Richard W. Dehn, MPA, PA-C, DFAAPA
PAs and PA leaders often ask for published articles that might support a specific viewpoint about the profession or to “prove” the profession’s value in the healthcare delivery system. Typically, I end up feeling like the pessimist in the room when I have to explain that more often than not, the requested published data on PAs do not exist. Why does the PA profession lack published research on itself and its contributions to American healthcare? This is
a complicated question with no one simple answer.
Likely one important factor is the relative youth of the profession. Other healthcare professions that we observe as having a richer body of literature, for example allopathic medicine, are relatively mature professions with long-established academic and research processes. One would hope that as our profession matures, we would diversify into supporting more PA research. However, several factors contribute to our current lack of published research.
The profession’s relative youth and unique history certainly have contributed to our current quandary. When the profession was created 50 years ago and the first PA programs were established, primarily at academic medical centers, programs were for the most part established by physicians or medical school administrators as non-academic programs offering a certificate at completion or undergraduate academic programs offering a bachelor’s degree. In most cases, these early programs were typically considered like “technical programs” in the academic structures of the time, and they were administered not by PAs but mostly by physicians. Typically in these programs, the PA faculty, due to their lack of advanced degrees, didn’t have true faculty status in their institutions, and thus were likely not part of their institution’s traditional research mission. Thus as more PA programs developed in the 1970s and 1980s, they followed the examples of the earliest programs and were designed as programs focused on teaching and not research. The faculty and staff workloads of PA programs were calculated without the expectation of research activity. In the first 20 years of the profession’s history, PA programs were not designed to support research, PAs teaching in those programs for the most part were not trained as researchers, and faculty workloads were not calculated to account for the time necessary to perform research. Thus, research published in the first decade of the profession’s history was performed mostly by the physicians and doctoral degree holders who in that era were the program directors.1,2 In the 1990s, PA educators were increasingly concerned about the lack of research activity in the profession, a concern that still persists today.3,4
Starting in the late 1980s and accelerating in the early 2000s, PA programs began to convert to conferring master’s degrees. This led to a trend in the institutions that housed PA programs to let PA faculty hold professorial appointments, as well as a move toward organizing PA programs as distinct academic departments. Along with these changes came the traditional duties of professorial appointments, including the expectation that faculty produce scholarly work. Although this expectation increased the pressure on PA faculty to perform research, PA research publications increased only modestly.The proportion of PA faculty who have written at least one publication in their career has increased from 39.6% in 2002 to 49.5% in 2015.
Most PAs have never had any formal research training other than the curriculum from their PA training designed to help them search and interpret the clinical medical literature. Training for becoming a researcher is traditionally done at the doctoral level. In 2016, only 560 of 109,593 certified PAs possessed a doctorate, or only 0.5% of all PAs.5 Even in PA education, only 7.7% of the PA faculty nationally in 2015 had doctorates.6,7 And only 19% of PA faculty have tenure-track appointments, positions that are more likely to mandate protected time for performing research than non-tenure positions.7 Thus, few PAs or PA faculty have been trained as researchers.
However, the biggest barrier to increasing PA research output is the lack of money available for PA research. In today’s higher education environment, workload allocations for performing research require funding, and very little external funding is available for PA research in the form of external grants. This is illustrated by the fact that only a handful of PA faculty have positions with research workload allocations of 40% or higher. Without additional external research funding, PAs who train as researchers by earning a doctorate will be challenged to find a faculty position that provides them the protected time and resources to conduct much research. However, the PA profession is not unique in its challenges to produce more research on itself. Other healthcare professions that have recently increased entry degree requirements report that despite requiring their faculty and students to conduct more research, the results in quantity of publications have been below disappointing.8
Certainly, more research needs to be conducted on the PA profession, preferably by PA researchers.9 However, increasing the output of good quality research on the PA profession will likely require multiple initiatives. Of course, we need encourage more PAs to train as researchers, particularly in rigorous doctoral programs. However, we also need more external funding available for PA research to help persuade those PAs with doctorates from working in non-research positions. Additionally, we need to have more PA programs consider how to configure additional faculty positions for PA researchers who have a funded and protected research workload. Part of our lack of research can be attributed to the relative youth of our profession but it is likely that our current predicament is the result of our profession not consistently supporting PA research over the long run. It is time for the PA profession to get serious about research so that the data needed to guide our future will be available.
1. Dehn RW, Everett CM, Hooker RS.
Research on the PA profession: the medical model shifts.
2. Cawley JF, Dehn RW. Physician assistant educational research fifty years on.
J Physician Assist Educ. 2017;28(3S):56-61.
3. Blessing JD, Dehn RW, Glicken AD, et al. Physician assistant research.
Physician Assistant Journal. 1999;22(4):76-93.
4. Cawley JF, Ritsema, TS.
Where are the PA researchers?
5. National Commission on Certification of Physician Assistants. 2016 Statistical Profile of Certified Physician Assistants: An Annual Report of the National Commission on Certification of Physician Assistants.
6. Hegmann T. Benchmarking scholarship activities of physician assistant faculty.
J Physician Assist Educ. 2008;19(3):13-17.
7. Physician Assistant Education Association. Physician Assistant Program Faculty and Directors Survey Report, 2015.
8. Seegmiller JG, Nasypany A, Kahanov L, et al. Trends in doctoral education among healthcare professions: an integrative research review.
Athletic Training Education Journal. 2015;10(1):47-56.
9. Dehn RW. Missing the mark: why is some research on PAs just wrong?
Richard W. Dehn is a professor in the College of Health and Human Services at Northern Arizona University's Phoenix Biomedical Campus and a professor in the Department of Biomedical Informatics at the University of Arizona College of Medicine in Phoenix. The views expressed in this blog post are those of the author and may not reflect AAPA policies.