Factors influencing the satisfaction of rural physician assistants: a cross-sectional study.

The purpose of the study was to determine factors that attract physician assistants (PAs) to rural settings, and what they found satisfying about their practice and community. A cross-sectional survey design was used. All PAs who were practicing in both nonmetropolitan counties and rural communities in metropolitan counties, in a single midwestern US state, served as the population for the study. A total of 414 usable questionnaires were returned of the 1,072 distributed, a 39% response rate. Factor analysis, descriptive statistics, Pearson's correlation analysis, and robust regression analyses were used. Statistical models were tested to identify antecedents of four job satisfaction factors (satisfaction with professional respect, satisfaction with supervising physician, satisfaction with authority/autonomy, and satisfaction with workload/salary). The strongest predictor of all four job satisfaction factors was community satisfaction, followed by importance of job practice. Additionally, the four job satisfaction factors had some significant associations with importance of socialization, community importance, practice attributes (years of practice, years in current location, specialty, and facility type), job responsibilities (percentage of patient load not discussed with physician, weekly hours as PA, inpatient visits), and demographics (marital status, race, age, education). J Allied Health 2014; 43(1):22-31.BECAUSE RECRUITMENT and retention of primary care physicians in rural communities is difficult, the use of physician assistants (PAs) has become a critical component of the health care delivery system.1 Nationally, three-fourths of hospital executives indicate they are using more PAs and advanced practice nurses (APNs), and that trend is reflected at a state level as well.1 If this trend continues, positions for PAs and APNs will become more difficult to fill, making this an emerging health care workforce shortage.1 Nationally, 15% of all physician assistants (PAs) practice in rural areas, and often the PA is the only medical provider in the community.2 At the same time, rural communities tend to have a disproportionately higher share of poor and elderly, a greater number of residents who lack any type of health insurance, and more people with substantial health problems of chronic illness and disability.3A number of studies validate that PAs play key roles in increasing access to primary care in rural areas by providing a wide range of services to patients, who range from newborns to the elderly and who have a diversity of illnesses and emergencies; they also do so at lower labor costs than physicians.3,4 The majority of research studies on PA roles have focused on personality, geographic locations, practice and population characteristics, and economics.4 In general, however, knowledge on PA satisfaction and retention in rural communities remains a less thoroughly studied area.4,5 Given the established association between work satisfaction and retention for PA health providers,5,6 and the fact that studies on PA job satisfaction were conducted a long time ago7 and thus not reflecting demographic changes in the patient population and medical needs, it becomes important to examine anew factors that may be related to job satisfaction among PA rural health care providers.The primary purpose of this study was to determine factors that attracted PAs to rural settings and what they found satisfying about their practice and community. This report has three main sections. The first section consists of a literature review to derive study hypotheses. The second section describes the sample and measures and the analytic procedures. Since no study has truly captured the multidimensional aspect of job importance for PAs, this section presents a thorough description of it using factor analysis. The third section reviews and discusses survey results, limitations, and future research directions.Literature ReviewThe study of job satisfaction has established its importance as one of the most extensively researched topics in industrial and organizational psychology, anthropology, and sociology for many years. …