Purpose: Employee turnover is an important indicator that carries a heavy financial cost for healthcare organizations. Although previous research has highlighted some factors associated with turnover, the reasons physician assistants (PAs) leave their jobs are not fully understood. This study aimed to determine the most common reasons behind PA turnover. Methods: In 2019, the American Academy of PAs (AAPA) distributed a survey to all PAs with an eligible email address. The survey included a question asking respondents if they had left or changed their job in the past year. Respondents answering this question in the affirmative were asked a follow-up multiple-choice question to determine the reason behind this change. Results: A total of 13,088 PAs responded to the AAPA salary survey; of these, 1,261 reported leaving a job within the past year. The most common reasons provided for leaving a job were: better work/life balance (n = 209, 16.8%), moved (n = 208, 16.7%), better management/leadership/environment (reasons related to toxic/abusive environment) (n = 170, 13.6%), and better compensation/benefits (n = 148, 11.9%). Conclusion: Employers should focus on common reasons for turnover that can be reasonably addressed. Of the top three reasons behind PA turnover, those related to toxic/abusive work environments may be the most practical and important to address.
Computer modeling was used to assess the pediatric NP workforce and to investigate the effect of potential policy changes to address forecasted shortages. Modeling included the admission of students into nursing bachelor's programs and followed them through advanced clinical programs. Prediction models were combined with optimal decisionmaking to determine best-case scenario admission levels. Two measures were computed: (1) the absolute shortage and (2) the expected number of years until the pediatric NP workforce will be able to fully satisfy pediatric NP demand (self-suffi ciency). A shortage of pediatric NPs is predicted over the next 13 years. Under the best-case scenario, at least 13 years are needed for the workforce to fully satisfy demand. Analysis of potential policy changes revealed that increasing the specialization rate for pediatric NPs and increasing the certifi cation examination passing rate to 96% would lead to selfsuffi ciency in 11 years. In addition, increasing the annual growth rate of master's programs to 36% from the current maximum of 10.7% would result in self-suffi ciency in 5 years. Forecasts of demand for pediatric NPs indicate that the current workforce will be incapable of satisfying the growing demand. 1Commentary by Jonathan Bowser: Even under the most favorable conditions, the supply of pediatric NPs will not meet the increasing demand for primary care and subspecialty pediatric NPs in the next two decades. According to the predictive pediatric NP supply model, several factors contribute to the forecasted shortage, including decreasing numbers of NP trainees choosing pediatrics, insuffi cient growth in pediatric NP training programs, and a low overall examination pass rate (86.9%). Although similar modeling has not been performed for the pediatric PA workforce, only 3% of PAs practice in nonsurgical pediatric primary or subspecialty care, and in most states, fewer than 50 PAs practice in pediatrics. 2 Although modeling of pediatric PA workforce trends is lacking, PAs clearly are poorly represented among the ranks of pediatric providers. Any discussion of primary care shortages is incomplete without consideration given to pediatric practice. PAs have an enormous and largely untapped potential to meet these needs. REFERENCES 1. Schell GJ, Lavieri MS, Li X, et al. Strategic modeling of the pediatric nurse practitioner workforce. Pediatrics. 2015;135(2):298-306. 2. Freed GL, Dunham KM, Moote MJ, et al. Pediatric physician assistants: distribution and scope of practice. Pediatrics. 2010; 126(5):851-855.
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