RESEARCH ARTICLE
Education of Military Veterans in Physician Assistant Programs Edward Michaud, PhD; Paul F. Jacques, DHSc, MEd, PA-C; F. J. Gianola, MA, PA; Ken Harbert, PhD, MHA, PA Purpose To assess the admission policies, experiences, and attitudes of physician assistant (PA) program directors regarding recruiting, admitting, and training military veterans after the announcement of the “Helping Veterans Become Physician Assistants” initiative. Methods A descriptive survey of 22 questions was distributed to all 173 PA program directors in the United States in April 2013. The survey covered years 2011 to 2013, although it was completed in June of 2013. The results of the survey were compared with the results of a similar survey that covered years 2008 through 2010. Results One hundred and five (60.7%) program directors participated in this survey. Veterans were admitted into 88.1% of responding programs and accounted for an average of 4.0% of all students. One-third of programs (33%) accepted transfer credits for veterans’ military training, and 20% accepted credits for off-duty educa-
INTRODUCTION In 2013, the unemployment rate for veterans who served in the military since September 2001 was 9.0% compared with 7.2% for the nonveteran workforce.1 Finding employment after leaving the military is especially challenging for younger veterans (aged 18–24 years), who experienced an unemployment rate of 21.4% in 2013 compared with 14.3% of nonveterans in the same age group. More than one million service members are projected to leave the military between 2011 and 2016,2 which will require innovative solutions from both the public and private sectors to help veterans get back to work. An excellent career choice for veterans with military medical education and training is the physician assistant (PA) profession. In fact, the PA profession was started with veteran Navy corpsmen and Army medics returning from Vietnam who were trained to serve as physician extenders to help alleviate the shortage of primary care physicians in underserved areas of the United States.3–6 Whereas the PA profession was started in 1967 with military veterans, only 4% of students matriculating into PA education programs in 2013 had any military experience.7 The authors had previously (in 2011) surveyed all directors of PA education programs in the United States and asked
tion. One-third (33%) of programs participated in the Yellow Ribbon Program. Almost 60% of programs had military veteran faculty members. Active recruitment of military veteran students occurred in 31.2% of programs. Program directors described multiple benefits of, and barriers to, admitting and educating veterans. Conclusions For the years 2011 through 2013, as compared to 2008 through 2010, there was an increase in the percentage of PA programs that actively recruited veterans, considered veteran status in the admission process, admitted veterans, and contributed to their financial support. There was also an increased percentage of students with military experience matriculating into PA programs. However, barriers still exist for veterans seeking admission into PA programs, the most significant of which is academic preparedness for a graduate-level PA program.
them about their policies, experiences, and attitudes toward recruiting and training veteran corpsmen and medics during the years 2008 through 2010.8 The purpose of that study was to identify any barriers that may exist for veterans applying to PA education programs. We identified several barriers and made suggestions about ways that PA programs can help veterans transition from military service to careers as PAs. Recently, various public and private efforts have focused on the need to provide veterans with more opportunities for employment in the civilian workforce.9 One such initiative, announced by the Obama Administration on October 25, 2011, is the Helping Veterans Become Physician Assistants Initiative.10 The Health Resources and Services Administration (HRSA) is facilitating this initiative by giving priority in PA training grant awards to colleges and universities that prepare veterans for PA careers. Given this heightened focus on providing all service members with additional career opportunities when they separate from the military, the authors again surveyed all directors of PA education programs in the United States to determine the extent to which policies, experiences, and attitudes toward recruiting and training veterans have changed since the original survey was conducted in 2011.
METHODS The authors declare no conflict of interest. J Physician Assist Educ 2015;26(2):77–85 Copyright ª 2015 Physician Assistant Education Association DOI 10.1097/JPA.0000000000000025
June 2015 Volume 26 Number 2
A descriptive survey of 22 questions was designed to assess the opportunities and barriers presented to veterans when seeking admission into PA educational programs in the United States (Table 1). The survey questions were similar to those in 77
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RESEARCH ARTICLE
Table 1: Survey Instrument 1
Please select the state and name of your physician assistant program’s home educational institution from the drop-down menus.
2
Does your institution offer a preprofessional track associated with the PA program?
3
What are the minimum prerequisite credit hours for admission into your PA program?
4
What credential(s)/degree(s) are awarded to students who graduate from your PA program? Check all that apply.
5
What is the classification of your home educational institution?
6
Which of the following best describes your home educational institution?
7
In each of the last 3 years (2011–2013), what is the total number of students who were admitted to the first year of the professional phase of your PA program? Please enter a number for each year.
8
Does your PA program have any dedicated seats for incoming students that are reserved specifically for military veterans?
8a
How many seats were reserved specifically for veterans in each of the last 3 years? Please enter a number for each year.
9
Were there any military veterans admitted into your PA program during the years of 2011–2013?
9a
In each of the last 3 years, how many students admitted to the first year of the professional phase of your PA program were military veterans? Please enter a number for each year.
10
Were any active duty, military reserve, or National Guard members admitted into your PA program during 2011–2013?
10a
In each of the last 3 years, how many students admitted into your PA program were active military, military reserve, or National Guard at the time of enrollment? Please enter a number for each year.
11
Did any of your students enlist or become commissioned in the military while enrolled in your PA program?
11a
In each of the last 3 years, how many students enrolled in your PA program enlisted or became commissioned in the military? Please enter a number for each year.
12
Does your PA program accept college credits earned by veterans for their military training and occupation through evaluations conducted by the ACE as prerequisite coursework?
13
Does your PA program accept college credits earned by veterans for their off-duty, voluntary education completed through the DANTES as prerequisite coursework?
14
Does your PA program have a mechanism that allows students with military medical experience to waive or be exempt from taking any of your PA curriculum courses?
14a
Please provide a brief description of your program’s mechanism that allows students with military medical experience to waive or be exempt from taking PA curriculum courses.
15
Does your home educational institution participate in the Yellow Ribbon GI Education Enhancement Program (Yellow Ribbon Program), a provision of the Post-9/11 Veterans Educational Assistance Act of 2008? Note: The Yellow Ribbon Program allows institutions of higher learning in the United States to voluntarily enter into an agreement with the Department of Veterans Affairs (VA) to provide tuition expenses that exceed the highest public in-state undergraduate tuition rate. The institution can contribute up to 50% of those expenses, and the VA will match the same amount as the institution.
15a
What is the maximum number of students that may participate in the Yellow Ribbon Program each year?
15b
What is your school’s maximum dollar contribution amount for students in the Yellow Ribbon Program? Please enter the amount per student per year.
16
Does your PA program have any military veteran faculty members, including program and medical directors?
16a
How many military veteran faculty members, including program and medical directors, are there in your program?
17
Does your PA program actively recruit military veterans to apply to your program (eg, invite veterans to information sessions at your school, make presentations about your program to military or veteran organizations, etc.)?
17a
Please describe the manner in which you recruit military veterans into your program.
18
My physician assistant educational program considers military veterans for admission but only if they meet all of the standardized admission prerequisites that we have established for all other applicants. True or False?
19
My PA educational program has admission criteria that give military veterans additional consideration for an interview and/ or admission into the program (eg, give veterans additional points when choosing applicants for interviews). True or False?
20
It is difficult to equate veterans’ military education and experience to our standardized admission requirements (strongly agree, agree, neither agree nor disagree, disagree, strongly disagree).
21
What do you believe are the most important benefits to your program for recruiting, admitting, and training military veterans?
22
What do you believe are the most significant barriers for recruiting, admitting, and training military veterans into your program?
ACE, American Council on Education; DANTES, Defense Activity for Non-Traditional Education Support; PA, physician assistant.
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RESEARCH ARTICLE the previously published study by the authors, with minor modifications and additions.8 The research received exempt status from the South College Institutional Review Board. The survey was created and published online using Qualtrics Survey Software. A link to the survey was distributed by email on April 17, 2013, to all directors of the 173 accredited PA programs. The email described the project, requested that program directors participate in the survey, and informed them that publication of survey results will contain only aggregate information from all programs and will not identify the facts or opinions expressed by individual programs. Participants provided informed consent by reading the information and completing the survey. Follow-up emails were sent to nonrespondent program directors in April and May. Finally, phone calls were made to the remaining nonrespondent program directors in early June. The survey was closed on June 26, 2013.
