New Program Proposal Master in Sciences Physician Assistant Studies University of the Pacific November 2014

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New Program Proposal

Master in Sciences

Physician Assistant Studies

University of the Pacific

November 2014

I. Executive

Summary

The Master of Sciences in Physician Assistant Studies aligns with University of the Pacific’s Strategic Plan, Pacific 2020. Goal 1.1 of this plan mandates that the University to “Expand and add new health-related programs,” and further details objectives that:

ͻ Pacific introduces multi-disciplinary programs in healthcare, business, law, engineering, and other fields

ͻ Pacific introduces pre-professional and professional programs in new, high-demand health-related fields and healthcare professions

The introduction of the Physician Assistant (PA) program as a high-demand healthcare program is based on high market need in the growing healthcare sector and a way to “build the strength, relevance, and reputation of Pacific’s academic programs.” In the combined San Francisco, Sacramento, and Stockton areas, there is a projected growth rate of 18% in job demand between 2012 and 2022, with a projected total of 67 average annual openings in the PA profession. As part of the Arthur A. Dugoni School of Dentistry, in locations to be determined,

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Pacific will deliver the in-person didactic and clinical experiences required for PA education requirements. The PA program will also provide a unique opportunity for inter-professional education that is required by accrediting bodies throughout the healthcare education field, strengthening this aspect of Pacific’s healthcare programs.

Due to ARC-PA regulations, the national accrediting body for Physician Assistant programs, the projected enrollment of this program would be capped at 30 students for the first two years, but then begins to increase by FY18. Under ARC-PA guidelines, provisionally accredited programs are not eligible to apply for an increase in class size until two years after completing the

accreditation process. However, once the provisional process is completed and accreditation is obtained, projected enrollments based on cohorts are 30 (FY17), 30 (FY18), 40 (FY19), 45 (FY20), 45 (FY21) with the break-even point for fiscal sustainability in FY18. The total annual

enrollments will be 30 (FY17), 59 (FY18), 69 (FY19), 84 (FY20), 89 (FY21). These numbers assume a 3% attrition rate.

A SIF funding request will be made for start-up expenses with revenue generation beginning FY18. Additional funding for the program will be sought from outside donors. Accreditation requirements necessitate that all faculty and facilities are in place before granting approval status. The addition of a physician assistant program brings status, talented applicants, strong demand for program graduates, and enhances the reputation of the University as a key provider of professional healthcare education in the Northern California region.

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II. Statement of Demand/Need

a) Market Research

The physician assistant profession is ranked nationally and locally as one of the fastest growing health occupations. Nationally the growth rate from 2008 to 2018 is projected to be 39%,1 and

locally the rate is 29% for the same period. Bureau of Labor Statistics employment projections for 2018 indicate that 103,900 new PAs will be needed.2 The projected growth does not take into consideration health care reform and the ongoing efforts by state health care leaders and health professions educators to gain a fuller recognition of the physician assistant profession within the medical community. The projected 39% increase in employment demand is much higher than the average for all occupations. The National Association of Community Health Centers recently released their primary care workforce needs and reported a two-year need of 11,273 midlevel providers. There are obvious workforce needs for physician assistants both within the state of California and nationally. Documentation that the physician assistant career is a high demand field can be found in occupational forecast resources, all showing the physician assistant career to be one of the fastest growing career options in the nation. The Health Care Career Map indicates that between 2002 -2012 the Physician Assistant profession is the second fastest growing health care practitioner career.3 The U.S. Department of Labor ranks it as the country’s third fastest growing career. Additionally, the website of the Physician Assistant Education

1 U.S. Bureau of Labor Statistics. Physician Assistants. Retrieved October 2013 from http://www.bls.gov/ooh/healthcare/print/physician-assistants.htm.

2 U.S. Bureau of Labor Statistics. Physician Assistants. Retrieved February 2014 from

http://www.bls.gov/ooh/healthcare/physician-assistants.htm#tab-1.

