TableĀ 3

Determinants for the sustainability of physician assistants in inpatient care

ThemePerceived facilitatorsPerceived 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.