RESULTS Response Rate and General Program Characteristics The response rate for the survey was 60.7% (105 responses of 173 distributed surveys). Some programs did not provide responses to all of the questions. Based on the general program characteristics reported by the 105 responding PA program directors (Table 2) compared with the 164 PA programs in the TwentyEighth Annual Report on Physician Assistant Educational Programs in the United States, 2011–2012,11 we determined that the programs in the survey are representative of all PA programs. PA Students With Military Experience The average class size for 2011 through 2013 was 42, which increased from 41 students in 2008 through 2010 (Table 3). Three PA programs reserved seats specifically for military veterans during 2011 through 2013, whereas no programs reserved seats for veterans during 2008 through 2010. During 2011 through 2013, 88.1% of PA programs admitted at least one military veteran into the first year of the professional phase of their programs compared with 83.6% of programs during 2008 through 2010. Four percent of students admitted into PA programs during 2011 through 2013 were military veterans compared with 2.6% of students during 2008 through 2010. Active duty, military reserve, or National Guard members were admitted into 59.6% of PA programs during 2011 through 2013 compared with 44.8% of programs during 2008 to 2010. The average percentage of students admitted into PA programs who were active duty, military reserve, or National Guard members was 1.3% during 2011 through 2013, which increased from 0.9% during 2008 through 2010. During 2011 through 2013, 44.7% of PA programs had students enlist or become commissioned in the military while enrolled in PA school, and an average of 0.8% of all enrolled students became enlisted or commissioned in the military (Table 3). Acceptance of American Council on Education and Defense Activity for Non-Traditional Education Support Credits The percentage of PA programs that accepted college credits earned by veterans for their military training and occupation through evaluations conducted by the American Council on Education (ACE) went down from 45.3% during June 2015 Volume 26 Number 2
Table 2: General Information About Participating Physician Assistant Programs Number Percent Is there a preprofessional track associated with your PA program? Yes
36
34.3
No
69
65.7
None
3
2.9
35 credit hours
1
1.0
40 credit hours
1
1.0
Associate’s degree or 60 credit hours
3
2.9
75 credit hours
1
1.0
Minimum prerequisite credit hours for admission into PA program?
90 credit hours
6
5.7
89
84.8
1
1.0
100
97.1
Bachelor
3
2.9
Associate
0
0
Certificate
0
0
University
68
65.4
Academic health institution
23
22.1
College
10
9.6
3
2.9
58
55.8
Bachelor’s degree or 120 credit hours Students can enter directly into preprofessional track or apply with a degree and the prerequisites completed Highest degree awarded? Master
Classification of home educational institution?
Community college Which best describes your home educational institution? Private, not for profit Private, for profit
9
8.7
36
34.6
Military
0
0
Public/private hybrid
1
1.0
Public
PA, physician assistant.
2008 through 2010 to 33.0% during 2011 through 2013. This change may be related to an additional answer choice in the 2011 through 2013 survey of “I don’t know” (Table 4). Twenty percent of PA programs accepted college credits earned by veterans for their off-duty voluntary education completed through the Defense Activity for Non-Traditional Education Support (DANTES) during 2011 through 2013 compared with 28.4% during 2008 through 2010, but again “I don’t know” was not a choice in the 2008 through 2010 survey. During 2011 through 2013, only one PA program allowed students with military medical experience to be exempt 79
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RESEARCH ARTICLE
Table 3: Matriculated Physician Assistant Students With Military Experience, 2008–20108 and 2011–2013 Question Number of students admitted to first year of professional phase of your PA program? Year: average (range)
2008–2010
2011–2013
N = 110 programs
N = 101 programs
2008: 38 (0–98)
2011: 39 (0–114)
2009: 40 (0–98)
2012: 42 (0–119)
2010: 44 (0–100)
2013: 44 (0–140)
2008–2010: 41
2011–2013: 42
Any dedicated seats for incoming students that are reserved specifically for military veterans? Response: percentage of responding programs
Yes: 0% (0/110)
Yes: 2.9% (3/102)
No: 100% (110/110)
No: 97.1% (99/102)
2008: 0
2011: 1.7 (0–5)
Number of seats reserved specifically for military veterans? Year: average (range)
2009: 0
2012: 1.7 (0–5)
2010: 0
2013: 5.3 (2–10)
Yes: 83.6% (92/110)
Yes: 88.1% (89/101)
No: 16.4% (18/110)
No: 11.9% (12/101)
N = 92 programs
N = 93 programs
2008: 2.7% (87/3276)
2011: 3.7% (135/3631)
2009: 2.3% (82/3532)
2012: 4.9% (191/3906)
2010: 2.8% (111/3906)
2013: 3.4% (142/4229)
2008–2010: 2.6%
2011–2013: 4.0%
Yes: 44.8% (43/96)
Yes: 59.6% (56/94)
No: 54.2% (52/96)
No: 40.4% (38/94)
Were any military veterans admitted into your PA program during the last 3 years? Response: percentage of responding programs
How many students admitted to first year of professional phase of PA program were military veterans? Year: percentage of all students who were veterans
Were any active duty, military reserve, or National Guard members admitted into your PA program during the last 3 years? Response: percentage of responding programs
NA: 1.0% (1/96) How many students admitted into PA program were active military? Year: percentage of all active
Did any of your students enlist or become commissioned in the military while enrolled in your PA program?
N = 92 programs
N = 91 programs
2008: 0.7% (22/3271)
2011: 1.5% (52/3547)
2009: 0.9% (33/3520)
2012: 1.4% (55/3797)
2010: 0.9% (36/3893)
2013: 0.9% (38/4120)
2008–2010: 0.9%
2011–2013: 1.3%
Question not asked in this survey
Yes: 44.7% (42/94)
Response: percentage of responding programs
No: 55.3% (52/94)
How many students enrolled in your PA program enlisted or became commissioned in the military?
N = 93 programs
Year: percentage of all enlisted/commissioned students
Question not asked in this survey
2011: 0.9% (31/3637) 2012: 1.0% (40/3912) 2013: 0.5% (21/4239) 2011–2013: 0.8%
NA, information not available; PA, physician assistant.
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Table 4: Assistance Provided to Military Veterans Enrolling in Physician Assistant Programs Question
2008–2010
2011–2013
Does your program accept college credits earned by veterans for their military training and occupation? Response: percentage of responding programs
Yes: 45.3% (43/95)
Yes: 33.0% (31/94)
No: 54.7% (52/95)
No: 33.0% (31/94)
Don’t know: was not a choice
Don’t know: 34.0% (32/94)
Yes: 28.4% (27/95)
Yes: 20.0% (19/95)
No: 71.6% (68/95)
No: 43.2% (41/95)
Don’t know: was not a choice
Don’t know: 36.8% (35/95)
Yes: 0% (0/110)
Yes: 1.1% (1/95)
No: 100% (110/110)
No: 98.9% (94/95)
Yes: 16.0% (15/94)
Yes: 33.0% (30/91)
No: 84.0% (79/94)
No: 67.0% (61/91)
Yes: 17.0% (16/94)
Yes: 59.6% (56/94)
No: 83.0% (78/94)
No: 40.4% (38/94)
How many military veteran faculty members are there in your program?
N = 16 programs
N = 56 programs
Average number of veterans (range)
2.2 (1–5)
2.1 (1–8)
Yes: 16.0% (15/94)
Yes: 31.2% (29/93)
No: 84.0% (79/94)
No: 68.8% (64/93)
Does your program accept college credits earned by veterans for their off-duty, voluntary education? Response: percentage of responding programs
Can students with military medical experience be exempt from any PA curriculum courses? Response: percentage of responding programs
Does your home educational institution participate in the Yellow Ribbon Program? Response: percentage of responding programs
Does your PA program have any military veteran faculty members, including program and medical directors?* Response: percentage of responding programs
Does your PA program actively recruit military veterans? Response: percentage of responding programs
*The question not asked in exactly the same way in the 2 surveys; see discussion for details. PA, physician assistant.
from taking any PA curriculum courses (Table 4). The program used ACE and viewed the transcripts from the military veterans to make this decision. No programs exempted veteran students from taking any PA curriculum courses during 2008 through 2010.
Mentorship of Veteran Students Almost 60% of PA programs had military veteran faculty members during 2011 through 2013 with an average of 2.1 veterans in each of these programs. Only 17.0% of programs had veteran faculty members during 2008 through 2010, although there was a slightly higher average of 2.2 veterans in these programs (Table 4).
