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Abstract Background Physician assistants/associates (PAs), due to their broad medical education and certification, have the flexibility to change specialties throughout their careers. Prior studies suggest that between half and three-quarters exercise this option at some point in their career, and a third do so within the first decade. However, more research is needed to understand the factors associated with PAs changing vs. remaining in the same specialty throughout their professional journey. Methods A cross-sectional analysis using a 2023 national dataset was conducted to examine specialty transitions throughout PAs' careers. We analyzed responses (N = 121,947 [81.3% response rate]) to a question asking how many times PAs changed specialties throughout their careers. Our investigation included specialty changes overall and separately within career-stage subgroups. We also explored demographics and practice attributes associated with specialty change patterns. Results Most PAs change specialties at least once during their careers, with some making this transition as many as six or more times. The highest proportion of change occurs in the first, followed by the second decade of practice. In the first 10 years, 40.3% of PAs changed specialties. In multivariate analysis, duration of practice was the strongest factor associated with increased odds of transitioning. PAs practicing for 31 or more years had over four-fold higher odds of changing specialties than PAs practicing for 10 or fewer years. Other factors strongly linked to specialty changes included working in critical care medicine or psychiatry, holding two or more clinical positions, practicing in urgent care, being an independent contractor, female gender, serving in the military, and possessing a doctorate. The pattern of significant PA characteristics linked with specialty changes was largely consistent when comparing the overall cross-sectional analysis with separate subgroups of PAs within different career stages. Conclusion PAs exhibit a high degree of career flexibility when it comes to changing specialties. Our research demonstrates that by the late-career stage, three-fourths of PAs have transitioned between at least two disciplines; however, most changes occurred in the first decade of practice. This study further substantiates the PA profession's attributes, highlighting its unique characteristics, such as its adaptability and capacity for career flexibility.

Abstract Background COVID-19 significantly impacted physician assistant/associate (PA) education programs. Most programs transitioned didactic and clinical education from in-person to remote, and clinical training opportunities diminished. Graduates of accredited PA programs take the Physician Assistant National Certifying Examination (PANCE), a five-hour exam with 300 multiple-choice questions, and must attain or exceed the scaled passing score of 350 (range: 200–800). We examined first-time examinees’ trends in PANCE scores and passing rates three years prior to the pandemic and three years during. Methods We analyzed data (N = 59,459) from the National Commission on Certification of Physician Assistants. The two primary outcomes were PANCE scores and pass rates. The main exposure was the timeframe: three years pre-pandemic (2017–2019) and three years during the pandemic (2020–2022). The 2017–2018 scores were equated to the new passing standard implemented in 2019. Covariates included age, gender, years the PA program has been accredited, program region, and rural-urban setting. Analyses consisted of descriptive, bivariate, and multivariate statistics. Results The mean PANCE score and pass rate during the six-year study period were 463 and 93%, respectively. In unadjusted analyses comparing each year individually, mean PANCE score was highest in 2020 and lowest in 2022 than in all other years except for 2017. When comparing each pandemic year to the pooled three pre-pandemic years and adjusting for test-taker and PA program covariates, examinees scored significantly higher in 2020; there was no difference in 2021, and they scored lower in 2022. When controlling for covariates, examinees had 1.24 higher odds of failing in 2022 compared to the pooled pre-pandemic period. Conclusion Findings suggest that PANCE scores and pass rates were impacted during the third year of the pandemic. PANCE assesses if examinees have the essential clinical knowledge to enter the PA profession. It is crucial to determine whether the pandemic affected PANCE scores and pass rates to ensure PAs provide safe and high-quality patient care.

Abstract Background To determine physician assistant/associate (PA) perceptions of the value of certification and explore how they vary across demographic and practice characteristics. Methods We conducted a cross-sectional online survey between March and April 2020 with PAs participating in the longitudinal pilot program for recertification administered by the National Commission on Certification of Physician Assistants (NCCPA). The survey was distributed to 18,147 PAs, of which 10,965 participated (60.4% response rate). In addition to descriptive statistics, chi-square tests were conducted on demographics and specialty to examine if perceptions of value of certification (1 global and 10 items measuring specific domains) were associated with a particular PA profile. A series of fully adjusted multivariate logistic regressions were performed, exploring the relationship between PA characteristics and the value of certification items. Results Most PAs strongly agreed/agreed that certification helps with fulfilling licensure requirements (9,578/10,893; 87.9%), helps with updating medical knowledge (9,372/10,897; 86.0%), and provides objective evidence of continued competence (8,875/10,902; 81.4%). The items receiving the lowest percentage of responses for strongly agreeing/agreeing were for certification providing no value (1,925/10,887; 17.7%), helping with professional liability insurance (5,076/10,889; 46.6%), and competing with other providers for clinical positions (5,661/10,905; 51.9%). Age 55 and older and practicing in dermatology and psychiatry were among the strongest predictors of less favorable views. PAs from underrepresented in medicine (URiM) backgrounds had more positive perceptions. Conclusions Overall, the findings indicate that PAs value certification; however, perceptions varied by demographics and specialties. PAs who were younger, from URiM backgrounds, and practicing in primary care specialties had among the most favorable perspectives. Continued feedback monitoring is critical in ensuring certification is relevant and meaningful in supporting PAs across demographics and specialties. Measuring PA perceptions of the value of certification is essential to understanding how to support the PA profession's current and future credentialing needs and those who license and hire PAs.

Mitosis occurs efficiently, but when it is disturbed or delayed, p53-dependent cell death or senescence is often triggered after mitotic exit. To characterize this process, we conducted CRISPR-mediated loss-of-function screens using a cell-based assay in which mitosis is consistently disturbed by centrosome loss. We identified 53BP1 and USP28 as essential components acting upstream of p53, evoking p21-dependent cell cycle arrest in response not only to centrosome loss, but also to other distinct defects causing prolonged mitosis. Intriguingly, 53BP1 mediates p53 activation independently of its DNA repair activity, but requiring its interacting protein USP28 that can directly deubiquitinate p53 in vitro and ectopically stabilize p53 in vivo. Moreover, 53BP1 can transduce prolonged mitosis to cell cycle arrest independently of the spindle assembly checkpoint (SAC), suggesting that while SAC protects mitotic accuracy by slowing down mitosis, 53BP1 and USP28 function in parallel to select against disturbed or delayed mitosis, promoting mitotic efficiency.

The COVID-19 pandemic drastically disrupted the functioning of U.S. public schools, potentially changing the relative appeal of alternatives such as homeschooling and private schools. We study changes in families' choices of school sector using longitudinal student-level administrative data from Michigan and nationally representative data from the Census Household Pulse Survey. Public school enrollment declined noticeably in fall 2020, with 3 percent of Michigan students and 10 percent of kindergartners using other options. Most of this came from homeschooling rates jumping substantially among families with children in elementary school. Consistent with heterogeneous parental preferences for instructional mode, homeschooling increased more where schools provided in-person instruction while private schooling increased more where instruction was remote. Kindergarten declines were highest among low income and Black families while declines in other grades were highest among higher income and White families, highlighting important heterogeneity by students' existing attachment to public schools. Our results shed light on how families make schooling decisions and imply potential longer-run disruptions to public schools in the form of decreased enrollment and changed composition of the student body.