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Association (PAEA) cites www.CNNMoney.com which ranked the Physician Assistant profession as the second best job in America in 2010.4

Demand in the State of California also appears to be strong based on occupational projections for states in the western U.S., excluding Alaska and Hawaii. It should be noted that of the four states included in the analysis (California, Nevada, Washington, and Oregon), Washington, Nevada, and Oregon have issued 2012 to 2022 occupational projections, while California only has projections for 2010 to 2020.

The projections for California expect strong growth for PAs over the ten-year period, with employment expansion of 2,100 positions (25.3 percent). These estimates place it as the 75th fastest-growing occupation in the state out of the approximately 750 California detailed

occupations. The average growth for all occupations in California is expected to be 16.3 percent over the ten years. California comprises the majority of the job market for PAs in this region. Washington has the next-highest employment of PAs, and that number is projected to increase nearly 23 percent from 2012 to 2022. Oregon is projected to experience the highest growth in the region at 38.7 percent from 2012 to 2022 but with employment increasing to only slightly over 1,200 and just over 50 average annual openings. Nevada is projected to have similar employment growth compared to the region as a whole (26 percent), with 46 annual openings on average.

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Regional Employment Projections for Physician Assistants Region Employment ȴϮϬϭϮ-2022 Average Annual Openings 2010 2020 Number Percent California 8,300 10,400 2,100 15.9% 380 Washington 2,060 2,532 472 20.9% 89 Oregon 931 1,291 360 37.5% 53 Nevada 1,036 1,309 273 25.3% 46 Total 12,327 15,532 3,205 26.0% 568

There are numerous factors which contribute to an increased demand for new allied health professionals, including PAs. With the passing of the 2010 Affordable Care Act (ACA), an aging population, and continued population growth, the nation is in need of more healthcare practitioners to care for patients, many of whom didn’t have health insurance prior to the implementation of ACA. PAs were listed as one of three primary care providers in the ACA due to their critical role in meeting the demand for healthcare.5 As of 2010, the estimated

employment of PAs in California reached approximately 8,300 compared to roughly 83,600 nationally.6 The job outlook for PAs in the U.S. is estimated to increase by 24,700 jobs (30%)

and, similarly in California, jobs are expected to increase by 2,100 (25.3%) between 2010 and

5 American Academy of Physician Assistants. Physician Assistant Workforce Critical to Expanding Healthcare Access in Crowded U.S. Marketplace. 2013. Retrieved February 2014 from

http://www.aapa.org/news_and_publications/news/item.aspx?id=6835.

6 Physician Assistants in California: A Report by the Office of Statewide Health Planning and Development. September, 2014).

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2020.7

Similar to the growth in occupational demand, student demand for a Physician Assistant Master’s degree has also been increasing. Applications to PA Master’s degree programs have risen dramatically. Samuel Merritt University and Touro University, both in California and within a 70 mile radius of Pacific’s Sacramento campus, saw an increase of 79% and 86% respectively, during the five year period of 2009-2013. Last year in 2013, Samuel Merritt University received 1,462 applications to fill only 44 seats. Touro University – California received 1,679 applications for student cohort of 40.

Completions of these programs have also been steadily increasing, growing 51% nationally between 2009-2013, with an average annual increase of 509 completions per year. Of the four Western States, (California, Oregon, Washington, and Nevada) California reported the most completions of a Physician Assistant Master’s Degree, with 1,203 completions for the five year period, a growth of 22.6%. It should be noted, however, that most of the increase was due to the fact that Touro did not graduate its first students until 2010, adding the majority of growth of degrees completed in California.8

b)

Competitive Advantage

The University of the Pacific’s regional brand recognition for the Northern California Region is a competitive advantage. Pacific is known for high quality professional healthcare programs with

7 Employment Development Department/Labor Market Information Division. Occupational Employment Statistics Survey, 2013. Retrieved October 2013 from www.labormarketinfo.edd.ca.gov/?PageID=1009

8 Market Analysis: Physician Assistant Master’s Programs – Prepared for University of the Pacific. Hanover Research. August 2014.