Financial Assistance for Veteran Students During 2011 to 2013, 33% of PA programs participated in the Yellow Ribbon GI Education Enhancement Program, more than twice the percentage that participated in the program during 2008 through 2010 (Table 4). Of the 30 PA programs that said they participated in the Yellow Ribbon Program during 2011 through 2013, only 9 programs provided an answer to the maximum number of students who may participate in the Yellow Ribbon Program each year. These 9 programs permitted an average of 36 students to participate in the Yellow Ribbon Program each year with a range of 5 to 50 students. These 9 programs contributed an average of $15,366 per student per year to the Yellow Ribbon Program ranging from $4000 to $50,000. June 2015 Volume 26 Number 2
Recruitment of Veterans During 2011 through 2013, 31.2% (29/93) of responding PA programs actively recruited military veterans to apply to their programs compared with only 16.0% of programs in 2008 through 2010 (Table 4). Of these 29 programs, 28 reported the methods they used to recruit veterans. Some programs used multiple methods. The method used by the largest number of programs (32.1%, 9/28) was to make presentations at military bases, military events, veterans hospitals, veterans groups, and/or veteran employer job fairs. The next most common method reported (25.0%, 7/28) consisted of communicating with selfidentified veterans during program information sessions and/or 81
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RESEARCH ARTICLE during the student application process. Additional reported methods for recruiting military veterans into PA programs included information sessions targeted to the military (21.4%), use of local military recruiters (21.4%), working with the university’s veterans office (14.3%), advertising with military societies or through military media (10.7%), advertising geared toward military veterans on the PA program’s Web site and/or Facebook page (10.7%), word of mouth by alumni of PA program (7.1%), word of mouth by military students enrolled in PA program (7.1%), forming relationships with education offices at military bases (3.6%), waiving the supplemental application fee for active duty military and military veterans (3.6%), and giving military applicants preference points during the application process (3.6%). Admission Criteria for Veterans All students who matriculate into an accredited PA program after December 31, 2020, must be awarded a master’s degree on successful completion of their PA curriculum.12 Ninetyseven percent of PA programs in this survey already have a master’s as the highest degree awarded to their graduates (Table 2). Most PA programs in this survey (84.8%) also require a bachelor’s degree or 120 credit hours as a minimum prerequisite for admission into their program (Table 2). Of 93 responding PA programs, 92 of them (98.9%) agreed with the statement that they consider military veterans for admission into their programs but only if the veterans meet all the standardized admission prerequisites that are established for all other applicants. Only one program (1.1%) disagreed with this statement. Thirty-five of these 92 programs (38.0%) agreed with the statement that they have admission criteria that give military veterans additional consideration in being invited for an interview and/or admission into the program (eg, giving veterans additional points when choosing applicants for interviews). The remaining 62% of programs disagreed with this statement. When asked to respond to the statement “It is difficult to equate veterans’ military education and experience to our standardized admission requirements,” 12.9% strongly agreed, 28.0% agreed, 38.7% neither agreed nor disagreed, 18.3% disagreed, and 2.2% strongly disagreed. Perceived Benefits and Barriers to Recruiting, Admitting, and Training Veterans Most program directors (83.9%, 78/93) described what they believed were the most important benefits related to recruiting, admitting, and training veterans during 2011 through 2013. Respondents may have reported a single or multiple benefits. These were grouped by the type of benefit and compared with the results of our previous survey (Table 5). Program directors (82.8%, 77/93) also described what they believed were the most significant barriers to recruiting, admitting, and training veterans, which were also compared with the results from our previous survey (Table 6).
DISCUSSION
PA programs have also increased their class size to address this need.11 Although the largest PA student class sizes increased between the 2008 through 2010 and 2011 through 2013 survey periods, the average class size for programs participating in our surveys was similar (42 and 41, respectively). The 2011 through 2013 time frame also witnessed an increase in the percentage of PA programs that admitted veterans and an increase in the percentage of matriculating students who were veterans, active duty, military reserve, or National Guard personnel. Three programs reserved seats specifically for military veterans during 2011 through 2013, whereas no programs did so during 2008 through 2010. A limitation of this study is that it was concluded in June 2013 likely before all PA programs had completed their 2013 recruiting season. Another limitation is that it is not possible to determine the extent to which the increased percentage of matriculating PA students with military experience can be attributed to the efforts of HRSA and others to create awareness in PA educators and veterans groups,9 or if this finding is primarily the result of a greater number of individuals separating from the military in recent years. Acceptance of American Council on Education and Defense Activity for Non-Traditional Education Support Credits The ACE and DANTES programs allow military personnel to receive college credits for their military training and experience. However, there is still a need to increase awareness about ACE and DANTES in PA programs. Only one-third of PA programs stated that their institutions accept ACE credits, and only onefifth of programs accept DANTES credits. More than one-third of PA program directors did not know whether their institutions accept ACE or DANTES credits. However, for the first time, during 2011 through 2013, one PA program exempted applicants with military medical experience from taking certain PA curriculum courses based on a review of their ACE credits. Physician assistant programs receive an abundance of applications each year. For the 2012 to 2013 cycle, the average number of applications per program (for programs participating in the Central Application Service for Physician Assistants) was 797, and the average class size for all PA programs was 45.11,13 Thus, on average, PA programs received about 18 applications for every seat. With plenty of highly qualified applicants, only a small percentage of whom are veterans, PA programs may not have the time, personnel, or motivation to consider ACE and DANTES credits during the application process. Additionally, 40.9% of PA program directors agreed or strongly agreed that it is difficult to equate military education and experience with their standardized admission requirements. Physician assistant programs should consider working with their home educational institutions to establish policies and procedures for reviewing and accepting ACE and DANTES credits as part of their routine application review process. Given the large percentage of PA programs that require a bachelor’s degree for admission, programs should work with feeder institutions to incorporate ACE and DANTES credits into the awarded bachelor’s degree.
Physician Assistant Students With Military Experience The number of new PA educational programs has increased dramatically in recent years to help meet the growing need for health care providers in the United States. A number of existing 82
Financial Assistance for Veteran Students The Yellow Ribbon GI Education Enhancement Program is a provision of the Post-9/11 GI Bill. The purpose of this program Journal of Physician Assistant Education
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RESEARCH ARTICLE
Table 5: Benefits of Recruiting, Admitting, and Training Military Veterans in Physician Assistant Programs 2008–20108, %
2011–2013, %
Health care/life experience
62.5
57.7
Maturity
32.5
38.5
Motivated/disciplined/focused/goal-oriented/good work ethic
32.5
25.6
Leadership skills
8.8
16.7
Professionalism
7.5
16.7
Strong team skills
5.0
3.8
Knowledge of self/PA profession
5.0
2.6
Excellent students
3.8
1.3
Proven capability
3.8
0
Ability to handle stress
2.5
5.1
Potential for better performance during program
1.3
0
Potential for better PANCE scores after program
1.3
0
Best and brightest of our applicant pool
1.3
0
Flexible
1.3
0
Ability to view the big picture, perspective
1.3
1.3
13.8
16.7
Promoting foundation of the PA profession
8.8
6.4
Providing the PA workforce with individuals who have military experience
2.5
2.6
Inspire other students to work in veteran health
0
1.3
Giving thanks/support for service to country
5.0
6.4
Giving veterans with medical experience the opportunity to practice in civilian setting
2.5
0
Veteran faculty members/mentors
0
2.6
Program is in military town/uses military training sites
0
2.6
None
2.5
0
Unsure
2.5
0
Veteran experience/preparedness
Benefit to program Adds diversity/richness to class body Benefit to profession
Benefit to individual
No benefits or unsure of benefits
Numbers of responding programs were 80 (2008–2010) and 78 (2011–2013). PA, physician assistant.
