Factors Influencing Selection and Retention of Primary Care Practice by Texas Physician Assistants: A Mixed Methods Approach




Williams, Jeffrey
Lemke, Henry
Orcutt, Venetia


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Purpose: Identify and describe factors that influence Texas Physician Assistant (PA) graduates to initially select and/or remain in primary care practice. We sought to answer these questions: 1) What factors influence PA graduates to select and/or remain in primary care in Texas? 2) How do these factors influence the PA’s choice to initially select and/or remain in primary care? and, 3) Based on factors explored, can strategies be developed to enhance placement of graduates in primary care settings? Methods: PA licensure data was extracted from the Texas Medical Board to determine graduate characteristics from 3 of 8 Texas PA programs, including age, gender, ethnicity, race, years since graduation and current practice type. A stratified purposeful sampling frame was used to identify subjects for participation in scripted telephone interviews. Transcripts were analyzed to identify, code, and sort emerging themes using NVivo 10 (QSR International, Australia). Results: 1556 licensed PAs were identified from 3 participating Texas PA programs, representing 21.5% of all licensed PAs (n=7253) in Texas as of January 2015. Of these, 35% (n=548) were practicing in primary care. Descriptive analyses revealed the majority of graduates working in primary care were female (70.6%) and white (57.5%), with a mean age of 40. A total of 24 PAs were interviewed. Factors impacting on participants’ decisions to select or remain in primary care fell into 4 general themes. These were relationships developed with patients, personal gratification from “making a difference” in the lives of patients, the intellectual challenge and/or variety of problems seen in the primary care setting and the influential role of educational experiences. Conclusions: While previous studies have examined factors influencing physician assistant career choice, this study contributes uniquely to the literature by qualitatively examining graduates perspectives on factors influencing their career decision. Our findings suggest that PAs decisions to work in primary care are motivated by similar factors as physicians. The decision to select or remain in primary care was influenced by the individual’s desire for meaningful patient relationships that provide a feeling of making a difference in an environment rich with variety and intellectual challenges. Results also suggest that educational experiences can be leveraged to improve the number of PA graduates selecting primary care as a career choice.