A Method to Study the Effect of a Physician Assistant Student on Preceptor Productivity.

PURPOSE: Guided clinical experience is a critical component of a physician assistant (PA) student's education. However, clinical precepting is strongly perceived to have deleterious effects on productivity. In this study, we sought to test a method for evaluating the effect that PA students have on clinical productivity. METHODS: We recruited 14 family medicine preceptors and second-year PA students from 2 programs, the University of Washington (UW) and the University of Texas Health Science Center San Antonio (UT). We collected productivity data during 3 weeks of preceptor clinical practice-one week without a PA student present and 2 weeks with a PA student present (one week early in the student's family medicine clinical rotation and a second week late in the rotation). We collected preceptor demographic data, patient characteristics, and the primary outcome-relative value units (RVUs) per preceptor per half-day during the 3 data collection weeks. At the end of the study, we asked preceptors about the ease of data collection and any negative effects of the study itself on their clinical productivity. RESULTS: No significant differences were found in preceptor demographics or in patient characteristics, numbers of patients, or RVUs per patient seen in any of the weeks or between UW and UT. In this pilot study, no significant differences were seen in RVUs per preceptor per half-day between the 3 weeks of observation or between UW and UT. CONCLUSION: In this pilot study, the protocol was straightforward, unintrusive, and preliminarily showed no significant effects of a PA student on preceptor productivity.

Common Questions About Pressure Ulcers.

Patients with limited mobility due to physical or cognitive impairment are at risk of pressure ulcers. Primary care physicians should examine at-risk patients because pressure ulcers are often missed in inpatient, outpatient, and long-term care settings. High-risk patients should use advanced static support surfaces to prevent pressure ulcers and air-fluidized beds to treat pressure ulcers. Physicians should document the size and clinical features of ulcers. Cleansing should be done with saline or tap water, while avoiding caustic agents, such as hydrogen peroxide. Dressings should promote a moist, but not wet, wound healing environment. The presence of infection is determined through clinical judgment; if uncertain, a tissue biopsy should be performed. New or worsening pain may indicate infection of a pressure ulcer. When treating patients with pressure ulcers, it is important to keep in mind the patient's psychological, behavioral, and cognitive status. The patient's social, financial, and caregiver resources, as well as goals and long-term prognosis, should also be considered in the treatment plan.

International medical graduates as physician assistants.

UNLABELLED: This study describes the MEDEX physician assistant (PA) program's experience with screening, educating, and graduating PA students who were international medical graduates (IMGs). METHODS: The study reviewed IMG-PA demographics including country of origin; prior primary care practice; and current practice location, specialty, and medically underserved designation. Descriptive statistics and chi-square analysis or Fisher exact test summarize outcomes. RESULTS: Thirty-nine IMG-PAs were graduated from 1991 through 2013. IMGs came from central and eastern Europe (48.7%), Asia (33.3%), and other regions. Most (69.2%) are women. Almost all (91.7%) practice in urban settings, 55.6% are in primary care, and 30.6% work in medically underserved areas. IMG-PAs in primary care were more likely to practice in underserved areas (P=0.009). CONCLUSION: MEDEX has graduated IMG-PAs who possess appropriate clinical and professional PA skills.

Physician assistant program outreach to military service members as potential applicants.

Recent efforts to facilitate the career pathway for military veterans into the physician assistant profession include outreach to current service members that will make information about physician assistant education more readily accessible. This research article reviews several topics that physician assistant programs would need to consider before conducting outreach to this population and discusses methods for outreach activities. Physician assistant programs may choose to apply similar approaches as appropriate for their individual circumstances. Outcomes will be evaluated separately.

Full circle: a new classroom site to facilitate the veteran to physician assistant pathway.

INTRODUCTION: Former military medics and corpsmen face challenges entering a civilian health care system that underutilizes their training and experience. The MEDEX Northwest physician assistant (PA) program launched a new classroom site in Tacoma, Washington, near local military bases, to ease entry into the PA profession for those in the local military and civilian communities. METHODS: To fill the new classroom, the program conducted outreach to prospective applicants at community colleges, on-base transition and education centers, and education and career events near local installations. RESULTS: Half of the first Tacoma class members are military veterans, half are female, 71% are from disadvantaged backgrounds, and the average age is 33. The Tacoma class demographics are equivalent to the overall 2013 MEDEX entering class with the exception of a higher veteran population (p < 0.001) and a higher rate of educational or economic disadvantage (p = 0.001). DISCUSSION: The MEDEX PA program has met its mission with the new Tacoma site in terms of access for former military, disadvantaged, and local enrollees. Offering a pathway to the PA profession for those with prior military medical experience recognizes the training and skills attained while in uniform and allows entry into a meaningful civilian career.

The military veteran to physician assistant pathway: building the primary care workforce.