is to give additional financial support to veterans who attend private schools and graduate programs that cost more than the Post-9/11 GI Bill will cover. Degree-granting institutions that participate in the Yellow Ribbon Program create a veterans-only scholarship and choose the number of students who may participate in the program and the amount of tuition and fees that they contribute per student. The US Department of Veterans Affairs will match this amount dollar for dollar up to the full cost of tuition and fees. During 2011 through 2013, one-third of PA program sponsoring institutions participated in the Yellow Ribbon Program, which was more than twice as many participants as in 2008 through 2010. Mentorship of Veteran Students One of the many ways that PA programs can assist students in the transition from military service to PA school is through June 2015 Volume 26 Number 2
mentorship by veteran faculty members or alumni. For this reason, the survey asked PA program directors about the number of veteran faculty members in their programs. During 2011 through 2013, almost 60% of PA programs had veteran faculty members, which was more than 3 times as many in 2008 through 2011. It seems unlikely that the number of PA programs with veteran faculty members would increase this much in such a short period of time. A limitation in comparing the number of PA programs with veteran faculty in 2011 through 2013 and 2008 through 2010 is that the question was not asked in the same way in both surveys. This survey (2011–2013) asked if the PA program had any military veteran faculty members including program and medical directors. The 2008 through 2010 survey asked if the PA program assigned military veteran faculty members to serve as mentors for their military veteran students. It is possible that some programs had veteran faculty members, but they 83
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RESEARCH ARTICLE
Table 6: Barriers Related to Recruiting, Admitting, and Training Military Veterans in Physician Assistant Programs 2008–20108, % 2011–2013, % Academic preparedness of veterans Lack of academic preparedness/lack of undergraduate educational requirements
37.3
39.0
Low GPAs and GPAs that may predate military service
5.3
11.7
Need more/appropriate bridge programs to prepare veterans to enter a graduate degree program
4.0
0
No barriers or unsure of barriers None
21.3
Unsure
7.8
4.0
0
12.0
15.6
Lack of familiarity with the most effective methods for recruiting corpsmen/medics
1.3
2.6
Need more outreach to inform veterans of the benefits of a PA career
1.3
1.3
12.0
5.2
Institutional academic prerequisites do not permit credit for nonacademic experiences
4.0
3.9
Difficulty equating military coursework to civilian coursework
4.0
10.4
Institution does not accept military training schools’ diplomas or credits
1.3
0
Overcoming the traditional view of the student GPA and educational background
1.3
2.6
Large number of qualified applicants/limited class size
1.3
2.6
Lack of support from university administration
0
3.9
All students admitted as freshmen, no previous college credit permitted
0
1.3
Have a 3 + 2 program with limited graduate admissions
0
1.3
University does not participate in the Yellow Ribbon Program
0
1.3
Veterans may have difficulty adjusting to a civilian classroom environment
2.7
2.6
Getting corpsmen to understand that their training is incomplete when it comes to PA education
2.7
0
2.7
2.6
1.3
1.3
Deployment of active duty students is difficult for student/program
5.3
0
Active duty military have been admitted into program but were not released from duty
1.3
0
Recruiting issues Lack of time/funding to recruit or lack of access to corpsmen/medic pool of applicants
Financial issues Cost of attending the PA program Admission issues
Veteran preparedness for PA education
Faculty/program preparedness to train veterans Lack of understanding of military terms/formalities/experiences on the part of the faculty PA educational policies The move to graduate degrees Active duty personnel issues
Numbers of responding programs were 75 (2008–2010) and 77 (2011–2013). PA, physician assistant.
did not assign them to serve as mentors for their veteran students and would not have been counted. Recruitment of Veterans Almost twice as many PA programs actively recruited veteran students during 2011 through 2013 than in 2008 through 2010 (31.2% and 16.0%, respectively). The methods of recruitment were similar for both time periods. Most recruiting efforts were focused on making presentations at military or veteran institutions or events. However, 25% of programs that said they actively recruit veterans are relying on veterans identifying themselves 84
during program information sessions or during the application process, which is not “active recruitment of veterans.” Many programs (15.6%) identified lack of time/funding to recruit veterans or lack of access to the corpsmen/medic pool of applicants as barriers to recruiting veterans. Admission Criteria for Veterans Although 84.8% of PA programs require a bachelor’s degree or 120 credit hours for entry into the program, and 98.9% require veterans to meet all the admission prerequisites established for all other applicants, 38.0% of programs Journal of Physician Assistant Education
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RESEARCH ARTICLE reported that they now have admission criteria that give veterans additional consideration for an interview and/or admission into the program. Perceived Benefits and Barriers to Recruiting, Admitting, and Training Veterans The main benefits and barriers perceived by program directors relative to recruiting, admitting, and training military veterans in PA programs were similar in the 2011 through 2013 and 2008 through 2010 surveys. The main benefits to programs are that military veterans have valuable health care and life experiences, they are mature and motivated individuals who exhibit leadership skills and professionalism, and they add diversity and richness to the class body. Educating veterans also promotes the military connection that is one of the foundations of the PA profession. The main barriers are that military veterans may lack academic preparedness for a graduate PA program, PA programs lack time and funding to recruit veterans, PA programs have a difficult time equating military coursework to civilian coursework, and the cost of attending the PA program is perceived as prohibitive.
CONCLUSIONS In recent years, the Obama administration, HRSA, veterans groups, and key stakeholders in PA education have worked to develop recruitment, retention, and mentoring strategies for veterans transitioning into PA programs and to increase the number of PA programs that accommodate veterans.9,10,14 The authors surveyed all PA education program directors in the United States both before8 and after (present survey) the White House announced the Helping Veterans Become Physician Assistants Initiative in 2011 and asked them about their policies, experiences, and attitudes toward recruiting and training veterans. The present survey demonstrates that there has been an increase in the percentage of 1) PA programs that admitted veterans; 2) matriculating students who had military experience; 3) PA programs that participated in the Yellow Ribbon Program; 4) PA programs that actively recruited veteran students; and 5) PA programs with admission criteria that give veterans additional consideration for an interview and/or admission into the program. Most PA programs also have veteran faculty members who can provide mentorship and counseling to veteran students. However, barriers still exist for veterans seeking admission into PA programs, the most significant of which is academic preparedness for a graduate-level PA program. Leaders in PA education should continue to work with the military to identify effective methods for informing active duty personnel about the requirements for entry into PA programs, and opportunities to complete these requirements, before they separate from the military. The PA education community needs to continue to develop best practice approaches for bridging veterans’ military medical training and education and entry into civilian PA programs. More PA programs also need to
June 2015 Volume 26 Number 2
work with their home educational institutions to establish policies and procedures for reviewing and accepting ACE and DANTES credits as part of their routine application review process. Edward Michaud, PhD, is a professor in the School of Physician Assistant Studies at South College, Knoxville, Tennessee. Paul F. Jacques, DHSc, MEd, PA-C, is an associate professor in the Division of Physician Assistant Studies at the Medical University of South Carolina, Charleston, South Carolina. F. J. Gianola, MA, PA, is a lecturer at MEDEX Northwest Division of Physician Assistant Studies at the University of Washington, Seattle, Washington. Ken Harbert, PhD, MHA, PA, is a professor and dean of the School of Physician Assistant Studies at South College, Knoxville, Tennessee. The authors give special thanks to Tony Miller, Lindsey M. Huang, Rachel Hamann, and other research staff at PAEA for administering the survey. The authors also thank Kathryn Markferding for assistance in data analysis. Correspondence should be addressed to: Edward Michaud, PhD, School of Physician Assistant Studies, South College, 400 Goody’s Lane, Knoxville, TN 37922. Telephone: (865) 288-8315; Email: [email protected]
REFERENCES 1. US Department of Labor, Bureau of Labor Statistics. Economic news release: employment situation of veterans summary. http://www.bls. gov/news.release/vet.nr0.htm. Accessed June 13, 2014. 2. The White House. Fact sheet: President Obama’s commitment to employing America’s veterans. http://www.whitehouse.gov/thepress-office/2011/08/05/fact-sheet-president-obama-s-commitmentemploying-america-s-veterans. Accessed June 13, 2014. 3. Dieter PM, Strand J. Snapshots in time: Duke University physician assistant classes, 1967–2007. J Physician Assist Educ. 2007;18(3): 16–23. 4. Smith RA. MEDEX. JAMA. 1970;211(11):1843–1845. 5. Physician Assistant History Center. Timeline. http://www.pahx.org/ timeline.html. Accessed June 13, 2014. 6. Jones PE. Physician assistant education in the United States. Acad Med. 2007;82(9):882–887. 7. Physician Assistant Education Association. Issue brief: matriculating student survey 2013. http://www.paeaonline.org/index.php?ht=a/ GetDocumentAction/i/156635. Accessed June 13, 2014. 8. Michaud E, Jacques PF, Gianola FJ, et al. Assessment of admissions policies for veteran corpsmen and medics applying to physician assistant educational programs. J Physician Assist Educ. 2012;23(1): 4–12. 9. Brock D, Bolon S, Wick K, et al. The military veteran to physician assistant pathway: building the primary care workforce. Acad Med. 2013;88(12):1890–1894. 10. The White House. Fact sheet: we can’t wait: Obama Administration’s new initiatives to help create jobs for veterans. http://m.whitehouse. gov/the-press-office/2011/10/25/fact-sheet-we-cant-wait-obamaadministrations-new-initiatives-help-creat. Accessed June 13, 2014. 11. Miller AA, Mayberry LA, Hamann RA, et al. Twenty-Eighth Annual Report on Physician Assistant Educational Programs in the United States, 2011–2012. Alexandria, VA: Physician Assistant Education Association; 2014. 12. Accreditation Review Commission on Education for the Physician Assistant. Accreditation Standards. http://www.arc-pa.org/acc_ standards. Accessed June 13, 2014. 13. McDaniel J. CASPA data report, cycle 12. Paper presented at: Physician Assistant Education Association Annual Education Forum; October 2013; Memphis, TN. http://www.paeaonline.org/index.php? ht=a/GetDocumentAction/i/154970. Accessed June 13, 2014. 14. AAPA Invited to White House Forum. http://www.pasconnect.org/ aapa-invited-to-white-house-forum. Accessed June 13, 2014.
