Are We Just Whining?!Understanding PA faculty workload determination

Kirsten Bonnin Elias Villarreal

Learning Objectives:

u Compare and contrast current PA program faculty structures and workload distribution.

u Discuss the usefulness of educational value units (EVUs) to PA education.

u Discuss measures of PA faculty sufficiency.

u Explore factors associated with PA faculty sufficiency, workload, and retention.

Backgroundu Growth of PA profession by 2026

• Projected employment• BLS: 145,900 (Increase by 37%)1• Hooker and Muchow: 126,000 PAs2

u Increase in number of accredited PA programs• Currently 246 programs à 304

programs by April 20223

u Demand for PA educators4u Transition from clinical practice

to academia5,6u Retention7,8

• 5th Edition Standards9 B2.20: “personal wellness”

Vacancies#

of programs%

of programs FTE

Faculty 70 32 108.2

Program Director

10 4.6 9.6

Medical Director

10 4.6 6.4

PROGRAM REPORT 33

How does your program assign faculty responsibilities?

u Contractu Whou Model – rigid or flexible?

u Apportionmentu Teaching

u Credits/courses

u Advisingu Serviceu Scholarshipu Clinical Practice

Education Value Units (EVUs)

u Productivity Measures for Educational Activities u Adapted from MGMA Relative Value Units from

Clinical Services

u Change how funds are allocated to programs within departments/divisions/schools, etc.

u Change how faculty earn credit and earn their salary for educational activities

EVU Basics

Development Processu Strategic planning

u Time-based

u Easy to quantify

u Tied to other measures of productivity ??

u Student education takes priority over all other measures

u Program activities weighted heavier than external activities ??

Typesu Direct EVUs

• Teaching not associated with billable services

u Indirect EVUs

• Clinical EVUs (associated with billable services)

EVU Categories

u Physical Diagnosis u Foundations of Clinical Medicineu Resident Noon Conference u Residency Interviewing u Medical Student Lectures u Education Committee Member u Morning Report u Medical Grand Rounds u Grand Rounds Prep Time

EVU Principles (example)

u Assign credit and value for teaching activities

u EVUs are based upon General Internal Medicine Median wRVUs for Academic Physician 3,200 (2005)

u 1 Education Hour = 2.1 EVUs

u 1EVU=1wRVU

u Salary value / Credit per EVU = $41.00 – (Based upon AAMC Median Salary - 2005)

EVU Seminal WorkExpert Panel (AAMC) published a blueprint for developing a relative-value-scale approach. The report includes definition of teaching/education programs, categories of education work, and education activities that faculty perform in each of the work areas.

Dosu Include faculty, learners, administrators, etc.

in the design and implementation

u Develop a Pilot

u Re-evaluate components over time

u Start simple

u Always choose incentives over punishments

u List education activities

u Consider time to conduct, time to prepare, level of experience and skill required to perform the activity, determine value of the activity (relevance)

u Count “performance”: was the activity performed alone or in a group? What was the “quality” of the activity?

Don’ts u One model fits all

u Complex systems

u Too Permissive System: over inflation

u Too Restrictive System: lack of engagement

u Ignore the administrative burden of the system

u Ignore the proper balance with other components of the mission (research, clinical, etc.)

Reference: Nutter et al. Measuring faculty effort and Contributions in Medical education. Acad Med 2000.

Other models

u Mission-Based Budgetingu Align revenues with actually activities performed based on

mission of the institution

u Educational Relative Value Units (ErVUs)u Assign units for educational work based on time or value u Financial incentives given based on number of units

u Time Bankingu Incentive for educational work are credits for work or home

support rather than money

Rank Range Instruction Research Service Clinical Practice

Admin

TenuredTypical 40 – 60 units 30 – 45 units 10– 20 units 0 units 0 – 10 units

Possible 0 – 60 units 10 – 99 units 1 – 50 units 0 – 20 units 0 – 40 units

Tenure TrackTypical 30 – 50 units 40 – 55 units 5 – 15 units 0 units 0 units

Possible 0 – 50 units 30 – 99 units 1 – 30 units 0 – 20 units 0 - 25 units

Non - TenureTypical 70 – 95 units 0 – 20 units 5 – 20 units 0 – 40 units 0 units

Possible 0 – 99 units 0 – 99 units 1 – 50 units 0 – 60 units 0 – 60 units

Program Director

Typical 10 – 30 units 10 – 30 units 10 – 20 units 0 – 10 units 40 – 60 units

Possible 0 – 50 units 10 – 30 units 10 – 20 units 0 – 20 units 40 – 80 units

Rule 1: 100 units per year is maximum workload for a 1.0 FTE faculty member (12 month contract)

Rule 2: One unit is equal to work for 20.8 hours a year; 0.40 hours within a work week of 40 hours, and 1.39 hours per week for a 15 week semester. (10 units = 4 hrs of a 40 hour week)

Faculty Member #1

u Tenure Track

u 60% teaching |30% research | 10% service

u 1 full-day/wk clinical practice

u Teaches two 3 credit hour courses

u Teaches one lab section (5 students)

u No grant buyouts

u Faculty senator

u No admin duties

u 2 program committees

u How would you assign workload for this faculty member?

u How much credit within each leg (teaching, scholarship, service) would you assign?

u How do you handle workload OVERLOAD?

u Any muddy areas/concerns?

Faculty Member #2

u Non-Tenure Track

u 80% teaching |10% scholarship | 10% service

u 1 full-day/wk clinical practiceu Teaches one 8 credit hour course

u Teaches three lab section (5 students)

u Teaches IPE 2 credit course with nursing

u Clinical Coordinatoru 3 program committees

u Master’s thesis advisor – 5 students

u How would you assign workload for this faculty member?

u How much credit within each leg (teaching, scholarship, service) would you assign?

u How do you handle workload OVERLOAD?

u Any muddy areas/concerns?