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particular distinction with the Dental and Pharmacy programs. Adding a physician assistant program can only enhance this reputation. Students will be assured that the curriculum reflects the demands of the profession in terms of having real interprofessional interactions. While the Pacific PA program would require similar coursework and experiential prerequisites as their local competitors, and would also be competitive with tuition, class size, and time required to

complete the degree, moving into a high demand market would become a realistic opportunity for students who would be considering application to geographic neighbors. The student and market demand for a PA program cannot be ignored. There is great demand for this program, allowing the University of the Pacific an opportunity to take advantage of the excess market share. In addition, the PA program would be the only one of its kind in the Nation to be set in a School of Dentistry. The close relationship of the PA program to other health professions educational operations such as dentistry and pharmacy gives it an immediate distinction among the 190 accredited PA programs in the country.

c)

Comparable Programs

There are a total of ten institutions in the Western Region that confirmed physician assistant master’s degrees in 2014. Three of them are public institutions, while the other seven are private. Of these ten, six are located in California, two in Oregon, and one each in Nevada (in the Las Vegas area) and Washington.

Accredited Physician Assistant Programs in California

Institution Location Degree Awarded Accreditation Status

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Loma Linda University Loma Linda, CA Master's Accredited Marshall B. Ketchum Fullerton, CA Master's Provisional Moreno Valley College Riverside, CA Associate's Probationary Samuel Merritt University Oakland, CA Master's Accredited San Joaquin Valley College Visalia, CA Associate's Probationary

Stanford University/Foothill College

Los Altos Hills,

CA Multiple Accredited

Touro University – California Vallejo, CA Master's Accredited University of California – Davis Davis, CA Master's Accredited University of Southern California Los Angeles, CA Master's Accredited Western University of Health Sciences Pomona, CA Master's Accredited

A scan of these institutions reveals a cluster of three institutions in southern California (Loma Linda University, University of Southern California, and Western University of Health Sciences), as well as a cluster of three in the San Francisco/Sacramento areas (Touro University –

California, Samuel Merritt University, and University of California – Davis). There are also three other programs that are currently in the process of developing a PA master’s degree program, two in southern California (Marshall B. Ketchum University and Chapman University), and one in Washington. Of note, Chapman University was not granted accreditation status at their recent ARC-PA review.

The new PA programs are expecting to receive their first class of students in 2015. Stanford University is also accredited at the Associate’s, Bachelor’s, and Master’s degree levels, but has only reported completions at the Associate’s degree-level to the National Center for Education Statistics. They do not require a bachelor’s degree for admission.

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All Physician Assistant Master’s programs require both didactic and clinical rotations within the program. The overall program lasts anywhere from 24-33 months, with full-time didactic coursework in the first year, and substantial clinical education in the second year. There are approximately 10-12 common clinical rotations in the curricula of most programs. All accredited programs offer rotations in Emergency Medicine and General Medicine, and all but three

required rotations in Pediatrics, Family Medicine, or Internal Medicine. The mean annual tuition for programs that are currently operating is $38,392.

The three established programs in the San Francisco/Sacramento areas are of particular interest to the University of the Pacific, and are uniquely different in regard to faculty size, class size, tuition, prerequisite courses/degrees required, clinical rotation schedules, and time it takes to complete the degree.