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Education of Military Veterans in Physician Assistant Programs Edward Michaud, PhD; Paul F. Jacques, DHSc, MEd, PA-C; F. J. Gianola, MA, PA; Ken Harbert, PhD, MHA, PA Purpose To assess the admission policies, experiences, and attitudes of physician assistant (PA) program directors regarding recruiting, admitting, and training military veterans after the announcement of the “Helping Veterans Become Physician Assistants” initiative. Methods A descriptive survey of 22 questions was distributed to all 173 PA program directors in the United States in April 2013. The survey covered years 2011 to 2013, although it was completed in June of 2013. The results of the survey were compared with the results of a similar survey that covered years 2008 through 2010. Results One hundred and five (60.7%) program directors participated in this survey. Veterans were admitted into 88.1% of responding programs and accounted for an average of 4.0% of all students. One-third of programs (33%) accepted transfer credits for veterans’ military training, and 20% accepted credits for off-duty educa-
INTRODUCTION In 2013, the unemployment rate for veterans who served in the military since September 2001 was 9.0% compared with 7.2% for the nonveteran workforce.1 Finding employment after leaving the military is especially challenging for younger veterans (aged 18–24 years), who experienced an unemployment rate of 21.4% in 2013 compared with 14.3% of nonveterans in the same age group. More than one million service members are projected to leave the military between 2011 and 2016,2 which will require innovative solutions from both the public and private sectors to help veterans get back to work. An excellent career choice for veterans with military medical education and training is the physician assistant (PA) profession. In fact, the PA profession was started with veteran Navy corpsmen and Army medics returning from Vietnam who were trained to serve as physician extenders to help alleviate the shortage of primary care physicians in underserved areas of the United States.3–6 Whereas the PA profession was started in 1967 with military veterans, only 4% of students matriculating into PA education programs in 2013 had any military experience.7 The authors had previously (in 2011) surveyed all directors of PA education programs in the United States and asked
tion. One-third (33%) of programs participated in the Yellow Ribbon Program. Almost 60% of programs had military veteran faculty members. Active recruitment of military veteran students occurred in 31.2% of programs. Program directors described multiple benefits of, and barriers to, admitting and educating veterans. Conclusions For the years 2011 through 2013, as compared to 2008 through 2010, there was an increase in the percentage of PA programs that actively recruited veterans, considered veteran status in the admission process, admitted veterans, and contributed to their financial support. There was also an increased percentage of students with military experience matriculating into PA programs. However, barriers still exist for veterans seeking admission into PA programs, the most significant of which is academic preparedness for a graduate-level PA program.
them about their policies, experiences, and attitudes toward recruiting and training veteran corpsmen and medics during the years 2008 through 2010.8 The purpose of that study was to identify any barriers that may exist for veterans applying to PA education programs. We identified several barriers and made suggestions about ways that PA programs can help veterans transition from military service to careers as PAs. Recently, various public and private efforts have focused on the need to provide veterans with more opportunities for employment in the civilian workforce.9 One such initiative, announced by the Obama Administration on October 25, 2011, is the Helping Veterans Become Physician Assistants Initiative.10 The Health Resources and Services Administration (HRSA) is facilitating this initiative by giving priority in PA training grant awards to colleges and universities that prepare veterans for PA careers. Given this heightened focus on providing all service members with additional career opportunities when they separate from the military, the authors again surveyed all directors of PA education programs in the United States to determine the extent to which policies, experiences, and attitudes toward recruiting and training veterans have changed since the original survey was conducted in 2011.
METHODS The authors declare no conflict of interest. J Physician Assist Educ 2015;26(2):77–85 Copyright ª 2015 Physician Assistant Education Association DOI 10.1097/JPA.0000000000000025
June 2015 Volume 26 Number 2
A descriptive survey of 22 questions was designed to assess the opportunities and barriers presented to veterans when seeking admission into PA educational programs in the United States (Table 1). The survey questions were similar to those in 77
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RESEARCH ARTICLE
Table 1: Survey Instrument 1
Please select the state and name of your physician assistant program’s home educational institution from the drop-down menus.
2
Does your institution offer a preprofessional track associated with the PA program?
3
What are the minimum prerequisite credit hours for admission into your PA program?
4
What credential(s)/degree(s) are awarded to students who graduate from your PA program? Check all that apply.
5
What is the classification of your home educational institution?
6
Which of the following best describes your home educational institution?
7
In each of the last 3 years (2011–2013), what is the total number of students who were admitted to the first year of the professional phase of your PA program? Please enter a number for each year.
8
Does your PA program have any dedicated seats for incoming students that are reserved specifically for military veterans?
8a
How many seats were reserved specifically for veterans in each of the last 3 years? Please enter a number for each year.
9
Were there any military veterans admitted into your PA program during the years of 2011–2013?
9a
In each of the last 3 years, how many students admitted to the first year of the professional phase of your PA program were military veterans? Please enter a number for each year.
10
Were any active duty, military reserve, or National Guard members admitted into your PA program during 2011–2013?
10a
In each of the last 3 years, how many students admitted into your PA program were active military, military reserve, or National Guard at the time of enrollment? Please enter a number for each year.
11
Did any of your students enlist or become commissioned in the military while enrolled in your PA program?
11a
In each of the last 3 years, how many students enrolled in your PA program enlisted or became commissioned in the military? Please enter a number for each year.
12
Does your PA program accept college credits earned by veterans for their military training and occupation through evaluations conducted by the ACE as prerequisite coursework?
13
Does your PA program accept college credits earned by veterans for their off-duty, voluntary education completed through the DANTES as prerequisite coursework?
14
Does your PA program have a mechanism that allows students with military medical experience to waive or be exempt from taking any of your PA curriculum courses?
14a
Please provide a brief description of your program’s mechanism that allows students with military medical experience to waive or be exempt from taking PA curriculum courses.
15
Does your home educational institution participate in the Yellow Ribbon GI Education Enhancement Program (Yellow Ribbon Program), a provision of the Post-9/11 Veterans Educational Assistance Act of 2008? Note: The Yellow Ribbon Program allows institutions of higher learning in the United States to voluntarily enter into an agreement with the Department of Veterans Affairs (VA) to provide tuition expenses that exceed the highest public in-state undergraduate tuition rate. The institution can contribute up to 50% of those expenses, and the VA will match the same amount as the institution.
15a
What is the maximum number of students that may participate in the Yellow Ribbon Program each year?
15b
What is your school’s maximum dollar contribution amount for students in the Yellow Ribbon Program? Please enter the amount per student per year.
16
Does your PA program have any military veteran faculty members, including program and medical directors?
16a
How many military veteran faculty members, including program and medical directors, are there in your program?
17
Does your PA program actively recruit military veterans to apply to your program (eg, invite veterans to information sessions at your school, make presentations about your program to military or veteran organizations, etc.)?
17a
Please describe the manner in which you recruit military veterans into your program.
18
My physician assistant educational program considers military veterans for admission but only if they meet all of the standardized admission prerequisites that we have established for all other applicants. True or False?
19
My PA educational program has admission criteria that give military veterans additional consideration for an interview and/ or admission into the program (eg, give veterans additional points when choosing applicants for interviews). True or False?
20
It is difficult to equate veterans’ military education and experience to our standardized admission requirements (strongly agree, agree, neither agree nor disagree, disagree, strongly disagree).
21
What do you believe are the most important benefits to your program for recruiting, admitting, and training military veterans?
22
What do you believe are the most significant barriers for recruiting, admitting, and training military veterans into your program?
ACE, American Council on Education; DANTES, Defense Activity for Non-Traditional Education Support; PA, physician assistant.
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RESEARCH ARTICLE the previously published study by the authors, with minor modifications and additions.8 The research received exempt status from the South College Institutional Review Board. The survey was created and published online using Qualtrics Survey Software. A link to the survey was distributed by email on April 17, 2013, to all directors of the 173 accredited PA programs. The email described the project, requested that program directors participate in the survey, and informed them that publication of survey results will contain only aggregate information from all programs and will not identify the facts or opinions expressed by individual programs. Participants provided informed consent by reading the information and completing the survey. Follow-up emails were sent to nonrespondent program directors in April and May. Finally, phone calls were made to the remaining nonrespondent program directors in early June. The survey was closed on June 26, 2013.
