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The correlation between social style and career satisfaction among emergency physicians was investigated. An e-mail survey was sent to a random sample of 1,000 members of the American College of Emergency Physicians in practice for at least three years; 707 had valid e-mail addresses. A twenty-item behavioral style survey instrument and a five-item career satisfaction scale were used. The study incorporated prenotification and reminder e-mails. Valid responses were obtained from 329 physicians (46.5%). No correlation was shown between social style and career satisfaction. Problems with both survey instruments were discovered. Survey respondents were unhappy with their careers, with an average satisfaction of 4.03, 1 being very satisfied, 5 very dissatisfied. Areas for future study include redoing the study using different survey instruments.

Cultural competency training in physician assistant (PA) education may improve patient care outcomes and help reduce health disparities. Research suggests that incorporating cross-cultural communication techniques into healthcare delivery improves provider-patient relationships, patient satisfaction, adherence to treatment, and health outcomes. While PA accreditation standards include mandatory elements regarding cultural competency training of PA students, there is little research on how PA students feel about the effectiveness of this training. This study focused on determining PA students’ perceived levels of preparedness to treat patients of culturally diverse backgrounds. Specifically, the study evaluated PA students’ knowledge, skills, encounters, attitudes, awareness, and abilities regarding cultural competence, as well as students’ evaluations of these components of their education. The study utilized an online cross-sectional questionnaire with quantitative and qualitative components to 239 PA student respondents across eight American professional preparation programs in higher education institutions. The survey used a modified version of the previously validated Self-Assessment of Perceived Level of Cultural Competence Questionnaire (SAPLCC). Descriptive statistics were measured using SPSS software (v. 24). Independent sample t-tests identified significant differences in subscale scores between race and academic year. Qualitative data were hand-coded for common themes. Overall, findings showed that PA students rated their attitudes, awareness, and abilities about cultural competence as significantly greater than their knowledge, skills, and encounters. Specific areas of identified weaknesses in cultural competency education included: knowledge regarding the cultural context of care; skills associated with managing cross-cultural clinical challenges; and encounters related to coping with aggressiveness and bias. Further analysis indicated that second-year students and non-Caucasian students reported higher personal ratings for levels of cultural competence. Qualitative data provided further insight into students’ levels of preparedness, indicating that most surveyed PA students felt well prepared (39%) or moderately prepared (46%), rather than those who did not feel at all prepared (15%). Students indicated that specific classes focusing on cultural topics, discussions about cultural issues, and clinical experiences were the most useful for promoting cross-cultural education. Future investigation might explore the effectiveness of standardized approaches to training, how student perceptions align with actual care outcomes, or examine how diversity within PA programs impacts students’ preparedness to provide cross-cultural care.

This study examined if physician assistants (PAs) are cost-beneficial to employers. In an era of cost accountability, questions arise about whether a visit to a PA for an episode of care differs from a visit to a physician, and if PAs erode their cost-effectiveness by the manner in which they manage patients. Four common acute medical conditions seen by PAs and physicians within a large health maintenance organization were identified to study. An episode approach was undertaken to identify all laboratory, imaging, medication and provider costs for these diagnoses. Over 12,700 medical office visits were analyzed and assigned to each type of provider and medical department. Patient variables included age, gender, and health status. A multivariate analysis identified significant cost differences in each cohort of patients. In every condition managed by PAs, the total cost of the visit was less than that of a physician in the same department. This was significant for episodes of shoulder tendinitis, otitis media, and urinary tract infections. In no instance were PAs statistically different from physicians in use of laboratory and imaging costs. In each instance the total cost of the episode was less when treated by a PA. Sometimes PAs ordered fewer laboratory tests than physicians. There were no differences in the rate of return visits for a diagnosis between physicians and PAs. Patient differences were held constant for age, gender, and health status. This study affirms that PAs are not only cost-effective from a labor standpoint but are also cost-beneficial to those who employ them. In most cases, they order resources for diagnosis and treatment in a manner similar to physicians for an episode of care, but the cost of an episode of an illness is more economical overall when the P A delivers the care. This study validates the federal policy of support for primary care P A education and suggests that PA employment should be expanded in many sectors of the health care system. These findings and the results of this cost-benefit model are evidence of its validity in predicting health care costs.

This dissertation analyzes one state's efforts to increase the number of its primary care physicians and encourage their retention and distribution to rural underserved areas. This analysis was accomplished through an examination of physicians as they completed training in Texas family medicine, internal medicine, pediatrics, and obstetric/gynecology residency programs. State licensure data provided insights into these primary care specialties by showing which residents remained in the state to practice, and by showing the numbers and specialties of physicians who practice in rural underserved areas. The primary purpose of this study was to increase understanding and document similarities and differences in the primary care residency programs' production of physicians who remained in Texas and who practiced in a whole county HPSA following training. The following analyses were used to evaluate the research questions and hypotheses: frequency distributions, geographic depictions, Chi-Square tests and binary logistic regression. These analyses provided supporting evidence that significant differences exist among resident programs in the four primary care medical specialties. Differences were also found in residents' likelihood to remain in Texas to practice and their likelihood to practice in whole county Health Professional Shortage Areas (HPSAs). This study showed that those residents who trained in Texas largely remained in Texas and actively practiced medicine years after their residency training had been completed. The training and location of primary care physicians in Texas is influenced by what medical specialty programs are available and where. This suggests that increasing the number and type of residency programs in more remote areas may have a positive influence on the physician workforce of those regions. This study confirms the finding of other institutional and single medical specialty studies that physicians tend to remain in the state in which they complete their residency training. However, this study found that there are variations by primary care specialty, gender, ethnicity, and program location. Residency training is an essential piece in supplying the Texas physician workforce and ensuring that its stability and long-term growth will position it to be prepared to care for the population.

Projection of the future supply of physician services has attracted considerable attention all over the world, especially in North America and Europe. Supply projections, however, have not taken into account physicians’ patterns of service provision. To date, no research on supply projections has examined the relative contribution to supply life-cycle activity patterns of physicians. This study examined the life-cycle activity patterns of two groups of non-postgraduate Directory Active fee-for-service physicians in British Columbia who had practised medicine for the period 1974-84 or 1980-84. Practice activity, the dependent variable, was measured by fee-adjusted payments made to individual physicians. Practice activity was conceptualized to be influenced by three groups of interrelated factors-- personal, professional, and environmental--each comprised of a number of distinct contributory variables. Data analyses included descriptive, logistical regression and time-series/ cross-section regression methods. The time-series/cross-section regression results showed that about 35% of the variance in practice activity could be explained by all variables except past practice activity. Including this variable in the regression equations increased the variances explained to about 90%. Specialty- and sex-specific analyses showed that variances explained by the three factors, and especially the variables comprising each of the factors, varied considerably. The personal factor accounted for most of the variances; the contributions of the professional factor were very small, while those of the environmental factor were negligible. A low previous year’s income emerged as the best predictor of self-declared retirement. Most GPs, medical, and surgical specialists retired long after the usual retirement age of 65 years. The practice activity of female GPs and medical specialists was significantly lower than those of their male counterparts; this observation did not apply to female surgical specialists. Sex-specific results showed that activity levels and patterns of childbearing-aged females did not differ significantly from their non-childbearing aged counterparts. The research provides comprehensive data on the major variables influencing physician activity in a setting with comprehensive, universal, first dollar health care insurance. It also offers many insights for those interested in policy respecting physician supply and requirements, physician retirement patterns, and sex- and specialty-specific differences in practice patterns.