Jaapa-Journal of the American Academy of Physician Assistants最新文献

Objective: Physician associates/assistants (PAs) and their equivalents offer a solution to the supply and demand crisis to alleviate global healthcare needs. This study investigated how PA and PA equivalents address global healthcare needs across different healthcare systems, revealing recommendations for their use. The study also sought to catalog the global healthcare needs that PAs and equivalents are successfully alleviating, the roles in which they function, and the barriers facing implementation.

Methods: A systematic review was conducted from October 2021 to April 2022 and rerun in June 2023 following PRISMA 2020 guidelines; additionally, supporting interviews were conducted with PAs and global health experts. Primary outcomes were geographic region, economy, healthcare needs, and healthcare systems. Secondary outcomes were PA use, license recognition, and successes or barriers when implementing PAs.

Results: The literature and interviews focused on the global use of PAs and PA equivalents in six geographic regions, 63 countries, and five US territories where PAs or PA equivalents are employed, have been employed, are volunteering, or are being considered to support global healthcare needs. Most countries have a developing economy and an out-of-pocket healthcare system. PAs and PA equivalents hold 35 different practice titles, and most work in primary care. PAs alleviate healthcare shortages and economic disparities, specifically related to inequitable healthcare access. Globally, the profession is limited by a lack of legislation, regulation, and support.

Conclusions: PAs and PA equivalents worldwide belong to an adaptable profession that has well-documented success in alleviating the global healthcare shortage and addressing healthcare needs. Countries desiring PAs or PA equivalents should identify their specific needs, train their existing workforce, employ pilot programs, and focus on seeking early legislation and regulation. Broad support for existing PA and PA equivalent international organizations is recommended for global collaboration. This study serves as a guide for those advocating for the continued or future implementation of PAs and PA equivalents in their own country and provides a comprehensive resource to aid in the globalization of this profession. We offer recommendations to address the dire healthcare needs and workforce shortage faced across the globe.

Abstract: Physician associate/assistant (PA) leaders are essential to healthcare and critical to a healthcare organization's success. In this article, the second of a two-part series on PA leadership, we summarize methods for implementing and sustaining PA leadership opportunities and organizational structures.

Abstract: Although vasovagal episodes are a common cause of syncope, vasovagal syncope can be cardioinhibitory in nature, resulting in a severe heart block or asystole. This case report focuses on a young man with a history of seizures and frequent syncopal episodes who required an extensive clinical workup and treatment for cardioinhibitory syncope.

Abstract: Extremely dense breasts can be an independent risk factor for breast cancer. A new FDA rule requires that patients be notified of their breast density and the possible benefits of additional imaging to screen for breast cancer. Clinicians should be cognizant of the data about breast cancer risk, breast density, and recommendations to change screening techniques if patients, particularly premenopausal females, have extremely dense breasts but no other known risk factors.

Abstract: During the 1980s and 1990s, international medical graduates (IMGs) sought legal and educational measures aimed at obtaining licensure as physician associates/assistants (PAs). Proponents of IMGs asserted that their ethnic backgrounds and identification with their respective communities could increase access to care for some segments of the population and therefore should be permitted pathways to qualify as PAs. A variety of legal measures were introduced into state legislatures in at least five states and were firmly opposed and defeated by the PA profession. Recent attempts by IMGs to obtain licensure as PAs have occurred in Puerto Rico and Arizona. In their haste to address healthcare access and satisfy various constituencies, state legislators and regulatory boards fail to recognize established professional norms. This is occurring as medical organizations are examining alternative pathways for state licensure of physicians who have completed training and/or practiced outside of the United States. PA organizations, particularly state chapters, must be vigilant in upholding qualifications for practice and licensure standards, and state PA organizations must work to convince legislators to avoid using PA professional regulations to solve a workforce issue that is essentially an issue of physician medical education remediation.