Research Projects

A National and State Level Analysis of Job Openings for Physician Assistants

  • Investigator: Perri Morgan, PhD, PA-C
  • Funded by: Physician Assistant Education Association Faculty Research Fund
  • Timeline: April 1, 2015-present

Labor analysts predict a growing market for physician assistants (PAs), due in part to an expected shortage of primary care physicians. For PAs to address this shortage there must be both sufficient numbers of PAs prepared and willing to work in primary care and, equally important, there must be employers ready to hire them. A detailed description of the job market, especially the market awaiting new graduates, would inform strategies that PAEA could use to address barriers to primary care placement of PAs. In addition, a job market analysis at this time of rapid growth in the PA pipeline and rapid change in the health system could provide a baseline for examination of future trends. Our project will address these needs by tabulating and mapping job openings and examining pertinent job opening characteristics across the United States. The project is ongoing and has received a grant to add 2016 data. Read more about the latest grant from PAEA.

View products of this project.

Health-Promoting Primary Care Team Models of Care

  • Investigator: Christine Everett, PhD, MPH, PA-C
  • Funded by: American Academy of Family Physicians Foundation
  • Timeline: January  1, 2015- June 30, 2016

U.S. primary care practices are currently investing significant resources to transform themselves into patient-centered medical homes (PCMH) in order to meet a variety of population health goals.  One of the key approaches to meeting these goals is the provision of team-based care.  The primary care team designs that best promote population health goals, and under which conditions they do so, remain unclear. The goal of this project is to understand approaches to selection of primary care team models of delivery in North Carolina by interviewing 36 primary care professionals in 6 primary care practices that have implemented team-based care in diverse communities in North Carolina to conduct a pilot qualitative study.  Understanding the range of team designs that are currently implemented and the factors influencing the selection of primary care teams can inform subsequent family practice transformation efforts, state and national policy, and provide preliminary data for future research regarding primary care team effectiveness.

Accessing Patient Care in a Changing Environment: Patient Preferences and Perceptions

  • Investigator: Margaret Gradison, MD, MHS-CL, FAAFP
  • Funded by: Physician Assistant Education Association
  • Timeline: January 1, 2015- June 30, 2015

Primary care is the foundation of quality healthcare, but the U.S. may have too few primary care providers. Team-based primary care with PA/NP providers may help to expand workforce capacity. Recent research suggests that many patients are willing to accept care by PAs/NPs, but the reasons behind their provider preferences have not been explored. In this qualitative study we will explore patient perceptions and provider preferences by analyzing data supplied by the Association of American Medical Colleges from their semi-annual surveys of consumer preferences in healthcare. Study results will help providers to understand patient perspectives, design care that satisfies patients, and communicate with patients more effectively about evolving roles in primary care.

Preceptors’ Perceptions of Physician Assistant Students’ Interprofessional Interactions and Competencies

  • Investigator: Nicholas Hudak, MSEd, MPA, PA-C
  • Funded by: Physician Assistant Education Association
  • Timeline: January 1, 2015- December 31, 2015

Interprofessional education (IPE) is a recommended strategy for promoting a team-based model in health professions education. IPE has been identified as a key component of the future expansion of the physician assistant (PA) profession and is a required area of instruction for accredited PA programs, though there are few PA-focused studies describing IPE interventions and outcomes. This qualitative study will assess preceptors’ perceptions of PA students’ interprofessional interactions and competencies during the clinical phase of education.

Understanding the Roles of Physician Assistants and Nurse Practitioners in Patient-Centered Medical Homes

  • Investigator: Christine Everett, PhD, MPH, PA-C
  • Funded by: Health Resources and Services Administration (Health Workforce Research Center, University of North Carolina at Chapel Hill)
  • Timeline: October 1 2014- September 30, 2015

The implementation of team-based care is considered essential to the redesign of the fragmented and inefficient US health care system. Team-based care involving physician assistants (PAs) and nurse practitioners (NPs) is one recommended strategy for improving access, quality, and cost of care in the patient-centered medical home (PCMH). Using a newly developed cross-sectional survey of a random sample of PA/NPs currently employed in PCMHs in the United States, this project will describe PA/NP roles currently implemented in accredited PCMH practices and assess primary care PA/NP perceptions of role changes due to PCMH implementation. This project will result in a description of the roles and tasks performed by PA/NPs in PCMHs nationally, an estimation of the type and magnitude of PA/NP role changing that has occurred due to PCMH implementation and identification of challenges associated with PA/NP role changes including adequacy of the training associated with roles and tasks.

National Trends in the Distribution of Physician Assistant Specialties and Salary: An Update

  • Investigator: Perri Morgan, PhD, PA-C
  • Funded by: Duke Physician Assistant Program
  • Timeline: October 2014- February 2015

This analysis will update the findings reported in a 2010 Health Affairs article (“Choice of Specialties Among Physician Assistants in the United States”) regarding the most recent distribution of physician assistants among major medical specialties, as well as median salaries in those specialties.

