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Herring J, Brantley E, Ritsema TS, Luo Q, Straker H, Salsberg E. Black and Hispanic Representation Declined After Increased Degree Requirements for Physician Assistants. J Physician Assist Educ 2024:01367895-990000000-00131. [PMID: 38377275 DOI: 10.1097/jpa.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE The physician assistant (PA) profession is one of the least racially and ethnically diverse health professions requiring advanced education. New PA graduates are even less diverse than the current PA workforce and less diverse than professions requiring doctoral degrees. Between 1995 and 2020, the percent of all PA graduates that were Black individuals fell from 7% to 3.1%, while Hispanic representation increased from 4.5% to 7.9%. METHODS Using the federal Integrated Postsecondary Education Data System, we examine the impact of transitions to master's degrees for PAs on Black and Hispanic representation between 1995 and 2020, using individual universities as the unit of analysis. RESULTS After adjusting for state and year effects, PA programs that transitioned from bachelor's to master's degrees experienced a 5.3% point decline in Black representation and a 3.8% point decline in Hispanic representation. Relative to the already low proportions of Black and Hispanic graduates in PA programs, these declines are significant. CONCLUSION Steps should be taken to ensure that underrepresented populations have greater access to PA education.
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Affiliation(s)
- Jordan Herring
- Jordan Herring, MS, is a program associate in the Fitzhugh Mullan Institute for Health Workforce Equity and PhD student in the Trachtenberg School of Public Policy and Public Administration at George Washington University, District of Columbia
- Erin Brantley, PhD, MPH, is a research scientist at NORC, University of Chicago, Bethesda, Maryland
- Tamara S. Ritsema, PhD, MPH PA-C/R, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Qian Luo, PhD, is an assistant research professor in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
- Howard Straker, EdD, MPH PA-C, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Ed Salsberg, MPA, is a lead research scientist in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
| | - Erin Brantley
- Jordan Herring, MS, is a program associate in the Fitzhugh Mullan Institute for Health Workforce Equity and PhD student in the Trachtenberg School of Public Policy and Public Administration at George Washington University, District of Columbia
- Erin Brantley, PhD, MPH, is a research scientist at NORC, University of Chicago, Bethesda, Maryland
- Tamara S. Ritsema, PhD, MPH PA-C/R, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Qian Luo, PhD, is an assistant research professor in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
- Howard Straker, EdD, MPH PA-C, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Ed Salsberg, MPA, is a lead research scientist in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
| | - Tamara S Ritsema
- Jordan Herring, MS, is a program associate in the Fitzhugh Mullan Institute for Health Workforce Equity and PhD student in the Trachtenberg School of Public Policy and Public Administration at George Washington University, District of Columbia
- Erin Brantley, PhD, MPH, is a research scientist at NORC, University of Chicago, Bethesda, Maryland
- Tamara S. Ritsema, PhD, MPH PA-C/R, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Qian Luo, PhD, is an assistant research professor in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
- Howard Straker, EdD, MPH PA-C, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Ed Salsberg, MPA, is a lead research scientist in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
| | - Qian Luo
- Jordan Herring, MS, is a program associate in the Fitzhugh Mullan Institute for Health Workforce Equity and PhD student in the Trachtenberg School of Public Policy and Public Administration at George Washington University, District of Columbia
- Erin Brantley, PhD, MPH, is a research scientist at NORC, University of Chicago, Bethesda, Maryland
- Tamara S. Ritsema, PhD, MPH PA-C/R, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Qian Luo, PhD, is an assistant research professor in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
- Howard Straker, EdD, MPH PA-C, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Ed Salsberg, MPA, is a lead research scientist in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
| | - Howard Straker
- Jordan Herring, MS, is a program associate in the Fitzhugh Mullan Institute for Health Workforce Equity and PhD student in the Trachtenberg School of Public Policy and Public Administration at George Washington University, District of Columbia
- Erin Brantley, PhD, MPH, is a research scientist at NORC, University of Chicago, Bethesda, Maryland
- Tamara S. Ritsema, PhD, MPH PA-C/R, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Qian Luo, PhD, is an assistant research professor in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
- Howard Straker, EdD, MPH PA-C, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Ed Salsberg, MPA, is a lead research scientist in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
| | - Ed Salsberg
- Jordan Herring, MS, is a program associate in the Fitzhugh Mullan Institute for Health Workforce Equity and PhD student in the Trachtenberg School of Public Policy and Public Administration at George Washington University, District of Columbia
- Erin Brantley, PhD, MPH, is a research scientist at NORC, University of Chicago, Bethesda, Maryland
- Tamara S. Ritsema, PhD, MPH PA-C/R, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Qian Luo, PhD, is an assistant research professor in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