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Northern California Institutions offering Physician Assistant Programs Institution Location Distance from Sacramento Campus Name of Program 2015 Class Capacity Time to Degree Annual tuition Samuel Merritt University Oakland, CA 66.4 miles Master Physician Assistant 44 27 months $44,400 Touro University - California Vallejo, CA 53.7 miles Master of Health Services - Physician Assistant studies 40 33 months $38,612 University of California - Davis Sacramento, CA 1.1 miles Master of Physician Assistant 30 27 months $27,536 (in-state) $39,781 (out-of-state)

Samuel Merritt University

Samuel Merritt University is a health sciences university with an enrollment of 1,542 students and is located in Oakland, CA. It has had an accredited PA program since 1999. The University has an average of 36 students per cohort, with a class capacity of 44. The program is 27 months long, with an annual tuition of $44,400. In order to be considered for admission, applicants must have a bachelor’s degree from a regionally accredited institution, with a minimum of 16

semester units of biological sciences, eight semester units of chemistry, and three semester units of statistics. A minimum of 1,000 hours of healthcare experience in a professional or

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volunteer setting are also required. The average GPA for the Fall 2013 cohort was 3.41. Graduates of the SMU program are very successful in passing the PANCE examination after graduating, with a first-time pass rate of 99%. In 2010, the program was awarded $1.23 million from the department of Health and Human Services as part of the Affordable Care Act to expand its clinical placement program into places designated as Health Professional Shortage Areas (HPSA), including Hawaii and other designated counties in northern California. The program employed 82 different instructors in the didactic phases during the 2009-2010 academic year, with 71 instructors holding a PA or MD degree. The program had 104 students enrolled during that same year.

Touro University – California

Touro University – California is a private, health sciences graduate university in Vallejo, California with an enrollment of 1,357 in 2013. Class capacity is set at 40 students, with an annual tuition of $38,612. The University has had an accredited PA master’s program since 2004, with students receiving both a Master of Science in Physician Assistant Studies and Master of Public Health degrees. Because of the dual degree aspect, Touro is one of the longest programs in the country spanning 33 months. The mission of the joint program is to increase access to quality health care, especially for underserved populations. Half of the alumni serve these populations. The program requires a bachelor’s degree and at least 500 hours of medical experience for admission, although most successful applicants tend to have 1,000 hours or more. Of the 40-student class of 2016, 70% are in-state students, with almost half of all students coming from the University of California system. The program is very successful in preparing the students to pass the PANCE exams, with a first time pass rate of 98%. It has also succeeded at placing its graduates in positions after graduation, with 99% reporting finding a job within six months of graduation. The MSPAS/MPH program employs nine full time physician assistant

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faculty members with an adjunct staff of four. An additional 11 full-time public health faculty and seven adjunct members are also employed at the University.

University of California – Davis

The University of California – Davis, a public university, is the latest institution to develop a master’s degree program in physician assistant studies. It is housing the program at the Betty Irene Moore School of Nursing at the institution’s campus in Sacramento, California. The program enrolled its first class of 21 students in the fall of 2013. The program is 27 months long, and has an annual tuition of $27,536 for in-state students and $39,781 for out-of-state students. Consistent with other PA programs, a primary goal of the program is to “improve the availability of culturally relevant primary care to underserved populations.” This focus involves the option of clinical rotations in fields like rural health, in which students will gain experience in health care access in rural areas. The program estimates that 60% of its graduates will work in

underserved areas. The program is 27-months long, and requires prospective students to have a bachelor’s degree, 1,000 hours of experience in a medical setting, and prerequisite coursework in Human Anatomy and Physiology, Chemistry, Microbiology, Calculus or Statistics, English Composition, and Social Sciences. As with other programs, first-year students take classes full-time, four days per week, while second-year students spend approximately one week per month on campus, with the balance spent in an assigned clinical setting, with rotations in Primary Care, Pediatrics, Women’s Health, Psychiatry, Emergency Medicine, Surgery, and Inpatient Medicine. It also requires students to complete a master’s thesis during the course of the second year. The fact that this program resides within the School of Nursing has created some scrutiny in the physician assistant community due to concerns around distinguishing the PA practice from the Nurse Practitioner profession.

