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Volume 25 | Number 2
The Special Theme issue about physician assistants addresses a variety of aspects of this profession. The Brief Overview offers a history and current state of the profession. The “Insight” article explores the sources of job satisfaction and dissatisfaction among PAs. The “Comparison of the Practice Expectations” study notes similarities and significant differences between the PA entering classes of 1977 and of 2003. “Where Do Physician Assistants Practice?” spotlights the Child Health Associate/Physician Assistant Program at the University of Colorado and supports the findings in previous articles about practice trends among PAs. The two articles, “A Commitment to Diversity” and “How a PA program is Addressing Professionalism and Cultural Competency through Problem-based Learning,” discuss the issue of workforce diversity and how one program encourages it.
A Brief Overview of Physician Assistants in the United States
James F. Cawley, M.P.H., PA-C
Roderick S. Hooker, Ph.D, P.A.
Cawley and Hooker provide an historical perspective as well as a current state of affairs for the physician assistant (PA) profession. The rise of the PA profession in the U.S. in the late 1960’s resulted from a fortuitous combination of physician shortage, healthcare maldistribution, and a trained workforce of medics returning from service in Vietnam. Eugene Stead, MD, at Duke University pioneered the PA concept as a way to use these military medics in the civilian world, founding the first PA training program. PAs were endorsed by the AMA in 1969, which opened the door for state licensing and prescribing laws. The PA was seen as a new type of medical generalist, extending, as opposed to replacing, physicians. Although the initial thought was to extend primary care to underserved areas, PAs have found their way into most medical specialties. Roughly half of PAs currently work in primary care and about as many work in rural, inner city, and small town communities.
Although PA programs initially varied widely in curricular models and credentialing, they were, and still are typically, two-year programs. In 2005, 134 PA programs were operating, 90 of which awarded a master’s degree or other graduate degree option. Most other programs have committed to being at this point by 2008. PAs are licensed in all 50 states, must pass the Physician Assistant National Certifying Exam (PANCE), and must continue to obtain medical education annually. The original competency-based educational philosophy is still reflected in state requirements. PAs have been widely accepted by physicians and patients, enjoy high job satisfaction, and provide cost-effective health care. Several other countries have begun to adopt this model.
Physician Assistant Education in an Evolving Health Care Delivery System
Anita Duhl Glicken, M.S.W.
Anticipating the Profession's Future
Justine Strand, PA-C
Insight into Physician Assistant Vocational Satisfaction
Dawn M. LaBarbera, PA-C, Ph.D.
According to an extensive vocational satisfaction study, physician assistants are, as a group, satisfied with their jobs. It is widely believed that a satisfied individual will produce higher quality work, a factor especially important in health care. The primary sources of job satisfaction were found to be substantial patient interaction, a work schedule that allows a good work/life balance, a team approach with co-workers, variety in terms of patients and medical conditions, medical problem solving, and limited (malpractice) liability.
There were some sources of dissatisfaction. These included lack of respect and understanding of the PA role, low compensation, long hours, and insurance issues.
LaBarbera also used the Holland typological system as part of the survey to predict the type of individual who would be most satisfied by a career as a PA. In general the Holland PA typology favors a Social and Integrative personality. Compensation does not appear to play a role in job satisfaction. PAs were found to dislike repetitive, mundane tasks such as paperwork.
The ASDA Advantage
Katherine A. Dwyer
The American Student Dental Association (ASDA) reaches out to current dental students, those who have graduated from dental school, international members, and pre-dental students. ASDA members take an active role in influencing policies of the American Dental Association (ADA). The organization is active in working to improve exam procedures, reduce student loan indebtedness, improve curriculum, and address licensure qualifications. For the pre-dental student ASDA provides an opportunity to learn about dentistry, keep current on issues affecting the profession, and connect with others who have similar vocational interests. Health professions advisors “often play a crucial role by encouraging school support for students participating in ASDA.” For advisors, involvement with an ASDA chapter is also a way to gain information and stay current with what is happening with dental school admissions and in dentistry.
Comparison of the Practice Expectations of First Year Physician Assistant Students of the Class of 1977 and the Class of 2003
J. Glenn Forister, M.P.A.S, PA-C
J. Dennis Blessing, Ph.D, PA-C
Eugene S. Schneller, Ph.D.
Two physician assistant cohorts, separated by a twenty-eight year interval, were compared in terms of characteristics and expectations. Despite the perception that there are significant differences in the backgrounds of the two groups, they are, in fact, quite similar. The results discussed centered mostly around professional expectations and these have changed significantly over twenty-eight years. More 2003 PA students expect to work in group practices rather than in a solo practice. They also expect to work in specialty practices as well as in urban and suburban areas. 46% of the entering class of 1977 expected to work more than 56 hours per week whereas only 11% of the 2003 group expected to do so. Most of the latter group expects to work a more standard 40-hour work week. Another major area of difference lies in the expected level of responsibility and autonomy. The 2003 cohort expects to be less physician supervised and more involved in diagnosis, prescription writing, and direct treatment than their 1977 counterparts. Finally, the current group seems to have realistic salary expectations.
A Commitment to Diversity in the Physician Assistant Profession
Grace Landel, PA-C, M.Ed.
Christina M. Robohm, M.S., PA-C
Cristina Gonzalez, M.A.
Suzanne Hage, M.H.S., PA-C
James R. Fry, M.S., PA-C
The Association of Physician Assistant Programs and the American Academy of Physician Assistants have both recently affirmed their commitment to providing diversity in the Physician Assistant work force. Citing the 2003 Institute of Medicine report, the 2004 Sullivan Commission Report, and the Supreme Court decision in Grutter v. Bollinger, et al, there seems little question that increasing diversity improves health care delivery to minority populations, but also improves health care delivery in general. Minority enrollment in PA programs has remained fairly level in the 20-22% range for the past 20 years. Nonetheless, the number of potential applicants still falls short of demographic representation.
How a P.A. Program is Addressing Professionalism and Cultural Competence through Problem-based Learning
Clara LaBoy, PA-C, M.S.
Clara LaBoy, the Academic Coordinator of the PA program at St. Vincent’s Catholic Medical Center, describes how problem-based learning is used to foster cultural competence. In fulfilling the program’s mission to serve “the poor, alienated, and the aged”, students learn to work in teams of people from diverse backgrounds to help them learn to better communicate, negotiate, and interact. Students with different backgrounds, ideas, and learning styles must work together to solve a problem and present their findings in a high-pressure situation. To connect the sensitivity gained in the first, didactic year with the clinical training, students participate in a forum, “Spoken from the Heart”, and keep a journal of issues such as cultural differences, ethical dilemmas, difficult cases, and interpersonal challenges of all types. LaBoy notes that the faculty must be willing to evaluate themselves and self reflect if they are to remain effective in this endeavor.
Where Do Physician Assistants Practice? A Comparison of National and Child Health Associate/Physician Assistant Program Trends
Christina Robohm, M.S., PA-C
Christina Robohm describes the history and current status of the PA program at the University of Colorado. Begun as the first specialized PA program (in pediatrics), this program evolved to include a full adult curriculum, although it retains its emphasis in pediatrics. Robohm then presents data indicating the trend away from primary care and toward a specialty focus among PAs over the last decade. Her point seems to be that PA training is versatile and adaptable, allowing PAs to enter a wide variety of medical fields with their generalist training.
Humanitarian P.A. Helps People One Day at a Time
CASPA: An Evolving Advisor Resource
The CASPA Advisory committee
Physician Assistant Liaison Report