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Few patients with opioid use disorder receive medication for addiction treatment. In 2017 the Comprehensive Addiction and Recovery Act enabled nurse practitioners (NPs) and physician assistants (PAs) to obtain federal waivers allowing them to prescribe buprenorphine, a key medication for opioid use disorder. The waiver expansion was intended to increase patients' access to opioid use treatment, which was particularly important for rural areas with few physicians. However, little is known about the adoption of these waivers by NPs or PAs in rural areas. Using federal data, we examined waiver adoption in rural areas and its association with scope-of-practice regulations, which set the extent to which NPs or PAs can prescribe medication. From 2016 to 2019 the number of waivered clinicians per 100,000 population in rural areas increased by 111 percent. NPs and PAs accounted for more than half of this increase and were the first waivered clinicians in 165 [corrected] rural counties with 5.7 million residents. In rural areas, broad scope-of-practice regulations were associated with twice as many waivered NPs per 100,000 population as restricted scopes of practice were. The rapid growth in the numbers of NPs and PAs with buprenorphine waivers is a promising development in improving access to addiction treatment in rural areas.

BackgroundEarly detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma.ObjectiveTo develop and demonstrate the efficacy of online training.DesignRandomized educational trial.ParticipantsPrimary care providers (PCPs).InterventionMastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard.Main MeasuresPre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention.Key ResultsAmong the 89 PCPs, 89.8% were internal medicine physicians, and the remainder were physician assistants embedded in internists’ practices. There were no differences between control and intervention groups regarding gender, age, race, or percentage of full-time PCPs. The control group had more PCPs who reported less than 5 years of practice (n = 18) than the intervention group (n = 6) (χ2 [6, n = 89] = 14.34, p = 0.03). PCPs in the intervention group answered more melanoma detection questions correctly on the post-test (M = 10.05, SE = 1.24) compared to control group PCPs (M = 7.11, SE = 0.24), and had fewer false-positive and no false-negative melanoma diagnoses (intervention, M = 1.09, SE = 0. 20; control, M = 3.1, SE = 0.23; ANCOVA, F[1,378] =27.86, p < 0.001; ηp2 = 0.26). PCPs who underwent training referred fewer benign lesions, including nevi, seborrheic keratoses, and dermatofibromas, than control PCPs (F[1,79] = 72.89, p < 0.001; ηp2 = 0.489; F[1,79] = 25.82, p < 0.001; ηp2 = 0.246; F[1,79] = 34.25, p < 0.001; ηp2 = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; ηp2 = 0.236). Referred melanomas (0.8  ± 0.07 per month for intervention, 0.17 ± 0.06 for control) were mostly located on the head and neck.ConclusionsMastery learning improved PCPs’ ability to detect melanoma on a standardized post-test and may improve referral of patients with suspected melanoma. Further studies are needed to confirm this finding.ClinicalTrials.gov NCT02385253.

Background The Physician Assistant (PA) bachelor’s degree program has been available in Germany for several years, and PAs are progressively being hired and assigned to hospitals. Although the German Medical Association has developed a curriculum, the specific roles and potential duties of PAs in hospitals remain undefined. This study aims to explore the various applications and responsibilities of PAs within the field of gynecology. Methods Between December 2023 and February 2024, a cross-sectional, web-based, and anonymized survey was sent to gynecologists via the mailing lists of the Young Forum of the German Society of Gynecology and Obstetrics (DGGG) and through their Instagram account. A total of 120 surveys were collected, of which 97 were completed. The topics of the questionnaire were related to the expected integration of PAs in routine working tasks in the hospital. Results This study shows that a significant proportion of respondents considered administrative duties (80%), blood sampling (95%), inserting intravenous catheters (95%), taking medical histories (81%), and conducting ward rounds under medical supervision (65%) to be suitable tasks for Physician Assistants (PAs). In contrast, procedures such as transvaginal sonography (22%), sonographic interventions (15%), and educational tasks (31%) were deemed unsuitable for delegation to PAs. Conclusion The introduction of PAs in gynecology may be integrated into everyday clinical practice, but the specific tasks should be clearly defined. Establishing these conditions may have the potential to enhance job satisfaction for doctors.

