Date of Award

Spring 5-15-2024

Degree Type

Dissertation

Degree Name

PhD Higher Education Leadership, Management, Policy

Department

Education Leadership, Management and Policy

Advisor

Rong Chen, PhD

Advisor

Rong Chen, PhD

Committee Member

Jason Burns, PhD

Committee Member

Bettie Coplan, PhD PA-C

Keywords

physician assistant, undergraduate students, career aspirations, education

Abstract

The United States (U.S.) has experienced a physician shortage since the 19th century, notably in primary care, and this issue is expected to continue, exacerbated by the effects of the COVID-19 pandemic (Hess, 2022; National Center for Health Workforce Analysis, 2023). Primary care providers (PCPs) are fundamental as they are patients' first point of contact and deliver comprehensive, continuous, preventative, and coordinated care; thus, an adequate supply of PCPs improves the quality of care and longevity. Improving access to primary care services and increasing the number of PCPs has been a persistent challenge for the healthcare system and policymakers. This is a crucial concern of healthcare today, especially in under-resourced communities and rural regions, as healthcare access is often limited due to socioeconomic status, inequality, and educational disparity. The physician assistant/associate (PA) profession was established in the 1960s to address this gap in the healthcare workforce. Despite the increase in the number of PAs in the U.S. healthcare system, there is a lack of research on how pre-PA students develop career aspirations as a PA, especially among underrepresented in medicine (URiM) student groups.

This longitudinal multiple-cohort quantitative national study examined the career aspirations of fourth-year undergraduate students as a PA, focusing on cultural, cognitive, and contextual factors from a social cognitive career theory perspective. It also sought to investigate contextual factors (parents' occupation, experiential learning/activities, and faculty support/mentorship) contributing to PA career aspiration gaps between URiM and non-URiM undergraduate students.

National data from the 2012 to 2019 College Senior Survey (CSS) and selected variables from the Freshman Survey (TFS) conducted by the Cooperate Institutional Research Program (CIRP) within the Higher Education Research Institute (HERI) at the University of California, Los Angeles (UCLA) were utilized focusing on pre-college and college attributes related to students' career aspirations as a PA compared to medicine (physician), other healthcare, and nonhealthcare careers. A total of 50,450 participants who responded to the career aspiration question were included in the analysis across 125 four-year colleges and universities nationwide. The analysis included descriptive statistics, cross-tabulation comparisons, multinomial logistic regression, and interaction terms.

The results revealed that women, individuals with a URiM background, and those choosing a healthcare-related college major were associated with a higher relative risk ratio (likelihood) to aspire to a PA career than other careers/occupations. Concerning factors include lower levels of faculty mentorship/support and academic self-concept reported by students aspiring to a PA career. Moreover, when analyzing interaction terms, the influence of contextual factors (parents' occupation, experiential learning/activities, and faculty mentorship) on PA career aspiration did not differ by URiM status. These findings underscore important implications for policymakers, higher education institutions, PA programs, college advisors, and stakeholders, emphasizing the urgent need to address how undergraduate students develop career decisions to pursue a career in the PA field. The policy and research implications should center on gender, URiM background, academic self-concept, healthcare-related college major, and faculty support.

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Available for download on Tuesday, April 24, 2029

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