title: Determinants of the sustained employment of physician assistants in hospitals: a qualitative study.
abstract: To identify determinants of the initial employment of physician assistants (PAs) for inpatient care as well as of the sustainability of their employment.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Participant included staff physicians, residents, PAs and nurses.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Radboud university medical centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|Faculty of Health and Social Studies, Physician Assistant Program, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Marijke J C
authors.initials: MJ
authors.lastname: Timmermans
authors.affiliation: Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Anneke J A H
authors.initials: AJ
authors.lastname: van Vught
authors.affiliation: Radboud university medical centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
authors.forename: Irma T H M
authors.initials: IT
authors.lastname: Maassen
authors.affiliation: Department of ENT, Head and Neck Oncology Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Lisette
authors.initials: L
authors.lastname: Draaijer
authors.affiliation: Department of Surgery, Zuyderland Medical Centre, Sittard, The Netherlands.
authors.forename: Anton G M
authors.initials: AG
authors.lastname: Hoofwijk
authors.affiliation: Department of Gastroenterology, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: Spanier
authors.affiliation: Netherlands Association of Physician Assistants and Physician Assistant, Utrecht, The Netherlands.|Department of Cardiology, VieCuri Medical Centre Noord-Limburg, Venlo, The Netherlands.
authors.forename: Wijnand
authors.initials: W
authors.lastname: van Unen
authors.affiliation: Radboud university medical centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.affiliation: Radboud university medical centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Miranda G H
authors.initials: MG
authors.lastname: Laurant
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands; D010823:Physician Assistants; D024382:Professional Role; D036301:Qualitative Research; D000078329:Workforce
keywords: QUALITATIVE RESEARCH