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Abstract
Israeli emergency medicine is undergoing change. The paramedic is experiencing high separation rates because the position is understaffed, overworked, and underpaid. Physician assistants (PAs) were introduced into the emergency department by training paramedics and to date they seem satisfied with this new role. Experience in other countries indicates that PAs can improve access to care, reduce errors, increase efficiency and have satisfying roles in health systems. The Israeli health system will need to determine if additional roles for PAs will be accepted by the public and physicians alike.
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Affiliation(s)
- Roderick S Hooker
- Israel Journal of Health Policy Research, 115917 NE Union Rd, Unit 45, Ridgefield, WA, 98642-8706, USA.
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Coombs LA, Max W, Kolevska T, Tonner C, Stephens C. Nurse Practitioners and Physician Assistants: An Underestimated Workforce for Older Adults with Cancer. J Am Geriatr Soc 2019; 67:1489-1494. [PMID: 31059140 PMCID: PMC6612567 DOI: 10.1111/jgs.15931] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the composition of the US provider workforce for adults with cancer older than 65 years and to determine whether there were differences in patients who received care from different providers (eg, nurse practitioners [NPs], physician assistants [PAs], and specialty physicians). DESIGN Observational, cross-sectional study. SETTING Adults within the 2013 Surveillance, Epidemiology, and End Results cancer registries linked to the Medicare claims database. PARTICIPANTS Medicare beneficiaries who received ambulatory care for any solid or hematologic malignancies. MEASUREMENTS International Classification of Diseases, Ninth Revision (ICD-9), diagnosis codes were used to identify Medicare patient claims for malignancies in older adults. Providers for those ambulatory claims were identified using taxonomy codes associated with their National Provider Identifier number. RESULTS A total of 2.5 million malignancy claims were identified for 201, 237 patients, with 15, 227 providers linked to claims. NPs comprised the largest group (31.5%; n = 4,806), followed by hematology/oncology physicians (27.7%; n = 4,222), PAs (24.7%; n = 3767), medical oncologists (10.9%; n = 661), gynecological oncologists (2.6%; n = 403), and hematologists (2.4%; n = 368). Rural cancer patients were more likely to receive care from NPs (odds ratio [OR] = 1.84; 95% confidence interval [CI] = 1.65-2.05) or PAs (OR = 1.57; 95% CI = 1.40-1.77) than from physicians. Patients in the South were more likely to receive care from NPs (OR = 1.36; 95% CI = 1.24-1.49). CONCLUSIONS A large proportion of older adults with cancer receive care from NPs and PAs, particularly those who reside in rural settings and in the southern United States. Workforce strategies need to integrate these provider groups to effectively respond to the rising need for cancer care within the older adult population.
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Affiliation(s)
| | - Wendy Max
- University of California San Francisco, San Francisco, CA
| | - Tatjana Kolevska
- University of California San Francisco, San Francisco, CA
- Kaiser Permanente Northern California, Vallejo, CA
| | - Chris Tonner
- University of California San Francisco, San Francisco, CA
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De Bruijn-Geraets DP, van Eijk-Hustings YJL, Bessems-Beks MCM, Essers BAB, Dirksen CD, Vrijhoef HJM. National mixed methods evaluation of the effects of removing legal barriers to full practice authority of Dutch nurse practitioners and physician assistants. BMJ Open 2018; 8:e019962. [PMID: 29934382 PMCID: PMC6020970 DOI: 10.1136/bmjopen-2017-019962] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the effects of granting legal full practice authority (FPA) to nurse practitioners (NP) and physician assistants (PA) regarding the performance of specified reserved medical procedures and to support governmental decision-making. DESIGN Nationwide mixed methods design with triangulation of quantitative (Pre-post test design) and qualitative data (expert interviews and focus groups). METHODS Surveys focused on the performance of the procedures (monthly number, authorisation mode, consultations and procedural time) and legal cross-compliance requirements (adherence with protocols, competence). Interviews focused on competence, knowledge, skills, responsibilities, routine behaviour, NP/PA role, acceptance, organisational structure, collaboration, consultation, NP/PA positioning, adherence with protocols and resources. Data collection took place between 2011 and 2015. RESULTS Quantitative data included 1251 NPs, 798 PAs and 504 physicians. Besides, expert interviews with 33 healthcare providers and 28 key stakeholders, and 5 focus groups (31 healthcare providers) were held.After obtaining FPA, the proportion of NPs and PAs performing reserved procedures increased from 77% to 85% and from 86% to 93%, respectively; the proportion of procedures performed on own authority increased from 63% to 76% for NPs and from 67% to 71% for PAs. The mean number of monthly contacts between NPs/PAs and physicians about procedures decreased (from 81 to 49 and from 107 to 54, respectively), as did the mean duration in minutes (from 9.9 to 8.6 and from 8.8 to 7.4, respectively). Utilisation of FPA was dependent on the setting, as scepticism of physicians and medical boards hampered full implementation. Legal cross-compliance requirements were mostly fulfilled. CONCLUSIONS Informal practice was legalised. The opportunities to independently perform catheterisations, injections, prescribing, punctures and small surgical procedures were highly used. Care processes were organised more efficiently, services were performed by the most appropriate healthcare provider and conditions were met. This led to the recommendation to continue with FPA.
