To update the National Physician Associate Research Agenda by identifying research priorities aligned with current health care delivery, policy, and education needs. A cross-sectional survey of 127 American Academy of Physician Associates (AAPA) leaders assessed the importance of 20 predefined research topics using Likert-scale ratings. Open-ended responses related to the top five priorities underwent thematic analysis. Patient outcomes, cost-effectiveness, and access to care associated with physician associate (PA) utilization were rated as the top research priorities, followed by PA role expansion and readiness to practice. Qualitative themes highlighted the need for empirical evidence to drive legislative reform, strengthen public trust, and affirm the profession's legitimacy. Structural barriers such as billing constraints and scope-of-practice laws were also noted. These findings offer a leadership-informed roadmap to guide research that advances the PA profession's contributions to cost-effective care, health equity, and workforce resilience. By centering priorities on patient outcomes, access, role expansion, and readiness to practice, the agenda supports future research that drives innovation, informs policy, and sustains PA relevance in a dynamic health care system.
Pediatric vaccination rates are declining in the United States, with the Centers for Disease Control and Prevention (CDC) reporting decreases in immunization coverage against measles-mumps-rubella (MMR), diphtheria-tetanus-acellular pertussis (DTaP), polio, and varicella. The recent measles outbreaks have resulted in tragic outcomes, highlighting the urgent need for clinician concern and proactive measures to prevent illness, hospitalizations, missed school and caregiver workdays, and deaths. According to the World Health Organization, MMR vaccination rates below 95% compromise herd immunity, increasing the risk of sustained outbreaks. This article reviews the decreasing rates of pediatric vaccine uptake and the measles outbreak; examines the role of health and vaccine literacy in shaping parental decision-making amid these crises; and explores factors contributing to disparities in vaccination rates including ethnicity, residence location, and birth country. Finally, it outlines strategies primary care clinicians can use to improve pediatric vaccination rates and summarizes CDC and American Academy of Pediatrics recommendations aimed at reducing morbidity and mortality from vaccine-preventable diseases.
Advanced practice providers (APPs) are integral to plastic surgery practices due to the frequency of staged procedures, perioperative care, and broad scope of practice. Our study evaluates the impact of APP utilization in one of the largest pediatric plastic surgery divisions in the United States. Descriptive analyses were conducted to describe productivity trends from October 2012 to September 2023. Metrics included the number of clinic encounters, providers, operating room (OR) cases, and surgical conversion rate. In 2013, APPs completed one patient encounter for every five completed by surgeons. Since 2020, APPs have matched or exceeded the number of clinic encounters conducted by surgeons. The surgeon surgical conversion rate (surgeon clinic encounters to OR cases) increased from 0.19 in 2018 to 0.26 in 2023. Enhanced utilization of APPs in the division of plastic surgery has optimized our patient care model, increasing procedural productivity for surgeons without reducing clinic volume.
Wait times for endocrinology care can delay diagnosis and management of many hormonal imbalance disorders. Physician associates (PAs) are now, more than ever, faced with the task of ordering and interpreting complex laboratory tests to diagnose these endocrine disorders in the face of specialty care shortages. When primary care providers diagnose a disorder, it speeds therapy initiation and slows or stops the risk of complications. This article aims to assist PAs in nonendocrinology settings by clarifying various confounding factors that may impede diagnosis, as well as to provide guidelines and practical advice for the diagnosis and treatment of common endocrine disorders.
Initially identified as a respiratory illness, COVID-19 has increasingly been linked to a range of neurologic complications, including myelitis, acute disseminated encephalomyelitis, and Guillain-Barré syndrome. Potential signals of central nervous system involvement-either during active infection or in the postinfectious period-include ataxia and cognitive changes. Though rarely observed in the setting of COVID-19 infection, these neurologic symptoms can be serious, and therefore, providers should maintain a high index of suspicion for central nervous system involvement in patients with current or recent COVID-19 infection. This article presents a rare case of concurrent cerebellitis and corpus callosum cytotoxicity after SARS-CoV-2 infection.
The intentional ingestion of caustic acidic or alkaline substances in adults is most commonly related to prior psychological history and suicidal ideation. Caustic ingestions are a medical emergency and are usually more life-threatening in adults than accidental ingestions in children. The degree of injury is determined by the physical state of the substance, its concentration, the amount ingested, and the duration of exposure to gastric mucosa. This case report describes the evaluation and management of a 36-year-old man with an intentional ingestion of sulfuric (battery) acid.