Social media is increasingly utilized as a resource in healthcare. We sought to identify perceptions of using social media as an educational tool among healthcare practitioners. An electronic survey was distributed to healthcare administrators, nurses, nurse practitioners, pharmacists, physicians, and physician assistants f hospital systems and affiliated health science schools in Georgia, Maryland, South Carolina, and Wisconsin. Survey questions evaluated respondents' use and views of social media for educational purposes and workplace accessibility using a Likert scale (1 = strongly disagree, 5 = strongly agree). Nurses (75%), pharmacists (11%), and administrators (7%) were the most frequent respondents. Facebook® (27%), Pinterest® (17%), and Instagram® (17%) were the most frequently accessed social media platforms. Nearly 85% agreed or strongly agreed that social media can be an effective tool for educational purposes. Among those who had social media platforms, 43.0% use them for educational purposes. Pinterest® (30%), Facebook® (22%), LinkedIn® (16%), and Twitter® (14%) were most frequently used for education. About 50% of respondents had limited or no access to social media at work. Administrators, those with unlimited and limited work access, and respondents aged 20-29 and 30-39 years were more likely to agree that social media is an educational tool (OR: 3.41 (95% CI 1.31 to 8.84), 4.18 (95% CI 2.30 to 7.60), 1.66 (95% CI 1.22 to 2.25), 4.40 (95% CI 2.80 to 6.92), 2.14 (95% CI 1.53 to 3.01) respectively). Residents, physicians, and those with unlimited access were less likely to agree with allowing social media access at work for educational purposes only. Healthcare practitioners frequently utilize social media, and many believe it can be an effective educational tool in healthcare.

Nurse practitioners and physician assistants are providing an increasing share of health care services, and education programs have proliferated. These dynamics will have lasting effects on the health care workforce and on relationships among health professionals.

Background The family medicine (FM) workforce in the United States (U.S.) includes physicians, physician associates/assistants (PAs), and nurse practitioners (NPs). These family medicine practitioners are patients’ first point of contact, providing preventative, continuous healthcare, care coordination, and patient-centered care. Yet, despite their importance in the healthcare system, the shortage of FM practitioners persists. Considering the general medical education of PAs and limited research on their roles in FM, this research aims to understand the employment characteristics of this professional group. Methods This cross-sectional observational research utilized a 2023 national dataset from the National Commission on Certification of PAs (NCCPA). We used standard descriptive and bivariate analyses to summarize the demographic and professional attributes of PAs in FM ( n  = 20,940) versus those in all other specialties ( n  = 106,001). Results In 2023, 16.5% of PAs indicated working in FM. PAs in FM had a median age of 41, and 68.8% self-identified as female. PAs in FM versus those in other medical specialties (all p  < 0.001) were more likely to self-identify as Black/African American (3.8% versus 3.4%) and Hispanic/Latino(a/x) (9.3% versus 6.6%). A higher ratio of PAs in FM indicated practicing in rural/isolated settings (15.3% versus 5.7%) and reported using another language other than English to communicate with patients (26.4% versus 21.7%; all p  < 0.001) than their colleagues in other medical specialties. FM PAs were more likely to indicate working in office-based private settings, community health centers, rural health clinics, and public/community health clinics than PAs in all other specialties. Compared to their colleagues in other specialties, a higher percentage of PAs in FM indicated providing telemedicine services (66.1% versus 38.1%; p  < 0.001). Family medicine PAs versus those in other medical disciplines reported earning $10,000 less (annual income). A slightly lower proportion of PAs in FM reported being satisfied with their current employment and were more likely to experience symptoms of burnout compared to PAs in other medical specialties. Conclusions This study reinforces the critical role of PAs in FM in mitigating the healthcare access crisis, particularly in underresourced and rural areas. A better understanding of factors associated with PAs pursuing and sustaining practice in FM could alleviate some of the burden of the projected healthcare provider shortage in primary care.