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Affiliation(s)
- Daisy P De Bruijn-Geraets
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Yvonne J L van Eijk-Hustings
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Monique C M Bessems-Beks
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Brigitte A B Essers
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Carmen D Dirksen
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Hubertus Johannes Maria Vrijhoef
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- Panaxea, Amsterdam, The Netherlands
- Department of Primary Care, Vrije Universiteit Brussel, Brussels, Belgium
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Affiliation(s)
- David I Auerbach
- From the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (D.I.A., P.I.B.); the Department of Economics, Dartmouth College, Hanover, NH (D.O.S.); and the National Bureau of Economic Research, Cambridge, MA (D.O.S.)
| | - Douglas O Staiger
- From the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (D.I.A., P.I.B.); the Department of Economics, Dartmouth College, Hanover, NH (D.O.S.); and the National Bureau of Economic Research, Cambridge, MA (D.O.S.)
| | - Peter I Buerhaus
- From the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (D.I.A., P.I.B.); the Department of Economics, Dartmouth College, Hanover, NH (D.O.S.); and the National Bureau of Economic Research, Cambridge, MA (D.O.S.)
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Abstract
OBJECTIVE To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. DESIGN Systematic review. SETTING Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. INCLUDED ARTICLES Peer-reviewed articles of any study design, published in English, 1995-2017. INTERVENTIONS Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. OUTCOME MEASURES Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs. RESULTS 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent. CONCLUSIONS PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting. PROSPERO REGISTRATION NUMBER CRD42016032895.
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Affiliation(s)
- Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Carly Wheeler
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Ferruccio Pelone
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guildford, Surrey, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Jim Parle
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Jonathan Gabe
- Centre for Criminology and Sociology, School of Law, Royal Holloway, University of London, London, UK
| | - Laura Nice
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Vari M Drennan
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
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Huff C. Shrinking the Psychiatrist Shortage. Manag Care 2018; 27:20-22. [PMID: 29369765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Demand for mental health services outstrips the supply of psychiatrists. Aggravating the situation: Many psychiatrists don't take insurance. Nurse practitioners and physician assistants are beginning to fill the gap.
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Conley J. Innovative Assistant Physician Program Enhances Patient Care: The Nevada Medical Clinic Experience. Mo Med 2017; 114:424-426. [PMID: 30228653 PMCID: PMC6139962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jennifer Conley
- Jennifer Conley, MD, MSMA member since 2003, is a family practice physician in Nevada, Missouri
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Sargen MR, Shi L, Hooker RS, Chen SC. Future growth of physicians and non-physician providers within the U.S. Dermatology workforce. Dermatol Online J 2017; 23:13030/qt840223q6. [PMID: 29469712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 06/08/2023] Open
Abstract
Trends in the training, supply, availability, career decisions, and retirement of US dermatology physicians are not well delineated. The current study evaluates whether growth in the dermatology workforce will keep pace with population expansion in the United States. A dermatologist supply model was projected to 2030 drawing on data from the American Academy of Dermatology, American Medical Association, Bureau of Labor Statistics, American Association of Medical Colleges, and other associations. The clinically active dermatologist workforce in 2015 was 36 per capita (1,000,000); entry following postgraduate training was age 30 with career separation at age 65 on average. Added to the provider model are physician assistants and nurse practitioners in dermatology practices. A linear regression micro simulation model based on age cohorts produced a per capita supply of dermatology providers of 61 (±3) per 1,000,000 by 2030, up from 47 in 2016. The dermatology workforce is growing faster than population expansion. Workforce estimates could be affected by changing trends in retirement and training of dermatology providers. Investments in training of nurse practitioners and physician assistants, in addition to training more doctors, may be an effective strategy for increasing access to care in populations with low dermatologist density.