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Pacific’s program in comparison with current competition

The University of the Pacific will be the most recent institution to offer a PA program in the Northern California region. Pacific’s strong reputation in healthcare education will add to the prestige of this new offering. It is initially suggested that the PA program be based at the Pacific Sacramento Campus, however, further analysis of where it will be located is underway to determine the final location. Student cohorts will initially be comprised of 30 students, and will eventually expand and be capped at 45 students in the fourth year. The program will be 24 months long, slightly less than competitive institutions, allowing a Pacific a competitive

advantage. Tuition will be based on a rate of $42,400 per year, with a 3.9% increase in each year of operation. Applicants to Pacific’s program will require students to have a bachelor’s degree, 1,000 hours of experience in a medical setting, and prerequisite coursework in Anatomy, Physiology, chemistry, Human Psychology, Microbiology, and Statistics. Similar to competing institutions, first year cohorts will take didactic courses, and follow up in the second year with a minimum of seven clinical rotations which will be determined by the Program Director and Clinical Coordinator. Pacific expects to meet a 98% PANCE exam pass rate and 99% graduate employment within the first six months of completing the program.

III.

Program Objectives and Outcomes

a) Relationship to University Mission and Strategic Plan

The PA Program is in alignment with Pacific 2020 as it will provide an excellent learning

experience for students by integrating professional education and clinical experience. It expands upon the “one university, three cities” vision, and will require a close working relationship between the San Francisco School of Dentistry, the Sacramento Law School, and health related

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programs on the Stockton campus through utilization of faculty expertise and common school experience in managing these types of programs.

b) Relationship to School Strategic Plan

The PA program aligns well with the Dugoni School of Dentistry’s strategic plan by allowing and creating interdisciplinary professional education for both programs. New requirements by the accrediting bodies of dentistry schools dictate that these relationships are necessary in creating well-rounded graduates in health related fields. By forming a unique collaborative relationship between the School of Dentistry and the PA program, the only such alignment in the nation, this requirement will be directly addressed. Students in both programs will be able to work together in both clinical and didactic settings to form a higher quality and more knowledgeable group of graduates from both schools of discipline. The University will use distributed learning

technology to create high levels of interaction and engagement between students across disciplines and locations. This may incorporate common cases and common problem based projects that require a high level of collaboration and application of inter-professional skills as part of the modern healthcare team. As the curriculum is developed, it will be patterned after the nationally recognized Helix curriculum from the Dugoni School of Dentistry, incorporating interprofessional education as a strand.

c)

Program Goals

Goals of the PA Program:

The primary goal of the University of the Pacific Physician Assistant (PA) program is to produce individuals who provide high quality, accessible patient-centered health care for the people of

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and clinical service, graduates of the PA program will produce didactically and clinically competent, as well as contextually sensitive Physician Assistants. The PA program will provide an interprofessional educational environment that fosters learning and prepares students to be skilled and compassionate health care practitioners in a wide range of clinical practice settings. The graduates of this program will be prepared to serve patients through health promotion, disease prevention, cultural competency, and primary care.

Program goals will be articulated in greater detail upon the hiring of the Program Director and Faculty members. Please see the Program Effectiveness discussion below for further

information on accreditation program goal requirements.

d)

Program Effectiveness

Program effectiveness is dictated by the national ARC-PA accreditation standards—which are very prescriptive in nature, as outlined below.

The gold standard of PA program performance is the pass rate on the Physician Assistant National Certification Examination (PANCE) administered by the National Commission on Certification of Physician Assistants. Top tier PA programs have pass rates between 97-100%. This would be the established benchmark for the Pacific PA Program.

Additional metrics for student success and program outcomes will be developed in further detail once the faculty members have been brought on board to determine levels of performance. Outcomes measures will include student pass rates on the PANCE, student placement within six months of graduation, one, three, and five year success measures, and so forth.

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Assessment of student learning will take place during and at the end of each semester, and a passing grade of 75% will be required to meet the competency criteria. Students not achieving a score of 75% on either the academic and/or clinic examination will be provided with

remediation (continued individual study, tutoring, additional assigned readings, etc.) and then be allowed to re-test. Students continuing to fail the exam after two retests will be dismissed from the program.