A2.03 Principal faculty must be sufficient in number to meet the academic needs of enrolled students and manage the administrative responsibilities consistent with the complexity of the program.9

A1.07 The sponsoring institution must provide the program with the human resources including sufficientfaculty, administrative and technical staff, necessary to operate the educational program, comply with the Standards, and to fulfill obligations to matriculating and enrolled students.9

According to the ARC-PA Glossary, sufficient means “enough to meet the needs of a situation or proposed end.”9

Date No. of Programs Cited

Standard(s) Accreditation Status

March 2015 2 A2.03 ContinuedA1.08 Continued

September 2015 2 A2.03 ContinuedA2.03 Provisional

July 2016 1 A2.03 ContinuedSeptember 2016 2 A2.03 Probation

A2.03 ContinuedJanuary 2017 2 A2.03 & A1.08 Probation

A2.03 ProbationMarch 2017 1 A2.03 ProbationJuly 2017 2 A2.03 Probation

A2.03 ProbationSeptember 2017 1 A2.03 ProbationSeptember 2018 2 A2.03 Probation

http://www.arc-pa.org/accreditation/accredited-programs/accreditation-actions/10

http://www.arc-pa.org/accreditation/accredited-programs/accreditation-actions/

How does your program measure faculty sufficiency?

Measures of Sufficiency

u PAEA Student-to-Faculty Ratio (SFR)u Total # of enrolled students ÷ full-time faculty headcount (Table 37)4

u Total # of enrolled students ÷ sum of filled faculty, PD, MD FTEs (Table 38)4

u Institutional?

Institution typeAcademic Health Center statusAdministrative housingSatellite campusesEnrolled classesRegion & Divisions

Potential contributing factors

u New or existing programu Institution typeu Size of programu Length of programu “Complexity” - Pedagogy/Andragogyu Experience level of facultyu Workload distributionu Organizational support11, 12

What’s the big deal?

uNegative impact11,12uBudget8

uProductivity8

uQuality/Outcomes12,13

uCulture8,13

uFaculty & studentsuReputation8

In Summary…

u No Magic Bullet u Difficulties encountered in all

u Measuring educational activities u Often overly complexu Difficulty attaining buy-in

u Solution needs to be individualized to local needs of institution, department

u Input from all local stake-holders is crucial

On a positive note… FACULTY & DIRECTORS REPORT 314

References (1/3)

1. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Physician Assistants. https://www.bls.gov/ooh/healthcare/physician-assistants.htm. Accessed September 30, 2019.

2. Hooker RS, Muchow AN. Supply of physician assistants: 2013-2026. JAAPA. March 2014; 27(3):39-45.

3. Projected Growth by State. Accreditation Review Commission on Education for the Physician Assistant, Inc. http://www.arc-pa.org/wp-content/uploads/2019/07/Projected-Growth-as-of-7.17.2019.pdf. As of July 17, 2019. Accessed September 30, 2019.

4. Physician Assistant Education Association, By the Numbers: Program Report 33: Data from the 2017 Program Survey. Washington, DC: PAEA; 2018. doi: 10.17538/PR33.2018

5. Min EA. Recruitment and retention of young faculty: A young faculty member’s perspective. Perspect Phys Assist Educ. 2003;14(2):101-102.

https://www.bls.gov/ooh/healthcare/physician-assistants.htmhttp://www.arc-pa.org/wp-content/uploads/2019/07/Projected-Growth-as-of-7.17.2019.pdf.%20As%20of%20July%2017

References (2/3)

6. Warner M. From clinical practice to academia. J Physician Assist Educ. 2015;26(2):109-110.

7. Graham K, Beltyukova S. Development and initial validation of a measure of intention to stay in academia for physician assistant faculty. J Physician Assist Educ. 2015;26(1):10-18.

8. Ries A, et al. Measuring Faculty Retention and Success in Academic Medicine. Acad Med. 2012; 87:1046-1051.

9. Accreditation Review Commission on Education for the Physician Assistant, Inc. Accreditation Standards for Physician Assistant Education, Fifth Edition. http://www.arc-pa.org/wp-content/uploads/2019/09/Standards-5th-Ed-Sept-2019-fnl.pdf. Accessed September 30, 2019.

http://www.arc-pa.org/wp-content/uploads/2019/09/Standards-5th-Ed-Sept-2019-fnl.pdf

References (3/3)

10. Accreditation Actions (2010-2019). Accreditation Review Commission on Education for the Physician Assistant, Inc. http://www.arc-pa.org/accreditation/accredited-programs/accreditation-actions/. Accessed September 30, 2019.

11. Beltyukova S, Graham K. Predictors of physician assistant faculty intent to leave academia: A Rasch regression analysis. J Physician Assist Educ. 2017;28(1):10-17.

12. Coniglio D, Akroyd D. Factors predicting physician assistant faculty intent to leave. J Physician Assist Educ. 2015;26(3):113-122.

13. Ellis PA. A comparison of policies on nurse faculty workload in the United States. Nurs Educ Perspect. 2013;34(5):303-309.

14. Physician Assistant Education Association, By the Numbers: Faculty Report 3: Data from the 2017 Faculty & Directors Survey. Washington, DC: PAEA; 2018. doi:10.17538/FR3.2018

15. Nutter et al. Measuring faculty effort and Contributions in Medical education. Acad Med 2000.

http://www.arc-pa.org/accreditation/accredited-programs/accreditation-actions/