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Orrantia E, Amand SS. Establishing and growing the scope of practice of physician assistants. Can Fam Physician 2017; 63:373-374. [PMID: 28500197 PMCID: PMC5429056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Eliseo Orrantia
- Rural family physician for the Marathon Family Health Team in Ontario and Associate Professor at the Northern Ontario School of Medicine in Marathon
| | - Stephanie St Amand
- Undergraduate student at Lakehead University in Thunder Bay, Ont, at the time of writing this paper
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Halter M, Wheeler C, Drennan VM, de Lusignan S, Grant R, Gabe J, Gage H, Ennis J, Parle J. Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment. Clin Med (Lond) 2017; 17:126-131. [PMID: 28365621 PMCID: PMC6297628 DOI: 10.7861/clinmedicine.17-2-126] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the UK secondary care setting, the case for physician associates is based on the cover and stability they might offer to medical teams. We assessed the extent of their adoption and deployment - that is, their current usage and the factors supporting or inhibiting their inclusion in medical teams - using an electronic, self-report survey of medical directors of acute and mental health NHS trusts in England. Physician associates - employed in small numbers, in a range of specialties, in 20 of the responding trusts - were reported to have been employed to fill gaps in medical staffing and support medical specialty trainees. Inhibiting factors were commonly a shortage of physician associates to recruit and lack of authority to prescribe, as well as a lack of evidence and colleague resistance. Our data suggest there is an appetite for employment of physician associates while practical and attitudinal barriers are yet to be fully overcome.
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Affiliation(s)
- Mary Halter
- Kingston University and St George's, University of London, London, UK
| | - Carly Wheeler
- Kingston University and St George's, University of London, London, UK
| | - Vari M Drennan
- Kingston University and St George's, University of London, London, UK
| | | | - Robert Grant
- Kingston University and St George's, University of London, London, UK
| | - Jonathan Gabe
- School of Law, Royal Holloway, University of London, London, UK
| | | | - James Ennis
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jim Parle
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Balasa DA. Nurse Practitioners and Physician Assistants: How Expanding Reimbursement and Scopes of Practice Can Facilitate High-Quality, Efficient Healthcare. J Med Pract Manage 2017; 32:298-300. [PMID: 30047697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As the demand for healthcare increases in the United States, nonphysician practitioners such as nurse practitioners (NPs) and physician assistants (PAs) are being called upon to provide more services in a greater variety of settings. State laws have been amended to broaden the scopes of practice of NPs and PAs. New Medicare programs such as Chronic Care Management and Transitional Care Management are well suited for NPs and PAs. This article discusses these developments, their impact on healthcare delivery and reimbursement, and how medical offices, clinics, and health systems can utilize NPs and PAs to provide excellent healthcare in an efficient manner.
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Gershengorn HB, Xu Y, Chan CW, Armony M, Gong MN. The Impact of Adding a Physician Assistant to a Critical Care Outreach Team. PLoS One 2016; 11:e0167959. [PMID: 27942002 PMCID: PMC5152859 DOI: 10.1371/journal.pone.0167959] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/23/2016] [Indexed: 11/25/2022] Open
Abstract
Rationale Hospitals are increasingly using critical care outreach teams (CCOTs) to respond to patients deteriorating outside intensive care units (ICUs). CCOT staffing is variable across hospitals and optimal team composition is unknown. Objectives To assess whether adding a critical care medicine trained physician assistant (CCM-PA) to a critical care outreach team (CCOT) impacts clinical and process outcomes. Methods We performed a retrospective study of two cohorts—one with a CCM-PA added to the CCOT (intervention hospital) and one with no staffing change (control hospital)—at two facilities in the same system. All adults in the emergency department and hospital for whom CCOT consultation was requested from October 1, 2012-March 16, 2013 (pre-intervention) and January 5-March 31, 2014 (post-intervention) were included. We performed difference-in-differences analyses comparing pre- to post-intervention periods in the intervention versus control hospitals to assess the impact of adding the CCM-PA to the CCOT. Measurements and Main Results Our cohort consisted of 3,099 patients (control hospital: 792 pre- and 595 post-intervention; intervention hospital: 1114 pre- and 839 post-intervention). Intervention hospital patients tended to be younger, with fewer comorbidities, but with similar severity of acute illness. Across both periods, hospital mortality (p = 0.26) and hospital length of stay (p = 0.64) for the intervention vs control hospitals were similar, but time-to-transfer to the ICU was longer for the intervention hospital (13.3–17.0 vs 11.5–11.6 hours, p = 0.006). Using the difference-in-differences approach, we found a 19.2% reduction (95 confidence interval: 6.7%-31.6%, p = 0.002) in the time-to-transfer to the ICU associated with adding the CCM-PA to the CCOT; we found no difference in hospital mortality (p = 0.20) or length of stay (p = 0.52). Conclusions Adding a CCM-PA to the CCOT was associated with a notable reduction in time-to-transfer to the ICU; hospital mortality and length of stay were not impacted.