ARC-PA SECTION B: CURRICULUM

The ARC-PA program requires that the curriculum enhances PA residents’ abilities to provide patient centered care and collegially work in physician-PA teams in a specialty discipline. The

curriculum must support the use of health information technology and evidence-based medicine and emphasize the importance of remaining current with the changing nature of clinical

practice.

B1.01 The curriculum must be consistent with the mission and goals of the program.

B1.02 The curriculum must include core knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to patient care.

B1.03 The curriculum must be of sufficient breadth and depth to prepare the student for the clinical practice of medicine.

B1.04 The curriculum design must reflect sequencing that enables students to develop the

competencies necessary for current and evolving clinical practice.

ANNOTATION: The concept of sequencing refers to the coordination and integration of content both horizontally and vertically across the curriculum. It does not mandate that content be delivered in separate courses with traditional discipline names. Appropriate sequencing involves considering overall program design and integration of content. Content and course sequencing

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are expected to build upon previously achieved student learning.

B1.05 The curriculum must include instruction about intellectual honesty and appropriate academic and professional conduct.

B1.06 The curriculum must include instruction to prepare students to provide medical care to patients from diverse populations.

ANNOTATION: Quality health care education involves an ongoing consideration of the constantly changing health care system and the impact of racial, ethnic and socioeconomic health disparities on health care delivery. Instruction related to medical care and diversity. It prepares students to evaluate their own values and avoid stereotyping. It assists them in

becoming aware of differing health beliefs, values and expectations of patients and other health care professionals that can affect communication, decision-making, compliance and health outcomes.

B1.07 The curriculum must include instruction related to the development of problem solving and medical decision-making skills.

B1.08 The curriculum must include instruction to prepare students to work collaboratively in interprofessional patient centered teams.

ANNOTATION: Such instruction includes content on the roles and responsibilities of various health care professionals, emphasizing the team approach to patient centered care beyond the traditional physician-PA team approach. It assists students in learning the principles of

interprofessional practice and includes opportunities for students to apply these principles in interprofessional teams within the curriculum.

B1.09 For each didactic and clinical course, the program must define and publish instructional objectives that guide student acquisition of required competencies.

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progress in developing the competencies required for entry into practice. They address learning expectations of students and the level of student performance required for success.

B1.10 The program should orient instructional faculty to the specific learning outcomes it requires of students.

ANNOTATION: Program and principal faculty need to work collaboratively with instructional faculty in designing courses with appropriate learning outcomes and student assessment tools that reflect the learning outcomes expected of students.

B1.11 The program must ensure educational equivalency of course content, student experience and access to didactic and laboratory materials when instruction is:

a) conducted at geographically separate locations and/or

b) provided by different pedagogical and instructional methods or techniques for some students.

B2 CLINICAL PREPARATORY INSTRUCTION

B2.01 While programs may require specific course(s) as prerequisites to enrollment, those prerequisites must not substitute for more advanced applied content within the professional component of the program.

B2.02 The program curriculum must include instruction in the following areas of applied medical sciences and their application in clinical practice:

a) anatomy, b) physiology, c) pathophysiology,

d) pharmacology and pharmacotherapeutics,

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B2.03 The program curriculum must include instruction in clinical medicine covering all organ systems.

B2.04 The program curriculum must include instruction in interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and other health professionals.

B2.05 The program curriculum must include instruction in patient evaluation, diagnosis and management.

ANNOTATION: Instruction in patient assessment and management includes caring for patients of all ages from initial presentation through ongoing follow-up. It includes instruction in interviewing and eliciting a medical history; performing complete and focused physical examinations; generating differential diagnoses; and ordering and interpreting diagnostic studies. Patient management instruction addresses acute and longitudinal management. Instruction related to treatment plans is patient centered and inclusive, addressing medical issues, patient education and referral.