The physician assistant (PA) profession emerged to utilize the skills of returning Vietnam-era military medics and corpsmen to fortify deficits in the health care workforce. Today, the nation again faces projected health care workforce shortages and a significant armed forces drawdown. The authors describe national efforts to address both issues by facilitating veterans' entrance into civilian PA careers and leveraging their skills.More than 50,000 service personnel with military health care training were discharged between 2006 and 2010. These veterans' health care experience and maturity make them ideal candidates for civilian training as primary care providers. They trained and practiced in teams and functioned under minimal supervision to care for a broad range of patients. Military health care personnel are experienced in emergency medicine, urgent care, primary care, public health, and disaster medicine. However, the PA profession scarcely taps this valuable resource. Fewer than 4% of veterans with health care experience may ever apply for civilian PA training.The Health Resources and Services Administration (HRSA) implements two strategies to help prepare and graduate veterans from PA education programs. First, Primary Care Training and Enhancement (PCTE) grants help develop the primary care workforce. In 2012, HRSA introduced reserved review points for PCTE: Physician Assistant Training in Primary Care applicants with veteran-targeted activities, increasing their likelihood of receiving funding. Second, HRSA leads civilian and military stakeholder workgroups that are identifying recruitment and retention activities and curricula adaptations that maximize veterans' potential as PAs. Both strategies are described, and early outcomes are presented.

Physician assistants in orthopedic practice. A national study.

UNLABELLED: Orthopedics is the third most common specialty practiced by physician assistants (PAs), but little is known at a national level about PAs backgrounds or specific contributions to orthopedic practices. We sought to describe, from a nationally representative sample, the demographic and practice characteristics of PAs working in orthopedics. METHODS: Surveys were sent to 1,200 PAs, identified from American Academy of Physician Assistants data, who reported orthopedics as their specialty between 2005 and 2007. Information was collected on demographic and educational background, PA training, current practice characteristics, clinical activities, and physician supervision. RESULTS: After three mailings, the adjusted response rate was 55.8%. Of respondents, 45% reported working in general orthopedics, and the remainder in orthopedic specialties. A majority (76.5%) completed a 4- to 8-week rotation in orthopedic surgery during PA school, but most did not complete any advanced postgraduate orthopedic training. Orthopedic group practices were the most commonly reported employer type (57.6% of respondents). Respondents performed an average of 59 outpatient visits per week and 16 inpatient visits per week. A large proportion (87.6%) participated in surgery on a regular basis, most often working as first assistants. Many orthopedic generalists and specialists performed a broad range of clinical activities, including ones suggestive of general, rather than close and direct, physician supervision such as closing surgical incisions independently and taking first call. CONCLUSIONS: PAs contribute to orthopedic care in many inpatient and outpatient settings and perform a wide variety of clinical tasks, often with only general supervision and little or no formal postgraduate training. Health workforce planning and the development of appropriate training models for PAs in orthopedics and other medical and surgical specialties require understanding the content of PA specialty practice.

The physician assistant profession and military veterans.

The physician assistant (PA) profession originated to train former medics and corpsmen for a new civilian health care career. However, baccalaureate degree prerequisites to training present barriers to discharged personnel seeking to enter this profession. A survey was administered (2006-2007) to all MEDEX Northwest PA program graduates who had entered with military experience. The survey addressed attitudes toward the profession, PA education, and practice and how military experience influenced their education and careers. The response rate was 46.4%, spanning all branches of the military. Respondents reported military experience positively impacting ability to handle stress and work in health care teams and that patients and colleagues viewed their military background positively. Most (75.5%) respondents did not hold a bachelor's degree at matriculation. Veterans bring substantial health care training to the PA profession. However, program prerequisites increasingly present barriers to entry. Veterans' contributions to health care and the consequences of losing this resource are discussed.

Academic degrees and clinical practice characteristics: the University of Washington physician assistant program: 1969-2000.

CONTEXT: The physician assistant profession has been moving toward requiring master's degrees for new practitioners, but some argue this could change the face of the discipline. PURPOSE: To see if there is an association between physician assistants' academic degrees and practice in primary care, in rural areas, and with the medically underserved. METHODS: Surveys were sent to 880 graduates of the first 32 University of Washington physician assistant classes through 2000. Respondents noted their academic degree at program entry and the highest degree attained at any time up to the time of survey. Relationships between practice characteristics and academic degree levels were tested by unadjusted odds ratios and logistic regression after controlling for year of graduation and sex. RESULTS: Of the 478 respondents, 54% worked in primary care, about 30% practiced in nonmetropolitan communities, and 42% reported providing care for the medically underserved. Respondents with no degree (33% of total at entry, 24% at survey) were significantly more likely than degree holders to work in primary care and nonmetropolitan areas. Respondents with no degree at program entry were significantly more likely, and those with no degree at the time of the survey were marginally more likely, to self-report work with the medically underserved. CONCLUSION: Respondents with no academic degree are significantly more likely to demonstrate a commitment to primary, rural, and underserved health care. These findings may inform the national debate about the impact of required advanced degrees on the practice patterns of nonphysician providers.