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Health services research
Research
Determinants of the sustained employment of physician assistants in hospitals: a qualitative study
  1. Marijke J C Timmermans1,2,
  2. Anneke J A H van Vught3,
  3. Irma T H M Maassen1,
  4. Lisette Draaijer4,
  5. Anton G M Hoofwijk5,
  6. Marcel Spanier6,
  7. Wijnand van Unen7,8,
  8. Michel Wensing1,9,
  9. Miranda G H Laurant1,3
  1. 1Radboud university medical centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
  2. 2Faculty of Health and Social Studies, Physician Assistant Program, HAN University of Applied Sciences, Nijmegen, The Netherlands
  3. 3Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
  4. 4Department of ENT, Head and Neck Oncology Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
  5. 5Department of Surgery, Zuyderland Medical Centre, Sittard, The Netherlands
  6. 6Department of Gastroenterology, Rijnstate Hospital, Arnhem, The Netherlands
  7. 7Netherlands Association of Physician Assistants and Physician Assistant, Utrecht, The Netherlands
  8. 8Department of Cardiology, VieCuri Medical Centre Noord-Limburg, Venlo, The Netherlands
  9. 9Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
  1. Correspondence to Marijke J C Timmermans; marijke.timmermans{at}radboudumc.nl

Abstract

Objectives To identify determinants of the initial employment of physician assistants (PAs) for inpatient care as well as of the sustainability of their employment.

Design We conducted a qualitative study with semistructured interviews with care providers. Interviews continued until data saturation was achieved. All interviews were transcribed verbatim. A framework approach was used for data analysis. Codes were sorted by the themes, bringing similar concepts together.

Setting This study was conducted between June 2014 and May 2015 within 11 different hospital wards in the Netherlands. The wards varied in medical speciality, as well as in hospital type and the organisational model for inpatient care.

Participants Participant included staff physicians, residents, PAs and nurses.

Results The following themes emerged to be important for the initial employment of PAs and the sustainability of their employment: the innovation, individual factors, professional interactions, incentives and resources, capacity for organisational change and social, political and legal factors.

Conclusions 10 years after the introduction of PAs, there was little discussion among the adopters about the added value of PAs, but organisational and financial uncertainties played an important role in the decision to employ and continue employment of PAs. Barriers to employ and continue PA employment were mostly a consequence of locally arranged restrictions by hospital management and staff physicians, as barriers regarding national laws, PA education and competencies seemed absent.

  • QUALITATIVE RESEARCH

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-011949

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    Footnotes

    • Contributors MGHL and MJCT are responsible for the design of the study with comments of AJAHvV and MW. MJCT and ITHMM carried out the interviews and performed the data analyses, with direct supervision from MGHL and AJAHvV. LD, AGMH, MS and WvU were involved in the data collection of the study. MJCT wrote the first draft of the manuscript and all other authors reviewed this critically. All authors read and approved the final manuscript.

    • Funding This work was funded by The Netherlands Organization for Health Research and Development (ZonMw), grant number 171202006.

    • Competing interests None declared.

    • Ethics approval Research Ethics Committee of the Radboud University Medical Centre.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The topic guide and coding tree are available by emailing MJCT: marijke.timmermans@radboudumc.nl.