RESULTS Response Rate and General Program Characteristics The response rate for the survey was 60.7% (105 responses of 173 distributed surveys). Some programs did not provide responses to all of the questions. Based on the general program characteristics reported by the 105 responding PA program directors (Table 2) compared with the 164 PA programs in the TwentyEighth Annual Report on Physician Assistant Educational Programs in the United States, 2011–2012,11 we determined that the programs in the survey are representative of all PA programs. PA Students With Military Experience The average class size for 2011 through 2013 was 42, which increased from 41 students in 2008 through 2010 (Table 3). Three PA programs reserved seats specifically for military veterans during 2011 through 2013, whereas no programs reserved seats for veterans during 2008 through 2010. During 2011 through 2013, 88.1% of PA programs admitted at least one military veteran into the first year of the professional phase of their programs compared with 83.6% of programs during 2008 through 2010. Four percent of students admitted into PA programs during 2011 through 2013 were military veterans compared with 2.6% of students during 2008 through 2010. Active duty, military reserve, or National Guard members were admitted into 59.6% of PA programs during 2011 through 2013 compared with 44.8% of programs during 2008 to 2010. The average percentage of students admitted into PA programs who were active duty, military reserve, or National Guard members was 1.3% during 2011 through 2013, which increased from 0.9% during 2008 through 2010. During 2011 through 2013, 44.7% of PA programs had students enlist or become commissioned in the military while enrolled in PA school, and an average of 0.8% of all enrolled students became enlisted or commissioned in the military (Table 3). Acceptance of American Council on Education and Defense Activity for Non-Traditional Education Support Credits The percentage of PA programs that accepted college credits earned by veterans for their military training and occupation through evaluations conducted by the American Council on Education (ACE) went down from 45.3% during June 2015 Volume 26 Number 2
Table 2: General Information About Participating Physician Assistant Programs Number Percent Is there a preprofessional track associated with your PA program? Yes
36
34.3
No
69
65.7
None
3
2.9
35 credit hours
1
1.0
40 credit hours
1
1.0
Associate’s degree or 60 credit hours
3
2.9
75 credit hours
1
1.0
Minimum prerequisite credit hours for admission into PA program?
90 credit hours
6
5.7
89
84.8
1
1.0
100
97.1
Bachelor
3
2.9
Associate
0
0
Certificate
0
0
University
68
65.4
Academic health institution
23
22.1
College
10
9.6
3
2.9
58
55.8
Bachelor’s degree or 120 credit hours Students can enter directly into preprofessional track or apply with a degree and the prerequisites completed Highest degree awarded? Master
Classification of home educational institution?
Community college Which best describes your home educational institution? Private, not for profit Private, for profit
9
8.7
36
34.6
Military
0
0
Public/private hybrid
1
1.0
Public
PA, physician assistant.
2008 through 2010 to 33.0% during 2011 through 2013. This change may be related to an additional answer choice in the 2011 through 2013 survey of “I don’t know” (Table 4). Twenty percent of PA programs accepted college credits earned by veterans for their off-duty voluntary education completed through the Defense Activity for Non-Traditional Education Support (DANTES) during 2011 through 2013 compared with 28.4% during 2008 through 2010, but again “I don’t know” was not a choice in the 2008 through 2010 survey. During 2011 through 2013, only one PA program allowed students with military medical experience to be exempt 79
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RESEARCH ARTICLE
Table 3: Matriculated Physician Assistant Students With Military Experience, 2008–20108 and 2011–2013 Question Number of students admitted to first year of professional phase of your PA program? Year: average (range)
2008–2010
2011–2013
N = 110 programs
N = 101 programs
2008: 38 (0–98)
2011: 39 (0–114)
2009: 40 (0–98)
2012: 42 (0–119)
2010: 44 (0–100)
2013: 44 (0–140)
2008–2010: 41
2011–2013: 42
Any dedicated seats for incoming students that are reserved specifically for military veterans? Response: percentage of responding programs
Yes: 0% (0/110)
Yes: 2.9% (3/102)
No: 100% (110/110)
No: 97.1% (99/102)
2008: 0
2011: 1.7 (0–5)
Number of seats reserved specifically for military veterans? Year: average (range)
2009: 0
2012: 1.7 (0–5)
2010: 0
2013: 5.3 (2–10)
Yes: 83.6% (92/110)
Yes: 88.1% (89/101)
No: 16.4% (18/110)
No: 11.9% (12/101)
N = 92 programs
N = 93 programs
2008: 2.7% (87/3276)
2011: 3.7% (135/3631)
2009: 2.3% (82/3532)
2012: 4.9% (191/3906)
2010: 2.8% (111/3906)
2013: 3.4% (142/4229)
2008–2010: 2.6%
2011–2013: 4.0%
Yes: 44.8% (43/96)
Yes: 59.6% (56/94)
No: 54.2% (52/96)
No: 40.4% (38/94)
Were any military veterans admitted into your PA program during the last 3 years? Response: percentage of responding programs
How many students admitted to first year of professional phase of PA program were military veterans? Year: percentage of all students who were veterans
Were any active duty, military reserve, or National Guard members admitted into your PA program during the last 3 years? Response: percentage of responding programs
NA: 1.0% (1/96) How many students admitted into PA program were active military? Year: percentage of all active
Did any of your students enlist or become commissioned in the military while enrolled in your PA program?
N = 92 programs
N = 91 programs
2008: 0.7% (22/3271)
2011: 1.5% (52/3547)
2009: 0.9% (33/3520)
2012: 1.4% (55/3797)
2010: 0.9% (36/3893)
2013: 0.9% (38/4120)
2008–2010: 0.9%
2011–2013: 1.3%
Question not asked in this survey
Yes: 44.7% (42/94)
Response: percentage of responding programs
No: 55.3% (52/94)
How many students enrolled in your PA program enlisted or became commissioned in the military?
N = 93 programs
Year: percentage of all enlisted/commissioned students
Question not asked in this survey
2011: 0.9% (31/3637) 2012: 1.0% (40/3912) 2013: 0.5% (21/4239) 2011–2013: 0.8%
NA, information not available; PA, physician assistant.
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RESEARCH ARTICLE
Table 4: Assistance Provided to Military Veterans Enrolling in Physician Assistant Programs Question
2008–2010
2011–2013
Does your program accept college credits earned by veterans for their military training and occupation? Response: percentage of responding programs
Yes: 45.3% (43/95)
Yes: 33.0% (31/94)
No: 54.7% (52/95)
No: 33.0% (31/94)
Don’t know: was not a choice
Don’t know: 34.0% (32/94)
Yes: 28.4% (27/95)
Yes: 20.0% (19/95)
No: 71.6% (68/95)
No: 43.2% (41/95)
Don’t know: was not a choice
Don’t know: 36.8% (35/95)
Yes: 0% (0/110)
Yes: 1.1% (1/95)
No: 100% (110/110)
No: 98.9% (94/95)
Yes: 16.0% (15/94)
Yes: 33.0% (30/91)
No: 84.0% (79/94)
No: 67.0% (61/91)
Yes: 17.0% (16/94)
Yes: 59.6% (56/94)
No: 83.0% (78/94)
No: 40.4% (38/94)
How many military veteran faculty members are there in your program?
N = 16 programs
N = 56 programs
Average number of veterans (range)
2.2 (1–5)
2.1 (1–8)
Yes: 16.0% (15/94)
Yes: 31.2% (29/93)
No: 84.0% (79/94)
No: 68.8% (64/93)
Does your program accept college credits earned by veterans for their off-duty, voluntary education? Response: percentage of responding programs
Can students with military medical experience be exempt from any PA curriculum courses? Response: percentage of responding programs
Does your home educational institution participate in the Yellow Ribbon Program? Response: percentage of responding programs
Does your PA program have any military veteran faculty members, including program and medical directors?* Response: percentage of responding programs
Does your PA program actively recruit military veterans? Response: percentage of responding programs
*The question not asked in exactly the same way in the 2 surveys; see discussion for details. PA, physician assistant.
from taking any PA curriculum courses (Table 4). The program used ACE and viewed the transcripts from the military veterans to make this decision. No programs exempted veteran students from taking any PA curriculum courses during 2008 through 2010.
Mentorship of Veteran Students Almost 60% of PA programs had military veteran faculty members during 2011 through 2013 with an average of 2.1 veterans in each of these programs. Only 17.0% of programs had veteran faculty members during 2008 through 2010, although there was a slightly higher average of 2.2 veterans in these programs (Table 4).