- Howard Straker, EdD, MPH PA-C, is an associate professor in the Department of Physician Assistant Studies at George Washington University, Washington District of Columbia
- Ed Salsberg, MPA, is a lead research scientist in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, Washington, District of Columbia
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Reisdorff EJ, Masselink LE, Gallahue FE, Suter RE, Chappell BP, Evans DD, Salsberg E, Marco CA. Factors associated with emergency physician income. J Am Coll Emerg Physicians Open 2023; 4:e12949. [PMID: 37064163 PMCID: PMC10090942 DOI: 10.1002/emp2.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/18/2023] Open
Abstract
Objective Income fairness is important, but there are limited data that describe income equity among emergency physicians. Understanding the magnitude of and factors associated with income differences may be helpful in eliminating disparities. This study analyzed the associations of demographic factors, training, practice setting, and board certification with emergency physician income. Methods We distributed a survey to professional members of the American College of Emergency Physicians. The survey included questions on annual income, educational background, practice characteristics, gender, age, race, ethnicity, international medical graduate status, type of medical degree (MD vs DO), completion of a subspecialty fellowship, job characteristics, and board certification. Respondents also reported annual income. We used linear regression to determine the respondent characteristics associated with reported annual income. Results From 45,961 members we received 3407 responses (7.4%); 2350 contained complete data for regression analysis. The mean reported annual income was $315,306 (95% confidence interval [CI], $310,649 to $319,964). The mean age of the respondents was 47.4 years, 37.4% were women, 3.2% were races underrepresented in medicine (Black, American Indian, or Alaskan Native), and 4.8% were Hispanic or Latino. On linear regression, female gender was associated with lower reported annual income; difference -$43,565, 95% CI, -$52,217 to -$34,913. Physician age, degree (MD vs DO), underrepresented racial minority status, and underrepresented ethnic minority status were not associated with annual income. Fellowship training was associated with lower income; Accreditation Council for Graduate Medical Education (ACGME) program difference -$30,048; 95% CI, -$48,183 to -$11,912, non-ACGME-program difference -$27,640, 95% CI, -$40,970 to -$14,257. Working at a for-profit institution was associated with higher income; difference $12,290, 95% CI, $3693 to $20,888. Board certification was associated with higher income; difference, $43,267, 95% CI, $30,767 to $55,767. Conclusions This study identified income disparities associated with gender, practice setting, fellowship completion, and American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certification.
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Affiliation(s)
| | - Leah E. Masselink
- George Washington University Fitzhugh Mullan Institute for Health Workforce EquityWashingtonDCUSA
| | - Fiona E. Gallahue
- Department of Emergency MedicineThe University of WashingtonSeattleWashingtonUSA
| | - Robert E. Suter
- Department of Emergency MedicineUniversity of Texas SouthwesternDallasTexasUSA
- Department of Military MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Brad P. Chappell
- Department of Emergency MedicineUniversity of California, Harbor‐UCLA Medical CenterLos AngelesCaliforniaUSA
| | - Dian D. Evans
- Emory University Nell Hodgson Woodruff School of NursingAtlantaGeorgiaUSA
| | - Ed Salsberg
- George Washington University Fitzhugh Mullan Institute for Health Workforce EquityWashingtonDCUSA
| | - Catherine A. Marco
- Department of Emergency MedicinePenn State Health, Hershey Medical CenterHersheyPennsylvaniaUSA
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Lupu D, Salsberg E, Quigley L, Wu X. The 2015 Class of Hospice and Palliative Medicine Fellows-From Training to Practice: Implications for HPM Workforce Supply. J Pain Symptom Manage 2017; 53:944-951. [PMID: 28189768 DOI: 10.1016/j.jpainsymman.2017.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/28/2016] [Accepted: 01/02/2017] [Indexed: 11/20/2022]
Abstract
CONTEXT A relatively new specialty, hospice and palliative medicine (HPM), is unusual in that physicians can enter from 10 different specialties. This study sought to understand where HPM physicians were coming from, where they were going to practice, and the job market for HPM physicians. OBJECTIVES Describe characteristics of the incoming supply of HPM physicians, their practice plans, and experience finding initial jobs. METHODS In October 2015, we conducted an online survey of physicians who completed accredited HPM fellowships the previous June. We had electronic mail addresses for 195 of the 243 graduating fellows. RESULTS About 112 HPM fellows responded (58% of those invited). The most common prior training was internal medicine (45%), followed by family medicine (23%), pediatrics (12%), and emergency medicine (10%). More than 40% had practiced medicine before their HPM training. After graduation, 97% were providing 20 or more hours per week of patient care, with most hours in palliative care. About 72% devoted more than 20 hours per week to palliative care, whereas only 13% worked that much in hospice care. About 81% reported no difficulty finding a satisfactory practice position. About 98% said that they would recommend HPM to others, and 63% took the time to provide written comments that were highly positive about the specialty. CONCLUSION New HPM physicians are finding satisfying jobs. They are enthusiastic in recommending the specialty to others. Most are going into palliative medicine, leaving questions about how the need for hospice physicians will be filled. Although jobs appear to be numerous, there are practice areas with more limited opportunities.