The Roles of Veterans Affairs Physicians, Physician Assistants and Nurse Practitioners in the Care of Patients with Diabetes

  • Investigators: George L. Jackson, PhD; Perri Morgan, PhD, PA-C
  • Consultant: Christine Everett, PhD, MPH, PA-C
  • Funded by: Veterans Affairs
  • Timeline: July 1, 2014- June 30, 2016

This retrospective cross-sectional study uses Veterans Health Administration (VHA) medical, administrative, and survey data to 1) examine VHA primary care clinical roles of nurse practitioners (NPs), physician assistants (PAs), and physicians and 2) assess the association of these roles with care outcomes, health service utilization, and costs in patients with diabetes in 2011. Results will inform VHA Patient-Aligned Care Team role implementation so that NPs and PAs contribute optimally to quality and economic outcomes while helping to maintain veteran access to care. 

Factors Associated with Physician Assistant and Nurse Practitioner Scope of Practice Legislation

  • Investigators: Christine Everett, PhD, MPH, PA-C; Perri Morgan, PhD, PA-C
  • Funded by: NA
  • Timeline: July 2014- present

A number of solutions have been proposed to ensure adequate access to care in the context of a projected primary care physician shortage, including increased involvement of nurse practitioners (NPs) and physician assistants (PAs) in team-based models of health care delivery. Despite universal concerns across all US states about limited access to care due to physician shortages, variation among state scope of practice (SOP) laws may limit the ability of PAs and NPs to improve health care access. Although consistency in professional competencies between states for both NPs and PAs is assured through national certification, there is considerable state variation in legal SOP within each profession. State public health factors, including workforce supply, need/demand for health services, and health services access may explain some of the variation in legal SOP variation. The goal of this project is to identify public health factors associated with NP and PA prescribing and supervision SOP laws. 

North Carolina Physician Assistant and Nurse Practitioner Specialty Transitions

  • Investigator: Perri Morgan, PhD, PA-C
  • Funded by: HRSA Cooperative Agreement U81HP26495-01-00: Health Workforce Research Centers Program in collaboration with the UNC Health Workforce Research Center
  • Timeline: September 2013- February 2015

Nurse practitioners (NPs) and physician assistants (PAs) fill workforce needs in many specialties. Specialty distributions of NPs and PAs have changed over time, with the proportion of NPs and PAs in primary care decreasing in recent years. Although many workforce analyses assume that NPs and PAs fill similar roles, there is evidence that they fill different niches in the healthcare workforce. Few previous studies have investigated time trends in the specific specialties in which NPs and PAs practice. This study examines specialty distribution among NPs and PAs in North Carolina (NC) in 1997 and 2013 and describes specialties that have experienced an increase or decrease in the use of NPs or PAs over this period.

Duke Physician Assistant Program Educational Research Database

  • Investigator: Perri Morgan, PhD, PA-C
  • Funded by:  Duke Physician Assistant Program
  • Timeline: Began August 2013; ongoing

As physician assistant (PA) roles expand and diversify in the US and around the world, there is a pressing need for research that illuminates how they may best be selected, educated, and used in health systems in order to maximize their potential contributions to health. Our PA program is creating a permanent longitudinal education database for research that contains extensive student-level data.  This database will allow us to conduct research on all phases of PA education, from admissions processes through the professional practice of our graduates. Over time, trends among different PA cohorts can be compared.  By merging other data onto our longitudinal database, we may be able to evaluate quality and efficiency outcomes of the care that our graduates provide.  We hope to encourage other PA programs to initiate similar projects so that in the future data can be combined for use in multi-institutional research that can contribute to improved education for PA students across programs.

Roles of Physician Assistants and Nurse Practitioners in Community Health Centers

  • Investigators: Perri Morgan, PhD, PA-C; Christine Everett, PhD, MPH, PA-C
  • Funded by: Physician Assistant Education Association
  • Timeline: May 2011- November 2014

Since their creation as part of the War on Poverty in the 1960s, community health centers (CHCs) have filled an important role in providing health care to underserved populations in the United States. Nurse practitioners (NPs) and physician assistants (PAs) have been employed extensively in CHCs for decades, but their use has increased, with NPs and PAs together providing 30% of CHC visits in 2006-07. In primary care in the U.S., NPs and PAs fill a variety of roles, including serving as the primary care provider for patients, providing acute care, and providing chronic disease management. Our project, using data from the National Ambulatory Medical Care Survey (NAMCS) Community Health Center stratum from 2006-2010, presents a more detailed analysis of patient and visit data to CHC providers and encompasses a time period of known rapid growth in CHCs and in the NP and PA professions. We analyze NPs and PAs separately and describe differences in their practice patterns in CHCs.

Primary Care Utilization and Roles of Physician Assistants and Advance Practice Nurses Using Data From the Health Tracking Household Survey

  • Investigator: Christine Everett, PhD, MPH, PA-C
  • Funded by: NA
  • Timeline: December 2013-October 2014

Team-based care involving physician assistants (PAs) and advance practice nurses (APNs) is one strategy for improving access and quality of care. PA/APNs can perform a variety of roles on the primary care team, but limited research exists that describe the patients served by these providers or the resulting outcomes. The objective of this project was to identify patient characteristics that predict primary care PA/APN role and identify outcomes associated with different PA/APN roles, including satisfaction, utilization of health services and reported unmet need using a sample of adult respondents to the 2010 Health Tracking Household Survey with a primary care clinician reported as a usual provider and at least one primary care visit in a 12-month period.