Background Physician Assistant/Associate (PA) students are facing increased impairment, adverse academic experiences, and impeded performance. Despite well-documented research demonstrating the multi-factorial wellness needs of many PA students nationally, the unnecessary challenges and continuance of harm persists. Such barriers have influenced student performance, stability, outcomes, and undesirable health events. Further, evidence suggests that student learner wellness is influenced by predisposing and mitigatable factors, which can be addressed proactively at the individual and program level. Early identification of well-being needs, risk factors, and modifiable action steps can enhance student success during the intensive educational journey of the PA student pre-clinical workforce. Therefore, examining, optimizing, and integrating longitudinal wellness practices across curricular design and program operations can have a lasting impact on learners, including as the future healthcare workforce (HCW). This scoping review aims to investigate wellness practices, alignment of their terminologies and implementations for PA students in the United States (U.S.) and evaluate health profession programs’ implications of the future HCW. Methods The authors utilized a Joanna Briggs Institute (JBI) scoping review protocol and logic model to investigate the research query. Literature retrieval was led by the research librarian using keywords, Boolean operators, and database-specific terminology. Using a population, intervention, comparison, outcome, and setting (PICOS) framework and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) tools, studies were vetted through a phased eligibility screening process according to inclusion/exclusion criteria (PA students, wellness practices, occurred within the U.S., original research). Data extraction occurred systematically and involved categorization of terminology (constructs, positive/negative tone), wellness practices, and student impact and outcomes. Findings were mapped to best-fit wellness dimensions using the National Wellness Institute (NWI) competency-based model and to the PA Core Competencies. Thematic and directed content analysis was performed in sequence to determine culminative study results. Results A total of 447 studies were retrieved from database searching ( n  = 439) and handsearching ( n  = 8). After initial screening and full-text review, 25 studies met inclusion criteria for a total of 9,628 PA student participants. Out of the 25 studies examined, 13/25 (52%) explored the didactic year, 3/25 (12%) examined the clinical year, 7/25 (28%) studied both, and 2/25 (8%) did not specify (Table 1). 28% ( n  = 7/25) of studies were anchored in evidence-based frameworks. Terminology, wellness practices, and implementation varied across the health professions programs. The ‘construct tone’ across studies used was nearly equivalent when examining positive (50.89%) versus negative (49.11%) terms related to ‘well-being,’ Three of 7 (42.86%) dimensions of wellness were most prevalent (EP, IM, and OA) (Fig. 2), whereas the remaining 4 of 7 (57.14%) dimensions (Ph, Sp, Soc, and OWB) had less representation (Table 2). Wellness practices were siloed or brief in nature as seen in 15/25 studies (60%), such as an isolated module or class session, and none of the studies ( n  = 0/25) addressed all the dimensions of wellness. Findings related to PA student positive/negative wellness experiences sourced directly from the included studies showed statistical significance ( p  < 0.0001 to p  = 0.05), a predominance of moderate to strong correlations ( r = -0.802, r  = 0.762), and a range of effect sizes: odds ratios (1.04 to 2.09), Cohen’s d (0.09 to 0.38), and Pearson’s r (0.0 to 0.16). Conclusions Unified terminology, definitions, and implementation of wellness practices are necessary to optimize PA student success as future clinicians practicing medicine. Establishing and fostering practices that promote wellness habits, work-life balance, and modernization of antiquated health professions programs is an investment in the iterative growth toward long-term well-being, resilience, and success.

BACKGROUNDGeneral internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable.OBJECTIVEWe aimed to assess academic GIM worklife and determine remediable predictors of stress and burnout.DESIGNWe conducted an email survey.PARTICIPANTSPhysicians, nurse practitioners, and physician assistants in 15 GIM divisions participated.MAIN MEASURESA ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses.KEY RESULTSOf 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10–56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders’ values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all p < 0.001). The 45 VA faculty had less burnout than civilian counterparts (17 % vs. 40 %, p < 0.05). Hospitalists described better teamwork than ambulatory clinicians and fewer hospitalists noted documentation time pressure (both p < 0.001). Key themes from the qualitative analysis were short visits, insufficient support staff, a Relative Value Unit mentality, documentation time pressure, and undervaluing education.CONCLUSIONSWhile GIM divisions overall demonstrate high stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.

BACKGROUND:Under the Affordable Care Act, the number and capacity of community health centers (HCs) is growing. Although the majority of HC care is provided by primary care physicians (PCMDs), a growing proportion is delivered by nurse practitioners (NPs) and physician assistants (PAs); yet, little is known about how these clinicians’ care compares in this setting. OBJECTIVES:To compare the quality of care and practice patterns of NPs, PAs, and PCMDs in HCs. RESEARCH DESIGN:Using 5 years of data (2006–2010) from the HC subsample of the National Ambulatory Medical Care Survey and multivariate regression analysis, we estimated the impact of receiving NP-delivered or PA-delivered care versus PCMD-delivered care. We used design-based and model-based inference and weighted all estimates. SUBJECTS:Primary analyses included 23,704 patient visits to 1139 practitioners—a sample representing approximately 30 million patient visits to HCs in the United States. MEASURES:We examined 9 patient-level outcomes3 quality indicators, 4 service utilization measures, and 2 referral pattern measures. RESULTS:On 7 of the 9 outcomes studied, no statistically significant differences were detected in NP or PA care compared with PCMD care. On the remaining outcomes, visits to NPs were more likely to receive recommended smoking cessation counseling and more health education/counseling services than visits to PCMDs (P≤0.05). Visits to PAs also received more health education/counseling services than visits to PCMDs (P≤0.01; design-based model only). CONCLUSIONS:Across the outcomes studied, results suggest that NP and PA care were largely comparable to PCMD care in HCs.

ObjectiveTo 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.DesignSystematic review.SettingElectronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles.Included articlesPeer-reviewed articles of any study design, published in English, 1995–2017.InterventionsBlinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken.Outcome measuresImpact on: patients’ experiences and outcomes, service organisation, working practices, other professional groups and costs.Results5472 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.ConclusionsPAs 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 numberCRD42016032895.