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Affiliation(s)
- Dale Lupu
- The George Washington University School of Nursing, Washington, DC, USA; Dale View Associates, Silver Spring, Maryland, USA.
| | - Ed Salsberg
- The George Washington University School of Nursing and Health Workforce Institute, Washington, DC, USA
| | - Leo Quigley
- The George Washington University School of Nursing and Health Workforce Institute, Washington, DC, USA
| | - Xiaoli Wu
- George Washington University, Washington, DC, USA
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Mouzakes J, Koltai PJ, Kuhar S, Bernstein DS, Wing P, Salsberg E. The impact of airbags and seat belts on the incidence and severity of maxillofacial injuries in automobile accidents in New York State. Arch Otolaryngol Head Neck Surg 2001; 127:1189-93. [PMID: 11587598 DOI: 10.1001/archotol.127.10.1189] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the effect driver-side and passenger-side airbags have had on the incidence and severity of maxillofacial trauma in victims of automobile accidents. DESIGN Retrospective analysis of all automobile (passenger cars and light trucks) accidents reported in 1994. SETTING New York State. PATIENTS Of the 595910 individuals involved in motor vehicle accidents in New York in 1994, 377054 individuals were initially selected from accidents involving cars and light trucks. Of this subset, 164238 drivers and 62755 right front passengers were selected for analysis. MAIN OUTCOME MEASURES Each case is described in a single record with approximately 100 variables describing the accident, eg, vehicle, safety equipment installed and utilized or deployed, occupant position, patient demographics, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses, and procedural treatments rendered. A maxillofacial trauma severity scale was devised, based on the ICD-9-CM diagnoses. RESULTS Individuals using airbags and seat belts sustained facial injuries at a rate of 1 in 449, compared with a rate of 1 in 40 for individuals who did not use seat belts or airbags (P<.001). Those using airbags alone sustained facial injuries at the intermediate rate of 1 in 148, and victims using seat belts without airbags demonstrated an injury rate of 1 in 217 (P<.001). CONCLUSION Use of driver-side airbags, when combined with use of seat belts, has resulted in a decrease in the incidence and severity of maxillofacial trauma.
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Affiliation(s)
- J Mouzakes
- Division of Otolaryngology-Head and Neck Surgery, Albany Medical Center Hospital, Albany, NY 12203, USA.
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Bazell C, Salsberg E. The impact of graduate medical education financing policies on pediatric residency training. Pediatrics 1998; 101:785-92; discussion 793-4. [PMID: 9544184] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To review special issues related to pediatric residency training in managed care organizations, the effects of the changing health care system on the demand for pediatricians and the potential impact on financial support for residency training, current methods of financing graduate medical education (GME), possible future approaches to financing GME, and policy directions to support training of pediatricians well prepared for future practice. METHODS We reviewed current information on residency education in managed care settings, including the rationale for training in such settings and the realities of such educational experiences. We then assessed the evidence concerning the supply and demand for pediatricians in the present health care marketplace, with its evolution to managed systems of health care. We summarized current approaches to financing GME through Medicare, Medicaid, private insurers and purchasers, and direct federal and state support, with emphasis on the financing of ambulatory training which could occur in managed care settings. Lastly, we described factors influencing the upcoming revolution in GME financing and outlined possible new policy directions for the financing of relevant GME training experiences. RESULTS Appropriate training experiences in managed care organizations may be a valuable strategy to address the current disconnect between the traditional hospital-based education of pediatricians and the expanded competencies necessary to practice in intensively managed, integrated and accountable health systems. Present pediatrician supply appears to be in relative balance with health maintenance organization staffing patterns and with needs-based requirements estimates. However, the pediatrician-to-child population ratio is predicted to increase rapidly over the next decade, leading to an oversupply of pediatricians under likely future health care delivery system scenarios. Medicare is the largest explicit payer of GME training costs, historically directing reimbursement primarily for hospital-based education. Numerous innovative financing strategies are being considered to facilitate funding of GME training in ambulatory settings and to open up funding to greater public scrutiny and accountability. CONCLUSIONS Although reforms in federal GME financing have been limited to date and other significant changes have been largely state-based, it is likely in the future that explicit funds will be targeted to specialties in demand that prepare physicians well for future practice. Pediatricians and medical educators must intensify their voices in the financing debate to ensure a productive future for quality pediatric residency training.
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Affiliation(s)
- C Bazell
- Bureau of Health Professions, Health Resources and Services Administration, Rockville, Maryland 20857, USA
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