This study aimed to evaluate the rates of depression screening between patient groups at an academic medical center (AMC)-associated family medicine clinic (FMC) that adopted universal annual depression screening. This study is a retrospective data analysis of electronic health records for patients seen within the AMC health system between June 1, 2021, and December 31, 2022, and whose assigned primary care provider practiced at the FMC. The demographic groups of interest were race, ethnicity, language preference, and insurance status. Of the 12,428 patients included, 78.7% were 30 years of age or older, 59.9% identified as female, 82.9% as White, and 88.7% as not Hispanic or Latino/a/x; 97.2% preferred English and 72.3% had commercial insurance. Patients were less likely to be screened if they identified as male, identified as a non-White race, had a non-English language preference, or were uninsured. Focused interventions are needed to address the disparities in depression screening rates among these groups.
The aim of this qualitative research study was to understand the barriers to PA advancement in hospital governance as perceived by PAs in current hospital leadership roles. This qualitative study of hospital-based PA leaders used grounded theory methodology through one-on-one, informal, semistructured virtual interviews. Thematic content analysis was used to analyze and report patterns within interview data. In examining the 14 completed interviews, thematic analysis yielded 4 major themes and multiple subthemes. The predominant themes were (I) professional barriers; (II) workplace barriers; (III) personal barriers; and (IV) tools for PA advancement. This study provides foundational data on perceived barriers to PA advancement in hospital governance from the perspectives of PA leaders. Gaining a deeper understanding of the challenges PAs encounter in pursuing hospital leadership roles can guide both the profession and health care organizations in implementing strategies to support PA leadership development and create more inclusive governance structures to meet the needs of a changing health care system.
Effective pain management without the risk of addiction, abuse, or dependence associated with opioids remains a key clinical challenge in patient care. Suzetrigine, a newly approved drug for acute pain management, is a nonopioid with a novel mechanism of action: it selectively targets voltage-gated sodium channels present only on peripheral, pain-sensing nerves. In phase 2 and 3 clinical trials, suzetrigine was found to be more effective for post-abdominoplasty and -bunionectomy pain than placebo and was noninferior to an opioid-acetaminophen combination for pain following abdominoplasty. The drug, which is taken twice daily for up to 14 days postoperatively, has shown no addiction or physical dependence risk to date in either animal or human studies. Suzetrigine expands options for acute pain management, and additional studies that further expanding on the drug's current indication are underway.
Menopause is often accompanied by vasomotor symptoms that negatively impact daily functioning and overall well-being. Hormone therapy remains the gold standard for relief; however, contraindications and patient preferences may limit its use. To address this gap, nonhormonal therapies have been developed and investigated. Two newer options, fezolinetant and elinzanetant, directly target hypothalamic pathways involved in thermoregulation through modulation of neurokinin B. Clinical studies of these selective neurokinin B receptor antagonists demonstrate reduced frequency of vasomotor symptoms with their use, positioning them as promising options for individuals who are unable or unwilling to pursue hormone-based treatment.
Leukocytosis, defined as an elevated white blood cell count, is a frequently encountered laboratory finding with a broad differential diagnosis ranging from transient reactive processes to life-threatening hematologic malignancies. Distinct patterns of elevation can provide valuable diagnostic clues that narrow the differential diagnosis and guide next steps. This article outlines a systematic approach to evaluating leukocytosis, emphasizing integration of clinical history, physical examination, and laboratory data. The discussion highlights both nonmalignant and malignant causes, including acute and chronic leukemias, lymphomas, and myeloproliferative disorders, and offers guidance on when to pursue advanced diagnostics. Finally, a practical evaluation algorithm is included to support clinical decision-making. By recognizing key clinical features, laboratory patterns, and risk factors associated with malignancy, clinicians can appropriately triage patients for specialist referral and ensure timely intervention.
Obesity is a complex, multifactorial disease. Rates of obesity are rising worldwide. Bariatric surgery is the most effective treatment for obesity, as it results in the greatest weight loss as well as significant improvement in or resolution of obesity-related comorbidities. Despite the efficacy of bariatric surgery, postoperative weight gain is a reality for up to 37% of patients. Significant weight regain is associated with recurrence or worsening of comorbidities as well as reduced quality of life. Early identification of those at risk and prompt intervention can minimize the amount of postoperative weight regain. Reinforcing lifestyle modifications, assessing mental health, and scheduling frequent office visits are necessary to minimize weight regain. Phentermine/topiramate, the glucagon-like peptide-1 (GLP-1) receptor agonists liraglutide and semaglutide, and the dual incretin tirzepatide are effective for treating postoperative weight regain. Referral to a bariatric surgeon may be indicated for those needing surgical revision. Further research is necessary to create a formal clinical treatment guideline for identifying and managing weight regain after bariatric surgery.
Psychodermatology examines the relationship between psychological factors and skin conditions. This overview introduces clinicians to key psychodermatologic disorders and their theoretical foundations, clinical presentations, and treatment approaches. Although theoretical support for various treatments is abundant, randomized controlled trials are limited due to funding challenges for generic medications. Despite this limitation, this article presents the most valuable and widely used treatment options for these conditions.
