TDNet Discover

Background: According to currently published literature, Physician Assistant students (PA-S) have high levels of stress and burnout, making them prone to substance abuse. Yet, these sparse studies have intertwined PA-S with other medical or graduate allied health students in their analyses, or remained focused at the local, state, or international level. Objective: To establish a national prevalence among PA-S for substances abused as compared to the age-relevant general United States population, while investigating whether progression within Physician Assistant (PA) program curricula, or level of stress, burnout, anxiety, or depression, play any attributable role within the prevalence observed. Methods: A novel survey instrument was designed based on an extensive search of current literature, piloted, hosted on the SurveyMonkey platform, and emailed to all national ~270 PA programs (29% response rate, 96% completion rate). Of those, 54 programs approved dissemination to their students, and 1,432 PA-S responses were collected. Survey Outcome Measures: Perceived stress scale (PSS) score, patient health questionnaire-2 (PHQ-2) score, alcohol use disorder identification test – concise (AUDIT-C) score;self-reported outcomes: demographics, anxiety, burnout, tobacco use, illicit substance use and prescription medication abuse and misuse. Participants: Current estimated matriculation is ~25,000 PA-S nationally. This research included a 20-item web-based survey that was completed by 1,378 students (773 didactic and 603 clinical). The mean respondent age was 26.37 yo (min: 20 yo;max: 52 yo), with 79.5% of respondents reporting as female, 20.3% as male, and 0.1% as nonbinary. Respondents hailed from each of the 9 U.S. regions identified (≥ 49 responses/ region) and were predominantly Caucasian (78.0%). Results: The prevalence of PA-S tobacco (18-25 yo: 9.1%;⩾26 yo: 13.2%) and illicit substance use (18-25 yo: 25.8%;⩾26 yo: 27.1%) are notably lower by comparison to the general population - tobacco, (18-25 yo: 52.7%;⩾26 yo: v 67.8%);- illicit substance, (18-25 yo: 55.8%;⩾26 yo: 52.2%). PA-S prevalence of alcohol consumption (18-25 yo: 85.0%;⩾26 yo: 80.7%) approximates that of the national average (18- 25 yo: 78.9%;⩾26 yo: 86.7%). The prevalence of PA-S prescription medication abuse and misuse (18-25 yo: 11.8%;⩾26 yo: 14.6%) are simply reported due to lack of comparative national data. All substances abused were intercorrelated. All risk factors were intercorrelated. Regarding substance abuse, amphetamines were the only substance correlated with all four risk factors. Conclusion: This research provided current prevalence of substance use among PA-S in the United States. While below the national average, there remains a concerning positive correlation of amphetamine and benzodiazepine use with high levels of PA-S stress, burnout, and anxiety. Higher rates of substance use are observed in the didactic vs. clinical phase of PA school matriculation. The COVID-19 pandemic had minimal impact on reported rates of substance use. PA programs are encouraged to provide improved student conversations and resources to mitigate observed trends due to program impact on PA-S throughout matriculation