Financial Assistance for Veteran Students During 2011 to 2013, 33% of PA programs participated in the Yellow Ribbon GI Education Enhancement Program, more than twice the percentage that participated in the program during 2008 through 2010 (Table 4). Of the 30 PA programs that said they participated in the Yellow Ribbon Program during 2011 through 2013, only 9 programs provided an answer to the maximum number of students who may participate in the Yellow Ribbon Program each year. These 9 programs permitted an average of 36 students to participate in the Yellow Ribbon Program each year with a range of 5 to 50 students. These 9 programs contributed an average of $15,366 per student per year to the Yellow Ribbon Program ranging from $4000 to $50,000. June 2015 Volume 26 Number 2
Recruitment of Veterans During 2011 through 2013, 31.2% (29/93) of responding PA programs actively recruited military veterans to apply to their programs compared with only 16.0% of programs in 2008 through 2010 (Table 4). Of these 29 programs, 28 reported the methods they used to recruit veterans. Some programs used multiple methods. The method used by the largest number of programs (32.1%, 9/28) was to make presentations at military bases, military events, veterans hospitals, veterans groups, and/or veteran employer job fairs. The next most common method reported (25.0%, 7/28) consisted of communicating with selfidentified veterans during program information sessions and/or 81
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RESEARCH ARTICLE during the student application process. Additional reported methods for recruiting military veterans into PA programs included information sessions targeted to the military (21.4%), use of local military recruiters (21.4%), working with the university’s veterans office (14.3%), advertising with military societies or through military media (10.7%), advertising geared toward military veterans on the PA program’s Web site and/or Facebook page (10.7%), word of mouth by alumni of PA program (7.1%), word of mouth by military students enrolled in PA program (7.1%), forming relationships with education offices at military bases (3.6%), waiving the supplemental application fee for active duty military and military veterans (3.6%), and giving military applicants preference points during the application process (3.6%). Admission Criteria for Veterans All students who matriculate into an accredited PA program after December 31, 2020, must be awarded a master’s degree on successful completion of their PA curriculum.12 Ninetyseven percent of PA programs in this survey already have a master’s as the highest degree awarded to their graduates (Table 2). Most PA programs in this survey (84.8%) also require a bachelor’s degree or 120 credit hours as a minimum prerequisite for admission into their program (Table 2). Of 93 responding PA programs, 92 of them (98.9%) agreed with the statement that they consider military veterans for admission into their programs but only if the veterans meet all the standardized admission prerequisites that are established for all other applicants. Only one program (1.1%) disagreed with this statement. Thirty-five of these 92 programs (38.0%) agreed with the statement that they have admission criteria that give military veterans additional consideration in being invited for an interview and/or admission into the program (eg, giving veterans additional points when choosing applicants for interviews). The remaining 62% of programs disagreed with this statement. When asked to respond to the statement “It is difficult to equate veterans’ military education and experience to our standardized admission requirements,” 12.9% strongly agreed, 28.0% agreed, 38.7% neither agreed nor disagreed, 18.3% disagreed, and 2.2% strongly disagreed. Perceived Benefits and Barriers to Recruiting, Admitting, and Training Veterans Most program directors (83.9%, 78/93) described what they believed were the most important benefits related to recruiting, admitting, and training veterans during 2011 through 2013. Respondents may have reported a single or multiple benefits. These were grouped by the type of benefit and compared with the results of our previous survey (Table 5). Program directors (82.8%, 77/93) also described what they believed were the most significant barriers to recruiting, admitting, and training veterans, which were also compared with the results from our previous survey (Table 6).
DISCUSSION
PA programs have also increased their class size to address this need.11 Although the largest PA student class sizes increased between the 2008 through 2010 and 2011 through 2013 survey periods, the average class size for programs participating in our surveys was similar (42 and 41, respectively). The 2011 through 2013 time frame also witnessed an increase in the percentage of PA programs that admitted veterans and an increase in the percentage of matriculating students who were veterans, active duty, military reserve, or National Guard personnel. Three programs reserved seats specifically for military veterans during 2011 through 2013, whereas no programs did so during 2008 through 2010. A limitation of this study is that it was concluded in June 2013 likely before all PA programs had completed their 2013 recruiting season. Another limitation is that it is not possible to determine the extent to which the increased percentage of matriculating PA students with military experience can be attributed to the efforts of HRSA and others to create awareness in PA educators and veterans groups,9 or if this finding is primarily the result of a greater number of individuals separating from the military in recent years. Acceptance of American Council on Education and Defense Activity for Non-Traditional Education Support Credits The ACE and DANTES programs allow military personnel to receive college credits for their military training and experience. However, there is still a need to increase awareness about ACE and DANTES in PA programs. Only one-third of PA programs stated that their institutions accept ACE credits, and only onefifth of programs accept DANTES credits. More than one-third of PA program directors did not know whether their institutions accept ACE or DANTES credits. However, for the first time, during 2011 through 2013, one PA program exempted applicants with military medical experience from taking certain PA curriculum courses based on a review of their ACE credits. Physician assistant programs receive an abundance of applications each year. For the 2012 to 2013 cycle, the average number of applications per program (for programs participating in the Central Application Service for Physician Assistants) was 797, and the average class size for all PA programs was 45.11,13 Thus, on average, PA programs received about 18 applications for every seat. With plenty of highly qualified applicants, only a small percentage of whom are veterans, PA programs may not have the time, personnel, or motivation to consider ACE and DANTES credits during the application process. Additionally, 40.9% of PA program directors agreed or strongly agreed that it is difficult to equate military education and experience with their standardized admission requirements. Physician assistant programs should consider working with their home educational institutions to establish policies and procedures for reviewing and accepting ACE and DANTES credits as part of their routine application review process. Given the large percentage of PA programs that require a bachelor’s degree for admission, programs should work with feeder institutions to incorporate ACE and DANTES credits into the awarded bachelor’s degree.
Physician Assistant Students With Military Experience The number of new PA educational programs has increased dramatically in recent years to help meet the growing need for health care providers in the United States. A number of existing 82
Financial Assistance for Veteran Students The Yellow Ribbon GI Education Enhancement Program is a provision of the Post-9/11 GI Bill. The purpose of this program Journal of Physician Assistant Education
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RESEARCH ARTICLE
Table 5: Benefits of Recruiting, Admitting, and Training Military Veterans in Physician Assistant Programs 2008–20108, %
2011–2013, %
Health care/life experience
62.5
57.7
Maturity
32.5
38.5
Motivated/disciplined/focused/goal-oriented/good work ethic
32.5
25.6
Leadership skills
8.8
16.7
Professionalism
7.5
16.7
Strong team skills
5.0
3.8
Knowledge of self/PA profession
5.0
2.6
Excellent students
3.8
1.3
Proven capability
3.8
0
Ability to handle stress
2.5
5.1
Potential for better performance during program
1.3
0
Potential for better PANCE scores after program
1.3
0
Best and brightest of our applicant pool
1.3
0
Flexible
1.3
0
Ability to view the big picture, perspective
1.3
1.3
13.8
16.7
Promoting foundation of the PA profession
8.8
6.4
Providing the PA workforce with individuals who have military experience
2.5
2.6
Inspire other students to work in veteran health
0
1.3
Giving thanks/support for service to country
5.0
6.4
Giving veterans with medical experience the opportunity to practice in civilian setting
2.5
0
Veteran faculty members/mentors
0
2.6
Program is in military town/uses military training sites
0
2.6
None
2.5
0
Unsure
2.5
0
Veteran experience/preparedness
Benefit to program Adds diversity/richness to class body Benefit to profession
Benefit to individual
No benefits or unsure of benefits
Numbers of responding programs were 80 (2008–2010) and 78 (2011–2013). PA, physician assistant.