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Affiliation(s)
- Hayley B. Gershengorn
- Division of Critical Care Medicine and Department of Neurology; Albert Einstein College of Medicine, Montefiore Medical Center; Bronx, New York, United States of America
- * E-mail:
| | - Yunchao Xu
- Department of Information, Operations, and Management Sciences; New York University Stern School of Business; New York, New York, United States of America
| | - Carri W. Chan
- Division of Decision, Risk, and Operations; Columbia Business School; New York, New York, United States of America
| | - Mor Armony
- Department of Information, Operations, and Management Sciences; New York University Stern School of Business; New York, New York, United States of America
| | - Michelle N. Gong
- Division of Critical Care Medicine and Department of Epidemiology and Population Health; Albert Einstein College of Medicine, Montefiore Medical Center; Bronx, New York, United States of America
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Anderson ME. A Role for Physician Assistants in Organ Procurement. Prog Transplant 2016; 11:245-8. [PMID: 11871271 DOI: 10.1177/152692480101100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Healthcare in the United States, as well as the environment in which physician assistants work, is rapidly changing. Consequently, the role of a physician assistant is expanding to meet the needs of patients and physicians of all specialties of medicine and surgery. In organ procurement, physician assistants can be a valuable asset to an organ procurement organization because of their medical education, versatility, and commitment to personalized care to organ donors and their families. Physician assistants are healthcare professionals who are uniquely qualified for a variety of roles within the organization: Clinician, educator, consultant, donor and family liaison, and researcher.
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Affiliation(s)
- M E Anderson
- University of Wisconsin Hospital, Clinics Organ Procurement Organization, Madison, Wis., USA
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Everett CM, Martinez-Bianchi V, Morgan P, Gradison M, Hills K, Weigle NJ, Dieter PM, Hull S, Strand de Oliveira J, Michener L. Dr Carek's Commentary on Training PAs and NPs. Fam Med 2016; 48:742-743. [PMID: 27740681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Whitehead B. "Nurses who become ACPs should not be mini medics". Nurs Times 2016; 112:11. [PMID: 27386705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Bruner T. Physician Assistants Increase Care Access. J Ark Med Soc 2016; 112:252-253. [PMID: 27263174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
PURPOSE This study highlights the trends and data points of interest in physician assistant (PA) applicant data over the first 10 years of the Central Application Service for Physician Assistants (CASPA) (2002-2011) and PA matriculant data over the last 5 years of that 10-year period (2007-2011). METHODS A retrospective study of data provided by applicants to all CASPA-participating PA programs between 2002 and 2011 was conducted. Applicant data analyzed over the 10-year period were provided by applicants and collected through an online CASPA applicant portal. Academic information was verified by CASPA staff through official transcript review. Matriculant data were obtained from CASPA-participating programs through the online CASPA admissions portal, which linked to applicant data in the CASPA applicant portal. RESULTS During the first 10 years of the CASPA service, the Physician Assistant Education Association experienced a 93% increase in the number of CASPA-participating programs and a 255% increase in the number of unique applicants identified through CASPA. Relatively constant trends were identified in the major demographic features (age, gender, ethnic composition, and disadvantaged status) and the academic data of applicants. Major demographic features of matriculants (2007-2011) also remained relatively constant, whereas trends in academic data of matriculants revealed an increasing total grade point average. CONCLUSION This 10-year comprehensive analysis of the CASPA data will benefit the profession by establishing a baseline of applicant characteristics. Ultimately, these data will help redefine recruitment strategies at program, state, and national levels by providing programs and national organizations with data needed to target applicants not previously included in recruitment activities.
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Affiliation(s)
- M Jane McDaniel
- M. Jane McDaniel, MS, MLS(ASCP)SC, is director of admissions and an assistant professor for the Department of Physician Assistant Studies, Wake Forest University School of Medicine, Winston-Salem, NC. Carol A. Hildebrandt, BA, is academic coordinator, Research and Scholarship and Curriculum and Student Evaluation, for the Department of Physician Assistant Studies, Wake Forest University School of Medicine, Winston-Salem, NC. Gregory B. Russell, MS, is senior biostatistician and associate director of the design and analysis unit in the Department of Biostatistical Sciences, Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC
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Salsberg ES. Is the Physician Shortage Real? Implications for the Recommendations of the Institute of Medicine Committee on the Governance and Financing of Graduate Medical Education. Acad Med 2015; 90:1210-1214. [PMID: 26177529 DOI: 10.1097/acm.0000000000000837] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In July 2014, the Institute of Medicine (IOM) Committee on the Governance and Financing of Graduate Medical Education released its report calling for a major overhaul of the financing of graduate medical education (GME). Several national organizations with an interest in GME faulted the report on the basis that the IOM Committee recommendations would worsen physician shortages. However, this conclusion is based on two questionable assumptions: first, that the nation is already facing a general physician shortage; and second, that the IOM Committee recommendations would make shortages worse. The author argues that although some communities and specialties do face shortages, currently and in the future a general national physician shortage is unlikely. Reasons cited include changes in the delivery system with an increased focus on efficiency and effectiveness; the increased use of interprofessional teams facilitated by the increasing supply of nurse practitioners, physician assistants and other health professionals; and technological advances.The author concludes that the IOM Committee recommendations would support an increase in GME positions in locations and specialties where there is a documented need, in effect removing the current cap on Medicare-funded GME positions. Given the current fiscal environment, the approach recommended by the IOM Committee--steady funding levels but improved targeting to meet documented needs--may be the best strategy for maintaining GME funds and meeting the nation's physician workforce needs.
