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Perspectives on PAs as researchers

Shade, Lindsay, MHS, PA-C; Tapp, Hazel, PhD; Dulin, Michael, MD, PhD

Journal of the American Academy of PAs: May 2018 - Volume 31 - Issue 5 - p 1–2
doi: 10.1097/01.JAA.0000532123.84917.4b
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At Atrium Health in Charlotte, N.C., Lindsay Shade is director of clinical trials and quality and a clinical assistant professor in the department of family medicine and Hazel Tapp is director of research and a professor in the department of family medicine. Michael Dulin is director of the academy of population health innovation and a professor in the department of public health sciences at the University of North Carolina at Charlotte. The authors have disclosed no potential conflicts of interest, financial or otherwise.

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Physician assistant (PA) roles have evolved since the profession's inception. Although the vast majority of the more than 115,000 practicing PAs in the United States work in traditional clinical settings, more PAs are extending their expertise into nontraditional roles such as research.1 The roots of PA researchers are deep, dating back to the mid-1960s when the first four Duke PA students were involved in barometric research. Today, research opportunities for PAs are numerous, ranging from implementing protocols to principal investigation and grant writing to peer-reviewed publication. Here, I (LS) describe my experience as a PA researcher and advocate for more PAs to join the research community.

My research career developed circularly. Before entering a PA program, I worked as a clinical trials assistant to gain the necessary patient care hours for PA program admission. I began my PA career in family medicine, moving through several positions in search of the right opportunity to complement my skills and interests. Meanwhile, an innovative physician researcher (MD) came up with the idea of expanding his research team to include a PA researcher. When I came across the job posting, I hesitated to apply, concerned that a return to research would be a step backward professionally. However, after seeking counsel from a wise PA program advisor, I was persuaded I had nothing to lose. I went for the interview and have spent the last 8 years engaged in various aspects of clinical and patient-centered pragmatic research. My professional growth and development as a PA researcher have been supported every step of the way by my collaborating physician (MD) and research director (HT).

Currently, 75% of my time is dedicated to research-related activities with 25% as a traditional family medicine PA. Just as I extend care working alongside collaborating physicians in clinic, I help to balance principal investigators' workloads as a PA researcher. As subinvestigator on multiple primary care clinical trials, including the Systolic Blood Pressure Intervention Trial, I oversee a team of research coordinators focused on participant recruitment and retention.2 I am responsible for evaluating participant safety through physical examinations and interpretation of laboratory results and other diagnostic tests including ECGs. In the coming year, I look forward to serving as principal investigator myself on a clinical trial, when I will have the opportunity to be primarily responsible for the conduct of the study. Knowledge of practice management has augmented my skills as a practice facilitator involved in the dissemination of an asthma-shared decision-making intervention, first locally and then statewide.3-5 I also have enjoyed building on my clinical base through health information technology research, where I first led the development and integration of a decision support tool into an electronic medical record and then helped build a virtual health coach for asthma management through iterative design.6

A typical day during my allocated research time involves juggling several ongoing projects. A meeting to discuss future grant submissions with research leadership is followed by evaluating a clinical trials participant for enrollment in a diabetes study. Then, I revise algorithms based on provider feedback to improve screening and linkage to care for a hepatitis C project. Later, I analyze focus group transcripts from an asthma study to identify common themes emerging across different study arms. Next, I discuss implementation challenges of a colorectal cancer screening video project with providers and staff and work with them to enhance, and not impede, their clinic workflow. The end of the day often is spent reviewing lab results and answering messages from continuity care patients seen in clinic the previous afternoon.

Research brings an abundance of variety—new challenges and rewards seem to arrive on a daily basis. The combination of adding to the evidence base of medicine while working to improve the outcomes of my patients and those across the broader community is incredibly rewarding. Additionally, having the flexibility to structure my day as the research workload necessitates, in contrast to the more regimented flow of clinical care, gives me a more flexible work-life balance. This balance has led me to find gratitude and enjoyment working one-on-one with my patients as well as being a part of the bigger healthcare picture through my research endeavors.

So how can you jump-start a career as a PA researcher? First, work with a collaborating physician actively engaged in research, ideally funded, who can serve in a mentoring role. Healthcare systems and/or teaching hospitals with research infrastructure are more likely to offer employment opportunities for PA researchers. Connect with researchers with relevant research interests that align with yours to see if they would consider expanding their team to include a PA researcher. Most importantly, advocate for the added value that you can bring to the team with your clinical background and practice management skills. Do your homework: read journal articles, attend research seminars, and talk to researchers as much as you can to gain a better understanding of your own research goals. And finally, practice patience and persevere, which will be key to developing this enhanced career.

My experience as a PA researcher has been a fulfilling alternative to a more conventional clinical career. For the PA profession to really progress in research, more PAs must become involved and ultimately serve as principal investigators. The PA profession's real measurement of success in research will be when a greater proportion of studies are conducted by teams led by PAs as principal investigators. After reading this article, I hope you better understand the roles and value of PA researchers and have potential strategies for considering this rewarding complementary role.

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REFERENCES

1. National Commission on Certification of Physician Assistants. 2016 Statistical Profile of Certified Physician Assistants. http://prodcmsstoragesa.blob.core.windows.net/uploads/files/2016StatisticalProfileofCertifiedPhysicianAssistants.pdf. Accessed February 20, 2018.
2. Wright JT Jr, Whelton PK, Reboussin DM. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2016;374(23):2294.
3. Tapp H, Kuhn L, Alkhazraji T, et al Adapting community based participatory research (CBPR) methods to the implementation of an asthma shared decision making intervention in ambulatory practices. J Asthma. 2014;51(4):380–390.
4. Tapp H, McWilliams A, Ludden T, et al Comparing traditional and participatory dissemination of a shared decision making intervention (ADAPT-NC): a cluster randomized trial. Implement Sci. 2014;9:158.
    5. Tapp H, Shade L, Mahabaleshwarkar R, et al Results from a pragmatic prospective cohort study: shared decision making improves outcomes for children with asthma. J Asthma. 2017;54(4):392–402.
    6. Kuhn L, Reeves K, Taylor Y, et al Planning for action: the impact of an asthma action plan decision support tool integrated into an electronic health record (EHR) at a large health care system. J Am Board Fam Med. 2015;28(3):382–393.
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