Gestational diabetes is a common complication of pregnancy. Its management requires diabetes expertise, prompt assessment, and frequent follow-up, all of which increasingly strains already overburdened specialty clinics. We aimed to assess the safety and effectiveness of a physician associate (PA)-led gestational diabetes clinic. We conducted a retrospective cohort study comparing outcomes between a PA-led interdisciplinary team clinic with a physician-led interdisciplinary team clinic. After adjustment for differences in patient characteristics, maternal and neonatal outcomes were comparable between the clinic models. Initiation of pharmacotherapy was lower in the PA-led clinic group (adjusted odds ratio 0.19; 95% CI, 0.11-0.31), likely due to differences in referral triage process. The PA was able to manage half of the gestational diabetes referrals during the study period while maintaining a high level of care.
Current acute coronary syndrome (ACS) protocols recommend against the administration of nitroglycerin to patients with inferior ST-elevation myocardial infarction (STEMI). Due to nitroglycerin's vasodilatory effects, which decrease preload and cardiac output, protocols warn of a possible critical drop in blood pressure with the drug's use that could be detrimental to patients with inferior STEMI. Research has shown, however, that nitroglycerin-induced hypotension occurs at similar rates in both inferior STEMI and non-inferior STEMI. Rather than the location of the culprit lesion, the development of hypotension depends on individual patient epidemiologic factors. An amendment to current ACS protocols for patients with inferior STEMI is warranted to reflect nitroglycerin's benefits in the preservation of myocardial function. Removing this barrier to the care of inferior STEMI would lead to therapeutic relief and improve patient survival overall.
As physician associates (PAs) and advanced practice registered nurses (APRNs) have steadily increased in numbers within the clinical realm, attention needs to be given to their career development. Some institutions have created professional advancement models (PAMs) to address career development for these professionals. These programs have the potential to decrease burnout, improve professional satisfaction, and increase retention. However, for advanced practice providers (APPs) to be successful in PAMs or to excel professionally at institutions without PAMs, they need academic and leadership skills, which vary widely among individuals. In this article, we share a career development framework, developed at the University of Chicago, to foster workplace-based academic and leadership skills development among APPs. L.E.A.D. encompasses 1) leadership (L) roles and opportunities, 2) embedding (E) interests in existing structures, and 3) academic (A) development (D) to provide a framework for diversifying APP careers and enhancing professional satisfaction.
Hemorrhage is a leading preventable cause of trauma-related death. Early hemorrhage control and resuscitation with blood products are both critical for survival. The use of whole blood and low-titer type O blood has been shown to reduce overall transfusion volume, mitigating the effects of dilutional coagulopathy. Historically, Rh(D)-negative blood products have been prioritized for people of childbearing potential given the feared risk of alloimmunization and hemolytic disease of the fetus and newborn. However, the survival benefit of whole blood resuscitation seems to outweigh the estimated risks associated with sensitization, although no prospectively collected data provide a definitive solution to this ongoing health equity and ethical dilemma.
Pott puffy tumor (PPT) is a condition characterized by frontal bone osteomyelitis with subperiosteal abscess and is typically a complication of sinusitis. PPT is rare in young children due to the timing of pneumatization of the frontal sinus. This case presents a healthy toddler who developed PPT with an epidural abscess requiring surgical drainage.
Ulcerative colitis (UC) is a type of chronic, relapsing inflammatory bowel disease (IBD) characterized by mucosal inflammation of the colon and rectum. Symptoms such as bloody diarrhea, abdominal pain, and fecal urgency significantly affect patient quality of life. Early recognition of UC is critical to facilitate specialist referral and initiate management. Recent advances in the therapeutic landscape include the introduction of novel biologic agents, small molecules, and biosimilars, which have expanded access to effective and affordable treatment options. Clinicians must remain informed of updates and indications for both pharmacologic and nonpharmacologic interventions, as treatment selection is based on disease severity, location, and individualized patient needs. Adjunctive therapies also play a role in comprehensive care and health maintenance. Optimizing therapy is essential for inducing and maintaining remission, promoting mucosal healing, and preventing disease progression. A multidisciplinary approach, involving primary care clinicians, gastroenterologists, colorectal surgeons, dietitians, and mental health professionals, is essential for delivering individualized care and improving long-term outcomes.
After a patient suffers a medical error or other adverse event, physician associates (PAs) and other health care providers involved in the patient's care are susceptible to experiencing their own physical and psychosocial symptoms. In this commonly occurring phenomenon, known as second victim syndrome, the health care provider becomes the second victim after the patient. This article reviews the symptoms, progression, management, and complications of second victim syndrome. Additionally, this review advocates for PA programs to integrate curricula focused on second victim experiences, equipping PA students with effective coping strategies, and for institutions to establish tiered support programs to help employees navigate the challenges of second victim experiences.