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Affiliation(s)
- Edward S Salsberg
- E.S. Salsberg is director of health workforce studies, GW Health Workforce Institute, and research faculty, School of Nursing, and adjunct faculty, Milken School of Public Health, George Washington University, Washington, DC
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Abstract
OBJECTIVE Examine availability of physician assistants (PAs) or nurse practitioners (NPs) in primary care physician practices by state and by state PA and NP scope-of-practice laws. METHODS Availability of PAs and NPs in primary care practices was examined in multivariate analysis using a 2012 state-based, nationally representative survey of office-based physicians. Covariates included practice characteristics, state, and in a separate model, PA and NP scope-of-practice variables. RESULTS After controlling for practice characteristics, higher use of PAs and NPs was found in three states (Minnesota, Montana, and South Dakota). In a separate model, higher use of PAs or NPs was associated with favorable PA scope-of-practice laws, but not with NP scope-of-practice laws. CONCLUSIONS Higher availability of PAs or NPs was associated with favorable PA scope-of-practice laws. Lack of association between PA or NP availability and NP scope-of-practice laws requires further investigation.
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Affiliation(s)
- Esther Hing
- Esther Hing is a survey statistician with the CDC's National Center for Health Statistics, Division of Health Care Statistics, in Hyattsville, Md. At the time this study was done, Chun-Ju Hsiao was a health scientist at the National Center for Health Statistics. He now is a health scientist administrator with the Agency for Healthcare Research and Quality's Center for Quality Improvement and Patient Safety in Rockville, Md. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the CDC the Agency for Healthcare Research and Quality
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Boehler M, Schechtman B, Rivero R, Jacob BA, Sherer R, Wagner C, Alabduljabbar SA, Linsk NL. Developing the HIV Workforce: The MATEC Clinician Scholars Program. J Assoc Nurses AIDS Care 2015; 27:246-60. [PMID: 26253024 DOI: 10.1016/j.jana.2015.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/25/2015] [Indexed: 11/19/2022]
Abstract
Engaging new clinical providers in the HIV workforce is a critical need due to rapidly evolving treatment paradigms, aging out of existing providers, and special population needs. The 1-year competency-based Clinician Scholar Program for minority-serving providers with limited HIV care experience was individually tailored for each provider (n = 74), mostly nurse practitioners, physicians, and clinical pharmacists. Baseline and endpoint self-assessments of clinical knowledge and skills showed significant improvements in all 11 targeted competencies, particularly in managing antiretroviral medications, screening and testing methods, incorporating prevention into HIV care, understanding risk reduction methods, and describing current care standards. Faculty mentor assessments also showed significant improvement in most competencies. Additional benefits included ongoing access to mentorship and training, plus sustained engagement in local and statewide HIV care networks. Our intensive mentoring program model is replicable in other AIDS Education and Training Centers and in other structured training programs.
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Walker F. Twenty-five years of serving the health care needs of rural North Carolina. N C Med J 2015; 76:34-36. [PMID: 25621478 DOI: 10.18043/ncm.76.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Community Practitioner Program seeks to improve access to quality health care for North Carolina's most vulnerable people by providing educational loan repayment grants to primary care physicians, physician assistants, and nurse practitioners in return for their service in rural and underserved communities.
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Affiliation(s)
- Franklin Walker
- North Carolina Medical Society Foundation, Raleigh, North Carolina, USA.
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Zimmermann GW. [Starting 2015 new non-medical assistants flood health care practice]. MMW Fortschr Med 2014; 156:14; discussion 14. [PMID: 25543351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Here come the physician assistants. Manag Care 2014; 23:25. [PMID: 25282861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Manchester A. 'You have chosen the right career'--Benny. Nurs N Z 2014; 20:22. [PMID: 25255540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Davis JS, Zuber K. Advanced practitioners are nephrology's future. Nephrol News Issues 2014; 28:14-16. [PMID: 24908821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Dowsing T, Chellamuthu P, Powell N, Forbes-Pyman R. Can someone call my PA? Acute Med 2014; 13:78-81. [PMID: 24940572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this paper is to outline the background of the Physician Associate (known in the USA as physician assistant¹) role in the USA and follow its recent journey to the UK where it is becoming a rapidly developing new healthcare role. Through the use of two case studies from UK Hospital Trusts who are currently utilising Physician Associates (PAs) in their workforce we describe the implementation and development opportunities for the role, with particular reference to their role in Acute Medicine teams of the future.
