completed surveys were returned. The fully completed surveys were used in the data analysis. Participants were asked about the use of 20 recruitment strategies and the importance of 34 perceived barriers to enrollment of URM applicants. RESULTS: Of the 20 recruitment strategies, only 4 were used by close to 50% or more of programs: site visits (61.2%), preadmission counseling (58.2%), student loans (57.6%), and presentations targeted to minority students (47.8%). Only 9% of programs used enrichment courses, but this strategy was rated as most effective. Of the 34 barriers, the most frequent was low undergraduate grade point average (GPA) (82.5%). Self-reported success in recruitment was correlated with increased URM matriculation. Higher proportion of African American and Hispanic faculty on admissions committees was correlated with increased rates of URM matriculation. According to a similar survey, compared with medical schools, physician assistant programs use URM recruitment strategies less frequently and perceive financial barriers as a larger problem. CONCLUSIONS: The academically competitive physician assistant applicant pool decreases the need for recruitment of all students. Use of GPA and standardized test scores as sole criteria for admission and lack of recruitment of URM students lead to a decrease in diversity. If the physician assistant profession desires to improve student diversity in programs, they should consider using a more holistic approach for the admission process, which may allow for a more flexible and individualized review of applicants.

Evaluation of a targeted curriculum on patient poverty funded by Title VII.

PURPOSE: There is limited knowledge about the perceptions of physician assistant (PA) students on poverty issues and the importance of treating the poor. We assessed whether a curriculum focused on these issues improved the perceptions of PA students on issues of poverty. METHODS: The study was designed to measure perception change after PA students were exposed to a patient poverty curriculum. A pre- and postpatient poverty survey of 14 questions was completed by three classes of PA students at one program. RESULTS: The mean posttest scores were significantly lower on all items except two, indicating that student perceptions of their abilities to serve indigent populations improved after experiencing the curriculum in the PA program. CONCLUSION: A targeted curriculum that emphasizes issues related to poverty appears to improve PA students' perceptions of their ability to serve indigent populations. This program's design could serve as a model for other programs striving to attain similar goals.

The perceptions of US physician assistants regarding physician assistant-to-physician bridge programs.

PURPOSE: Since Dr. Stead first envisioned the physician assistant (PA) profession, there has been discussion of an accelerated PA-to-physician "bridge" program. Despite some conversations in the 1960s and the creation of other professional programs, such as the paramedic-registered nurse bridge, no formal long-term PA-to-physician programs were created in the United States, and the discourse faded over the years. With recent consideration of creating a clinical doctorate PA program of study, discussion has been revived about the need, efficacy, and propriety of a bridge program. The purpose of this study was to determine the perceptions of PAs on the creation of a PA-to-physician bridge program; whether they would support a bridge program, its feasibility, and generally whether or not bridge programs should be initiated. METHODS: An online survey was sent to a cross-sectional, random sampling of PAs in the United States. The survey used a 5-point Likert scale to assess the perceptions of a PA-to-physician bridge program. A chi-squared analysis was performed to determine significant relationships. RESULTS: PA respondents were strongly supportive of the bridge program concept; however, knowledge level about such a program was low. The chi-square analysis revealed that gender was the only variable with a significant relationship, with females being most in agreement about the concept. CONCLUSIONS: The results of the study may help the PA and medical communities evaluate the applicability, feasibility, and practicality of a PA-to-physician bridge program. There is an overall tendency for PAs to support such a program.

Factors that influence physician assistant choice of practice location.

OBJECTIVE: Certain US rural areas have inadequate access to health care providers. Health care educational institutions have made nationwide efforts to recruit students from rural areas, in the hope that they will return upon graduation. This 2009 study focused on the physician assistant (PA) profession's endeavors in this effort. METHODOLOGY: A cross-sectional survey used a random sample of 2000 practicing PAs from the United States. Factor analysis was used to categorize the responses to 20 Likert-type questions about possible reasons behind the PA's choice of first practice location. RESULTS: Respondents who graduated from a rural high school were significantly more likely to practice in a rural setting. Six identifiable factors emerged from the factor analysis. Chi-square analyses determined that significant relationships existed between these factors and demographic variables. Gender influenced the greatest number of items; specialty and PA degree level influenced the fewest items. Factor 2 (support of/for significant other) held the most sway in the decision about first employment location. CONCLUSION: Respondents felt that support of and for the significant other was the most important factor in their first practice-location choice. Recruiters searching for health care professionals in areas needing medical services may wish to pay closer attention to spousal opportunities and should not underestimate the impact of family in the decision about work location.

