Document Type
Dissertation
Date of Degree
Summer 2024
Primary Advisor
Dr. Tamara Ritsema
Keywords
Physician Assistant; Negotiated Autonomy; Negotiated Order; Team Science; Dyadic Relationship
Abstract
Physician Assistants (PAs) are integral members of multidisciplinary medical care teams who practice medicine legally under the supervision of physicians. During medical care, supervision is a dynamic process of collaboration wherein a PA who displays competence is granted increasing independence by the supervising physician. This process has been referred to as negotiated autonomy. Despite being noted in work-force literature, the mechanics of how negotiated autonomy operates in real-time have not been described. As organizations increasingly work to integrate PAs into practice, new-hire training programs called ‘on-boarding’ have been implemented to accelerate PA professional development with a goal of increased efficiency and autonomy. This study sought to develop an operational model of PA-physician collaboration and negotiated autonomy at the point of care in urban, academic emergency departments to enhance PA education and early career development.
This is a grounded theory study composed of two phases. The first phase is a series of interviews with practicing PAs and physicians regarding their collaborative process. Interviews were transcribed and analyzed utilizing grounded theory techniques to develop emergent themes related to PA-physician collaboration. Findings revealed insight into how PAs and physicians view their respective roles in PA practice. Unexpected findings included the influence of practice similarities between PAs and resident physicians. Ultimately, findings were consolidated into a series of themes coined the 5 P’s of PA-physician collaboration: perspective, place, preparation, process, and progression. These themes formed the basis for the development of a complex-adaptive system model of PA-physician collaboration. The second phase of the study reviewed the phase one findings and model with a focus group of PA-physician practice leaders to explore how these findings could be translated into actionable items to inform on-boarding training and PA practice.
This is the first study that has developed a specialty-specific, evidence-based model of PA-physician collaboration as a framework for negotiated autonomy in practice. Translational research concepts were utilized as the phase one findings were then translated during phase two into a series of implementation recommendations. The results form a foundation for future research into PA-physician collaboration as well as into the role of PAs in practice within academic medical centers. The study additionally contributes to the growing body of team science literature exploring professional dyads. Organizations may use these findings to enhance training programs for new-hired PAs while also informing physicians on how to approach PA supervision and collaboration.
Recommended Citation
Robie, Stephen, "Exploring Negotiated Autonomy in the Physician–Physician Assistant Collaborative Dyad" (2024). Doctor of Philosophy in Translational Health Sciences Dissertations. Paper 33.
https://hsrc.himmelfarb.gwu.edu/smhs_crl_dissertations/33
Open Access
1
Comments
©2024 by Stephen Robie. All rights reserved.