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Affiliation(s)
- T Dowsing
- Physician Associate in Acute Geriatrics George Eliot Hospital NHS Trust and President of the UK Association of Physician Associates
| | - P Chellamuthu
- Acute Medicine Consultant, George Eliot Hospital NHS Trust
| | - N Powell
- Acute Medicine and Geriatrics Consultant, Surrey and Sussex Healthcare NHS Trust
| | - R Forbes-Pyman
- Physician Associate in Acute Medicine and Secretary of the UK Association of Physician Associates
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Wolfgang K. Nephrology as a practice focus. Adv NPs PAs 2014; 5:8. [PMID: 24575575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Stange K. How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants. J Health Econ 2014; 33:1-27. [PMID: 24240144 DOI: 10.1016/j.jhealeco.2013.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 10/03/2013] [Accepted: 10/16/2013] [Indexed: 05/23/2023]
Abstract
Nurse practitioners (NPs) and physician assistants (PAs) now outnumber family practice doctors in the United States and are the principal providers of primary care to many communities. Recent growth of these professions has occurred amidst considerable cross-state variation in their regulation, with some states permitting autonomous practice and others mandating extensive physician oversight. I find that expanded NP and PA supply has had minimal impact on the office-based healthcare market overall, but utilization has been modestly more responsive to supply increases in states permitting greater autonomy. Results suggest the importance of laws impacting the division of labor, not just its quantity.
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Affiliation(s)
- Kevin Stange
- Gerald R. Ford School of Public Policy, University of Michigan, 735 S. State Street #5236, Ann Arbor, MI 48109, United States.
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Allen SM, Ballweg RA, Cosgrove EM, Engle KA, Robinson LR, Rosenblatt RA, Skillman SM, Wenrich MD. Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study. Acad Med 2013; 88:1862-1869. [PMID: 24128621 DOI: 10.1097/acm.0000000000000008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.
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Affiliation(s)
- Suzanne M Allen
- Dr. Allen is clinical professor of family medicine and vice dean for regional affairs, University of Washington School of Medicine, Seattle, Washington. Ms. Ballweg is professor of family medicine and director, MEDEX Northwest Program, University of Washington School of Medicine, Seattle, Washington. Dr. Cosgrove is professor of medicine and vice dean for academic affairs, University of Washington School of Medicine, Seattle, Washington. Ms. Engle is director of operations, Office of Regional Affairs, University of Washington School of Medicine, Seattle, Washington. Dr. Robinson is professor of rehabilitation medicine and vice dean for graduate medical education and clinical affairs, University of Washington School of Medicine, Seattle, Washington. Dr. Rosenblatt is professor and vice chair of family medicine and director, Rural/Underserved Opportunities Program, University of Washington School of Medicine, Seattle, Washington. Ms. Skillman is deputy director, WWAMI Rural Health Research Center and UW Center for Health Workforce Studies, University of Washington School of Medicine, Seattle, Washington. Ms. Wenrich is affiliate assistant professor of biomedical informatics and medical education, University of Washington School of Medicine, and chief of staff, UW Medicine, Seattle, Washington
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Brock D, Bolon S, Wick K, Harbert K, Jacques P, Evans T, Abdullah A, Gianola FJ. The military veteran to physician assistant pathway: building the primary care workforce. Acad Med 2013; 88:1890-1894. [PMID: 24128629 DOI: 10.1097/acm.0000000000000011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- Douglas Brock
- Dr. Brock is associate professor, University of Washington Department of Family Medicine and MEDEX Northwest, Seattle, Washington. Dr. Bolon is chief, Primary Care Medical Education Branch, Division of Medicine and Dentistry, Bureau of Health Professions, Department of Health Resources and Services Administration, U.S. Department of Health and Human Services, Washington, DC. Dr. Wick is assistant professor, University of Washington Department of Family Medicine and MEDEX Northwest, Seattle, Washington. Dr. Harbert is dean and program director, South College School of Physician Assistant Studies, Knoxville, Tennessee. Dr. Jacques is associate professor, Division of Physician Assistant Studies, Medical University of South Carolina, Charleston, South Carolina. Dr. Evans is associate professor, University of Washington Department of Internal Medicine and MEDEX Northwest, Seattle, Washington. Ms. Abdullah is director of government relations, Physician Assistant Education Association, Alexandria, Virginia. Mr. Gianola is lecturer, University of Washington Department of Family Medicine and MEDEX Northwest, Seattle, Washington
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Abstract
For over four decades, physician assistants (PAs) have demonstrated that they are effective partners in a changing health care environment, readily adaptable to the needs of an evolving delivery system. With increased expectations of physician shortages, especially in primary care, PAs will be called on to fill provider gaps and new roles in interprofessional team-based delivery systems. There are over 90,000 certified PAs in the workforce and 173 accredited programs yielding an estimated 6,545 graduates annually, with an estimated 65 new programs seeking provisional accreditation by the end of 2016. New data on the PA pipeline and practice provide key information about the potential of this workforce; however, the overall impact of the PA pipeline on projected shortages remains unclear. Barriers exist to optimal deployment, including faculty shortages, scope-of-practice regulations, and a lack of clinical placement sites.This article brings together data from the Physician Assistant Education Association and the National Commission on Certification of Physician Assistants and its supporting organization, the nccPA Health Foundation. Primary sources include PA candidates, educational programs, students, and certified PAs. Collectively, these data provide a comprehensive picture of PAs' contributions to the health care workforce. Armed with pipeline and graduate practice data, policy makers and workforce planners will be equipped to design new models of practice that maximize the potential contributions of this growing PA workforce on health care teams.