Perceptions of physician assistants regarding a specialty certification examination.

A national sample of physician assistants (PAs) responded to a survey about their perceptions of specialty certification. Fewer than one-third planned to certify. Of three factors, advantage of specialization was most related to awareness, plans to certify, and demographics. Respondents were unsure whether certification would increase PA salaries. Many felt specialty certification will be the undoing of the profession.

Perceptions of U.S. physicians regarding the entry-level doctoral degree in physician assistant education.

UNLABELLED: Minimal research has been done to determine the appropriateness of entry-level doctoral physician assistant (PA) education. Previously, only PAs, PA faculty, and a small number of PA program medical directors had been surveyed about their perceptions of the Doctorate of Physician Assistant (DPA), and none of these groups supported the DPA as the entry-level degree. The purpose of this study was to compare the perceptions of physicians with those of PAs and PA faculty regarding an entry-level DPA degree. METHODS: This 2009 cross-sectional study surveyed representative samples of physicians, PAs, and PA faculty in the U.S. regarding their perceptions of the DPA. RESULTS: The response rate was 15% (n = 832, with 351 PAs, 302 PA faculty, and 179 physicians). Chi-squared analyses showed that physician responses were less congruent with PA and PA faculty responses (p < 0.001). For example, 79.1% of PAs and 95.1% of PA faculty but 56.2% physicians agreed that the master's degree was sufficient for PA practice. A larger percentage of PAs and PA faculty disagreed that the DPA should be the entry-level degree (PA 82.8%, PA faculty 89.8%, physicians 55.9%) and that the DPA was necessary to deliver the highest standard of care (PA 83.1%, PA faculty 95.1%, physicians 56.5%). CONCLUSION: PAs and PA faculty were not supportive of the DPA. However, the results raise questions about the perceptions of physicians. If the move to the DPA is considered in the future, information and data from this study may be beneficial.

Relationships of demographic background and practice setting among practicing physician assistants in the United States.

INTRODUCTION: it is assumed that minority health care providers continue to work in primary care and in underserved areas in higher proportions than their nonminority counterparts, regardless of changing workforce practice patterns. The primary purpose of this study was to determine whether this assumption still holds true among US physician assistants (PAs) in light of recent PA specialization. This assumption is important as there is continuing evidence that a similar background between providers and patients can be beneficial to the provider-patient relationship and to patient outcomes. A secondary purpose was to determine the relationships between various demographic variables (eg, race) and current practice specialty and population served among all PAs. METHODS: this cross-sectional study measured demographic and practice setting survey data. A random sample of 10,500 PAs was surveyed. RESULTS: the main finding was that minority PAs were more likely to care for the underserved (31.9% vs. 19.3%) and to work in primary care practices (38.8% vs. 29.3%) than were nonminorities. A significant relationship was also found between serving underserved populations and nonmarried status, as well as age over 39 (these groups were more likely to serve this population, p < 0.01). Household income less than $50,000 at the time of high school graduation was significantly related to caring for underserved individuals (p < 0.01) and working in primary care settings (more likely to serve in these settings, p 0.001). CONCLUSIONS: Minority PAs were more likely to care for the underserved and work in primary care settings. Certain other demographic variables among all respondents were also significantly related to service to the underserved and work in primary care settings.

Attitudes of US physician assistants toward persons with HIV/AIDS.

BACKGROUND: Early in the HIV/AIDS epidemic, a large number of health care workers had negative attitudes toward persons infected with HIV, but a more positive shift has occurred in these attitudes over the past decade. However, recent information about attitudes of physician assistants (PAs) is missing. METHODOLOGY: A nationwide randomized sample of 1,500 PAs was surveyed through the US mail. The AIDS Attitudes Scale (AAS) developed by Froman, Owen, and Daisy in 1992 was used for this purpose. The results were analyzed using descriptive, t test, and analysis of variance (ANOVA) statistics. RESULTS: A majority of respondents had high empathy, low avoidance, and positive general attitude scores. Respondents living in the South had the highest avoidance and lowest general attitude scores compared with those living in other regions (ANOVA, P < .05). CONCLUSION: The results were consistent with similar current studies of health care workers, which demonstrated supportive attitudes towards persons with HIV/AIDS.

