Table 3

Determinants for the sustainability of physician assistants in inpatient care

Theme	Perceived facilitators	Perceived barriers
The innovation	Dual character of the education Clinical work experience within similar speciality Knowing own limits Experiencing relative advantages: efficiency of care, bridging role, communication with patients The PA can fulfil different roles depending on team needs	Stagnation of care processes because of less autonomy Limited employable within the broadness of the medical speciality
Patient factors	Satisfied patients Accessibility of the PA Informing patients about the roles and responsibilities on the ward	Patients are not familiar with PA position Patients do not know whether they saw a physician or PA
Professional interactions	Mutual trust Broad support of the medical staff Support of the ward care team Equal treatment of PAs and MRs Satisfied nurses Improved job satisfaction of staff physicians Physician is known with PA profession Adequate interaction between physician and PA	Physician wants to consult a physician instead of a PA Resistance from individual physicians or professional associations Difficult positioning of PAs: not a doctor, not a nurse PA pretends to be a physician MRs see PAs as a threat because of less jobs or less education possibilities Imaging that PAs may not make mistakes
Capacity for organisational change	Long-term planning and vision by the management
Social, political and legal factors	Improved legislation Frameworks from professional associations of medical specialists	Not authorised to prescribe medication Frameworks from professional associations
Organisational factors	Accessible staff physicians for supervision A written clear description of job responsibilities/job specifications Sufficient attention for the job satisfaction of PA/opportunities for personal development Adequate supervision, including extra attention for clinical reasoning skills during education period	Part-time job extent

MR, medical resident; PA, physician assistant.