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Affiliation(s)
- Anita Duhl Glicken
- Ms. Glicken is president/CEO, nccPA Health Foundation, Johns Creek, Georgia, and associate dean and professor emerita, University of Colorado School of Medicine, Denver, Colorado. Mr. Miller is senior director of education policy and strategy, Physician Assistant Education Association, Alexandria, Virginia, and distinguished professor, Division of Physician Assistant Studies, Shenandoah University, Winchester, Virginia
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Wolfgang K. Diabetes as a practice focus. Adv NPs PAs 2013; 4:12. [PMID: 24354227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Cawley JF, Hooker RS. Physician assistants in American medicine: the half-century mark. Am J Manag Care 2013; 19:e333-e341. [PMID: 24304180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The concept of the physician assistant (PA) was developed by US physicians in the 1960s as a workforce strategy to improve the delivery of medical services. Then as now there is an anticipated shortage of physicians, particularly in primary care. Use of PAs is viewed as 1 possible strategy to mitigate this growing gap in provider services. OBJECTIVES To describe the PA in US medicine for policy background and analysis. DESCRIPTION In January 2013, approximately 89,500 PAs were licensed: 65% were women. Four-fifths were under the age of 55 years. PAs are trained in 2.5 years at one-fourth the cost of a physician and begin producing patient care 4 years before a physician is independently functional. One-third of PAs work with primary care physicians; 65% work in non-primary care practices. Popular specialties are family medicine, emergency medicine, surgery, and orthopedics. PAs are revenue producers for employers and expand access and clinical productivity in most practice settings. Roles for PAs have expanded into hospital settings and graduate medical education programs. About 7300 PAs graduate annually, and this number is expected to grow to 9000 by the end of the decade. Predictive modeling suggests that demand for medical services will grow faster than the combined supply of physicians, PAs, and nurse practitioners, particularly in primary care. PA quality of care appears indistinguishable from that of physician-delivered services. CONCLUSIONS Optimal organizational efficiency and cost savings in health services delivery will depend on how well the PA can be utilized.
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Affiliation(s)
- James F Cawley
- Professor, Department of Prevention and Community Health, The George Washington University, 2175 K Street, NW, Washington, DC 20037. E-mail:
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Shock LP. Are you doing your part for the future? Adv NPs PAs 2013; 4:11. [PMID: 24279065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Lisa P Shock
- Cornerstone Internal Medicine at Westchester in High Point, NC, USA
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Wolfgang K. Geriatrics: a specialty that needs more. Adv NPs PAs 2013; 4:12. [PMID: 24079080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Hinkley K. Rx for doctor shortage? Expanding nurses' range of duties is one way to address our nation's shortage of doctors. State Legis 2013; 39:30-31. [PMID: 24040687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Petterson SM, Phillips RL, Bazemore AW, Teevan Burke B, Koinis GT. Relying on NPs and PAs does not avoid the need for policy solutions for primary care. Am Fam Physician 2013; 88:230. [PMID: 23944725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Dr. Who? The next 'doctor' you see might be a nurse practitioner. Getting Health Care Right: one in a series. Consum Rep 2013; 78:34-6. [PMID: 23866388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Coombs J, Hooker RS, Brunisholz K. Physician assistants and their intent to retire. Am J Manag Care 2013; 19:e256-e262. [PMID: 23919445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To determine predictors of physician assistants (PAs) to retire or to permanently leave clinical practice. The intent was to create a measure of retention and attrition for purposes of forecasting PA supply. STUDY DESIGN All PAs 55 years or older who were nationally certified in 2011 were surveyed. METHODS Statistical analysis included descriptive measures utilizing means, standard deviations, range, and proportions for all survey questions. Univariable analysis using χ² test for the categorical variables determined gender differences in participants' intent to retire. A studentized t test analysis for continuous variables was used to compare differences across genders. The estimated time interval until retirement was calculated using reported values from participants and then subtracting their projected retirement age from current age. The same calculation was used for estimating PA career length from date of graduation to retirement. For all analyses, a P value < .05 was considered statistically significant. RESULTS A total of 12,005 were eligible and surveyed online; 4767 responded (38%). The mean age was 60 years and the years in clinical practice was 25. When asked to predict a retirement date or age, the mean duration of working beyond age 55 years was 12 years (range 5 to 21). Most respondents reported being confident they were on track to retire with an adequate income. The significant differences that emerged were that men were more confident than women in preparing to retire, having enough money for medical expenses, and being able to live comfortably in retirement. Men more than women stated that, if forced to retire, they were more confident in the preparation to do so. CONCLUSIONS PAs 55 years and older report they are likely to delay retirement from practice until age 67 years, on average. Women were less confident than men in retirement preparation. This age prediction expands career projections and refines forecasting models for the profession. Correlations based on expectation-action chain of events should be developed by periodically measuring how often intent and reality coalesce.