Evaluation of a diversity intervention funded by Title VII.

PURPOSE: The purpose of this study was to evaluate an intervention intended to make an impact in heightening the cultural training of health care-focused high school and physician assistant (PA) students, increasing the number of underrepresented minority faculty and preceptors, and increasing the number of minority/disadvantaged applicants and ultimately graduates from the PA program. METHODS: A parsimonious design was developed to assess program components, including PA student instruction of leading health indicator/career information in low-income high schools; affiliating with a diverse faculty; implementing a PA race-neutral application process; and PA student retention activities. RESULTS: The ability of the project to strengthen and expand the cultural training of health care students was demonstrated in the number of participants (high school students [n = 549]; PA students [n = 163]) in the diversity intervention. The scores from the leading health indicator and health care career knowledge tests were above average among high school students. The cultural competency evaluation indicated PA student awareness of health disparities before and after the intervention. Thirty-five percent of each PA class received exposure to underrepresented minority clinicians. The underrepresented and disadvantaged applicant pool increased during the grant project. The number of accepted underrepresented minority matriculates was maintained. CONCLUSIONS: The project was successful in terms of heightening the training of health care students as measured by the number of participants and their performance on surveys. Exposure of PA students to underrepresented minority faculty was limited. The number of underrepresented minorities increased in the applicant pool; however, the number of underrepresented minorities accepted remained constant.

Use of Mintzberg's model of managerial roles to evaluate academic administrators.

Quantitative and qualitative methods were used to measure the administrative activities of physician assistant (PA) department chairpersons as compared with Henry Mintzberg's model of managerial roles. The use of Mintzberg's model is unique in that it was developed from observations in the corporate setting but was applied here in an academic setting. Both PA department chairpersons (n = 77) and PA faculty (n = 94) identified Mintzberg's leader role as one that was used most by PA chairpersons and one that was viewed as most important as perceived by PA chairpersons and faculty. Both groups agreed that PA chairpersons were more concerned about functioning in the interpersonal realms of Mintzberg's managerial roles as opposed to the informational and decisional realms, and there was a great deal of unanimity about the perceived role use and importance of the roles in regard to the job of a PA chairperson. This finding was important according to Mintzberg's model because it is through leader role use that PA chairpersons can weld diverse elements into a cooperative enterprise (an important aspect of managing academic departments). Chairpersons and faculty were given the opportunity to identify other constructs not covered by Mintzberg's model in an effort to include other roles unique to PA education. Although a handful of roles were identified, when compared with Mintzberg's model, each one matched an existing role defined in the model. These data indicate that both chairpersons and faculty were in agreement with the way Mintzberg's model can describe PA chairperson roles.

Examining attitudes of specialist physicians regarding physician assistant referrals.

Referral of a patient from a primary care provider to a referral specialist physician for consultation is an important link in the continuum of patient care. Although the relationship between the physician assistant (PA) and supervising physician has been studied extensively, the effectiveness of the relationship between the primary care PA and the referral specialist physician is unclear. The purpose of this study was to examine the attitudes of the referral specialist physician toward direct referral of patients from primary care PAs. A random sample of 5,000 specialist physicians in five specialty areas across the United States were surveyed to determine their willingness to accept referrals from PAs, their attitudes about the appropriateness of PA referrals, and reasons for dissatisfaction, if any. Data analysis revealed that specialist physicians generally are willing to accept patient referrals from primary care PAs and that specialist physicians generally are satisfied with the appropriateness and timeliness of referrals from PAs. Whether or not the specialist physician employed (supervised) a PA in his or her own practice made a significant difference in level of satisfaction with PA referral. To determine the significance of these results, more research is needed to determine specialist physician satisfaction with referrals from primary care physicians compared with PAs.