is to give additional financial support to veterans who attend private schools and graduate programs that cost more than the Post-9/11 GI Bill will cover. Degree-granting institutions that participate in the Yellow Ribbon Program create a veterans-only scholarship and choose the number of students who may participate in the program and the amount of tuition and fees that they contribute per student. The US Department of Veterans Affairs will match this amount dollar for dollar up to the full cost of tuition and fees. During 2011 through 2013, one-third of PA program sponsoring institutions participated in the Yellow Ribbon Program, which was more than twice as many participants as in 2008 through 2010. Mentorship of Veteran Students One of the many ways that PA programs can assist students in the transition from military service to PA school is through June 2015 Volume 26 Number 2
mentorship by veteran faculty members or alumni. For this reason, the survey asked PA program directors about the number of veteran faculty members in their programs. During 2011 through 2013, almost 60% of PA programs had veteran faculty members, which was more than 3 times as many in 2008 through 2011. It seems unlikely that the number of PA programs with veteran faculty members would increase this much in such a short period of time. A limitation in comparing the number of PA programs with veteran faculty in 2011 through 2013 and 2008 through 2010 is that the question was not asked in the same way in both surveys. This survey (2011–2013) asked if the PA program had any military veteran faculty members including program and medical directors. The 2008 through 2010 survey asked if the PA program assigned military veteran faculty members to serve as mentors for their military veteran students. It is possible that some programs had veteran faculty members, but they 83
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RESEARCH ARTICLE
Table 6: Barriers Related to Recruiting, Admitting, and Training Military Veterans in Physician Assistant Programs 2008–20108, % 2011–2013, % Academic preparedness of veterans Lack of academic preparedness/lack of undergraduate educational requirements
37.3
39.0
Low GPAs and GPAs that may predate military service
5.3
11.7
Need more/appropriate bridge programs to prepare veterans to enter a graduate degree program
4.0
0
No barriers or unsure of barriers None
21.3
Unsure
7.8
4.0
0
12.0
15.6
Lack of familiarity with the most effective methods for recruiting corpsmen/medics
1.3
2.6
Need more outreach to inform veterans of the benefits of a PA career
1.3
1.3
12.0
5.2
Institutional academic prerequisites do not permit credit for nonacademic experiences
4.0
3.9
Difficulty equating military coursework to civilian coursework
4.0
10.4
Institution does not accept military training schools’ diplomas or credits
1.3
0
Overcoming the traditional view of the student GPA and educational background
1.3
2.6
Large number of qualified applicants/limited class size
1.3
2.6
Lack of support from university administration
0
3.9
All students admitted as freshmen, no previous college credit permitted
0
1.3
Have a 3 + 2 program with limited graduate admissions
0
1.3
University does not participate in the Yellow Ribbon Program
0
1.3
Veterans may have difficulty adjusting to a civilian classroom environment
2.7
2.6
Getting corpsmen to understand that their training is incomplete when it comes to PA education
2.7
0
2.7
2.6
1.3
1.3
Deployment of active duty students is difficult for student/program
5.3
0
Active duty military have been admitted into program but were not released from duty
1.3
0
Recruiting issues Lack of time/funding to recruit or lack of access to corpsmen/medic pool of applicants
Financial issues Cost of attending the PA program Admission issues
Veteran preparedness for PA education
Faculty/program preparedness to train veterans Lack of understanding of military terms/formalities/experiences on the part of the faculty PA educational policies The move to graduate degrees Active duty personnel issues
Numbers of responding programs were 75 (2008–2010) and 77 (2011–2013). PA, physician assistant.
did not assign them to serve as mentors for their veteran students and would not have been counted. Recruitment of Veterans Almost twice as many PA programs actively recruited veteran students during 2011 through 2013 than in 2008 through 2010 (31.2% and 16.0%, respectively). The methods of recruitment were similar for both time periods. Most recruiting efforts were focused on making presentations at military or veteran institutions or events. However, 25% of programs that said they actively recruit veterans are relying on veterans identifying themselves 84
during program information sessions or during the application process, which is not “active recruitment of veterans.” Many programs (15.6%) identified lack of time/funding to recruit veterans or lack of access to the corpsmen/medic pool of applicants as barriers to recruiting veterans. Admission Criteria for Veterans Although 84.8% of PA programs require a bachelor’s degree or 120 credit hours for entry into the program, and 98.9% require veterans to meet all the admission prerequisites established for all other applicants, 38.0% of programs Journal of Physician Assistant Education
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RESEARCH ARTICLE reported that they now have admission criteria that give veterans additional consideration for an interview and/or admission into the program. Perceived Benefits and Barriers to Recruiting, Admitting, and Training Veterans The main benefits and barriers perceived by program directors relative to recruiting, admitting, and training military veterans in PA programs were similar in the 2011 through 2013 and 2008 through 2010 surveys. The main benefits to programs are that military veterans have valuable health care and life experiences, they are mature and motivated individuals who exhibit leadership skills and professionalism, and they add diversity and richness to the class body. Educating veterans also promotes the military connection that is one of the foundations of the PA profession. The main barriers are that military veterans may lack academic preparedness for a graduate PA program, PA programs lack time and funding to recruit veterans, PA programs have a difficult time equating military coursework to civilian coursework, and the cost of attending the PA program is perceived as prohibitive.
CONCLUSIONS In recent years, the Obama administration, HRSA, veterans groups, and key stakeholders in PA education have worked to develop recruitment, retention, and mentoring strategies for veterans transitioning into PA programs and to increase the number of PA programs that accommodate veterans.9,10,14 The authors surveyed all PA education program directors in the United States both before8 and after (present survey) the White House announced the Helping Veterans Become Physician Assistants Initiative in 2011 and asked them about their policies, experiences, and attitudes toward recruiting and training veterans. The present survey demonstrates that there has been an increase in the percentage of 1) PA programs that admitted veterans; 2) matriculating students who had military experience; 3) PA programs that participated in the Yellow Ribbon Program; 4) PA programs that actively recruited veteran students; and 5) PA programs with admission criteria that give veterans additional consideration for an interview and/or admission into the program. Most PA programs also have veteran faculty members who can provide mentorship and counseling to veteran students. However, barriers still exist for veterans seeking admission into PA programs, the most significant of which is academic preparedness for a graduate-level PA program. Leaders in PA education should continue to work with the military to identify effective methods for informing active duty personnel about the requirements for entry into PA programs, and opportunities to complete these requirements, before they separate from the military. The PA education community needs to continue to develop best practice approaches for bridging veterans’ military medical training and education and entry into civilian PA programs. More PA programs also need to
June 2015 Volume 26 Number 2
work with their home educational institutions to establish policies and procedures for reviewing and accepting ACE and DANTES credits as part of their routine application review process. Edward Michaud, PhD, is a professor in the School of Physician Assistant Studies at South College, Knoxville, Tennessee. Paul F. Jacques, DHSc, MEd, PA-C, is an associate professor in the Division of Physician Assistant Studies at the Medical University of South Carolina, Charleston, South Carolina. F. J. Gianola, MA, PA, is a lecturer at MEDEX Northwest Division of Physician Assistant Studies at the University of Washington, Seattle, Washington. Ken Harbert, PhD, MHA, PA, is a professor and dean of the School of Physician Assistant Studies at South College, Knoxville, Tennessee. The authors give special thanks to Tony Miller, Lindsey M. Huang, Rachel Hamann, and other research staff at PAEA for administering the survey. The authors also thank Kathryn Markferding for assistance in data analysis. Correspondence should be addressed to: Edward Michaud, PhD, School of Physician Assistant Studies, South College, 400 Goody’s Lane, Knoxville, TN 37922. Telephone: (865) 288-8315; Email: [email protected]
REFERENCES 1. US Department of Labor, Bureau of Labor Statistics. Economic news release: employment situation of veterans summary. http://www.bls. gov/news.release/vet.nr0.htm. Accessed June 13, 2014. 2. The White House. Fact sheet: President Obama’s commitment to employing America’s veterans. http://www.whitehouse.gov/thepress-office/2011/08/05/fact-sheet-president-obama-s-commitmentemploying-america-s-veterans. Accessed June 13, 2014. 3. Dieter PM, Strand J. Snapshots in time: Duke University physician assistant classes, 1967–2007. J Physician Assist Educ. 2007;18(3): 16–23. 4. Smith RA. MEDEX. JAMA. 1970;211(11):1843–1845. 5. Physician Assistant History Center. Timeline. http://www.pahx.org/ timeline.html. Accessed June 13, 2014. 6. Jones PE. Physician assistant education in the United States. Acad Med. 2007;82(9):882–887. 7. Physician Assistant Education Association. Issue brief: matriculating student survey 2013. http://www.paeaonline.org/index.php?ht=a/ GetDocumentAction/i/156635. Accessed June 13, 2014. 8. Michaud E, Jacques PF, Gianola FJ, et al. Assessment of admissions policies for veteran corpsmen and medics applying to physician assistant educational programs. J Physician Assist Educ. 2012;23(1): 4–12. 9. Brock D, Bolon S, Wick K, et al. The military veteran to physician assistant pathway: building the primary care workforce. Acad Med. 2013;88(12):1890–1894. 10. The White House. Fact sheet: we can’t wait: Obama Administration’s new initiatives to help create jobs for veterans. http://m.whitehouse. gov/the-press-office/2011/10/25/fact-sheet-we-cant-wait-obamaadministrations-new-initiatives-help-creat. Accessed June 13, 2014. 11. Miller AA, Mayberry LA, Hamann RA, et al. Twenty-Eighth Annual Report on Physician Assistant Educational Programs in the United States, 2011–2012. Alexandria, VA: Physician Assistant Education Association; 2014. 12. Accreditation Review Commission on Education for the Physician Assistant. Accreditation Standards. http://www.arc-pa.org/acc_ standards. Accessed June 13, 2014. 13. McDaniel J. CASPA data report, cycle 12. Paper presented at: Physician Assistant Education Association Annual Education Forum; October 2013; Memphis, TN. http://www.paeaonline.org/index.php? ht=a/GetDocumentAction/i/154970. Accessed June 13, 2014. 14. AAPA Invited to White House Forum. http://www.pasconnect.org/ aapa-invited-to-white-house-forum. Accessed June 13, 2014.
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