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Affiliation(s)
- Jennifer Coombs
- Department of Preventive and Family Medicine, Division of Physician Assistant Education, University of Utah, 375 Chipeta Way, Ste A, Salt Lake City, UT 84108, USA.
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Shock LP. Are you an advocate for your profession? Adv NPs PAs 2013; 4:15. [PMID: 23795410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Lisa P Shock
- Cornerstone Internal Medicine at Westchester in High Point, N.C., USA
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Cawley JF. Policy strategies to increase primary care. Adv NPs PAs 2013; 4:18. [PMID: 23724442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- James F Cawley
- Department of Prevention and Community Health, George Washington University, Washington, D.C., USA
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Eisenman A. How do retired paramedics fit into remote, rural emergency departments? Rural Remote Health 2013; 13:2057. [PMID: 23514589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
The reluctance of physicians to stay in remote and rural hospitals has resulted in a shortage of doctors in these settings, and therefore a decline in the quality of care and an intolerable overload on functioning doctors. However, mature paramedics find it difficult to comply with the demands of ambulance work and look for easier tasks that suit their age. The two problems may have a common solution if senior paramedics are incorporated into in-hospital work. Paramedics' skills, education and experience enable them to become useful physician assistants who may relieve much of the doctors' burden, allowing physicians in remote hospitals to concentrate on genuine medical duties. However, the objection of doctors' and nurses' professional organizations constitute a substantial obstacle to this solution.
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Affiliation(s)
- A Eisenman
- Medical Emergency Department, Western Galilee Hospital, Nahariya, Israel.
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Selvam A. The next level. Annual workforce report shows nurse practitioners pushing for increased autonomy in their roles. Mod Healthc 2013; 43:28-30. [PMID: 23947262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Rosemann T, Schneemann M. [Physician shortage in family practice concerns us all]. Praxis (Bern 1994) 2013; 102:313-314. [PMID: 23485749 DOI: 10.1024/1661-8157/a001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Keenum AJ, Rawlings LM, Odoi A, Wortley MG, Lamsen L, Jones L, Wallace LS. Tennessee emergency medicine workforce, 2009. Tenn Med 2013; 106:41-43. [PMID: 23544291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Describe the characteristics of the Tennessee (TN) Emergency Medicine (EM) workforce. METHODS A cross-sectional mail survey of all non-government emergency departments (EDs) in TN was performed between January and April 2009. Data collected included: number and residency training of physicians, ED volume, employment and type of mid-level providers. Survey datawere compared to recent national EM workforce data. Subgroup analysis of rural EDs using Rural-Urban Commuting Area Code (RUCA) criteria was conducted. RESULTS We received responses from 50 of the 100 emergency departments surveyed. Roughly half (53 percent) were rural, based on RUCA criteria. Mid-level providers worked with physicians in 31 departments, with physician assistants(PAs) being employed more commonly than nurse practitioners(NPs). Paramedics and emergency medical technicians (EMTs) were employed less frequently. Most EM residency trained physicians in Tennessee are working in EDs with approximately 39,000 annual visits per year or greater. Subspecialty physicians such as neurosurgeons, gastroenterologists and otorhinolaryngologists are generally not available to rural EDs, except by patient transfer, illustrating the marked differences in the work environments. CONCLUSION While there is clearly a need for more emergency medicine residency training programs in Tennessee, the need to continue to provide advanced training for family medicine residency trained physicians is also clear. Family medicine doctors provide most of the rural emergency medicine in Tennessee.
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Affiliation(s)
- Amy J Keenum
- Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA.
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Worsowicz GM, Harlan K. Physician extenders in physical medicine and rehabilitation: a roundtable discussion. PM R 2013; 5:148-51. [PMID: 23415250 DOI: 10.1016/j.pmrj.2012.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 10/26/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Gregory M Worsowicz
- Department of Physical Medicine and Rehabilitation, DC046.00, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.
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Evans KA. Reducing readmission rates. Adv NPs PAs 2013; 4:12. [PMID: 23437611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Shock LP. Workforce volume strives to meet patient demand. Adv NPs PAs 2013; 4:11. [PMID: 23437610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Physician assistants turn away from primary care. Manag Care 2013; 22:11. [PMID: 23451532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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