B2.06 The program curriculum must include instruction in the provision of clinical medical care across the life span.

ANNOTATION: Preclinical instruction prepares PAs to provide preventive, emergent, acute, chronic, rehabilitative, palliative and end-of-life care. It includes content relevant to prenatal, infant, children, adolescent, adult and elderly populations.

B2.07 The program curriculum must include instruction in technical skills and procedures based on current professional practice.

B2.08 The program curriculum must include instruction in the social and behavioral sciences as well as normal and abnormal development across the life span.

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Instruction includes detection and treatment of substance abuse; human sexuality; issues of death, dying and loss; response to illness, injury and stress; principles of violence identification and prevention; and psychiatric/behavioral conditions.

B2.09 The program curriculum must include instruction in basic counseling and patient education skills.

ANNOTATION: Instruction in counseling and patient education skills is patient centered, culturally sensitive and focused on helping patients cope with illness, injury and stress, adhere to prescribed treatment plans and modify their behaviors to more healthful patterns.

B2.10 The program curriculum must include instruction to prepare students to search, interpret and evaluate the medical literature, including its application to individualized patient care. ANNOTATION: This instruction assists students in maintaining a critical, current and operational knowledge of new medical findings required for the prevention and treatment of disease. Instruction often includes topics such as framing of research questions, sampling methods, interpretation of basic biostatistical methods, and the limits of medical research. The use of common medical databases to access medical literature is also included.

B2.11 The program curriculum must include instruction in health care delivery systems and health policy.

B2.12 The program curriculum must include instruction in concepts of public health as they relate to the role of the practicing PA.

ANNOTATION: Instruction in concepts of public health includes an appreciation of the public health system and the role of health care providers in the prevention of disease and

maintenance of population health. It includes participating in disease surveillance, reporting and intervention.

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prevention of medical errors and risk management.

B2.14 The program curriculum must include instruction about PA licensure, credentialing and laws and regulations regarding professional practice.

B2.15 The program curriculum must include instruction regarding reimbursement, documentation of care, coding and billing.

B2.16 The program curriculum must include instruction in the principles and practice of medical ethics.

B2.17 The program curriculum must include instruction in the PA profession, its historical development and current trends.

ANNOTATION: Instruction related to PA professional issues addresses the physician-PA team relationship, political issues that affect PA practice, the PA professional organizations.

B3 SUPERVISED CLINICAL PRACTICE

B3.01 PA students must be clearly identified in the clinical setting to distinguish them from physicians, medical students and other health profession students and graduates.

B3.02Supervised clinical practice experiences must enable students to meet program expectations and acquire the competencies needed for clinical PA practice.

ANNOTATION: It is anticipated that the program expectations of students will address the types of patient encounters essential to preparing them for entry into practice. It is required that at a minimum these will include preventive, emergent, acute, and chronic patient encounters.

B3.03Supervised clinical practice experiences must provide sufficient patient exposure to allow each student to meet program-defined requirements with patients seeking:

a) medical care across the life span to include, infants, children, adolescents, adults, and the elderly,

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b) women’s health (to include prenatal and gynecologic care),

c) care for conditions requiring surgical management, including pre- operative, intra-operative, post-operative care and

d) care for behavioral and mental health conditions.

B3.04Supervised clinical practice experiences must occur in the following settings: a) outpatient,

b) emergency department, c) inpatient and

d) operating room.

ANNOTATION: While patients often use emergency departments for primary care complaints, students are expected to interact with patients needing emergent care in this setting. Urgent care centers may be used for supervised clinical practice experiences, but do not replace the requirement to have students in emergency departments.

B3.05Instructional faculty for the supervised clinical practice portion of the educational program must consist primarily of practicing physicians and PAs.

B3.06Supervised clinical practice experiences should occur with:

a) physicians who are specialty board certified in their area of instruction, b) PAs teamed with physicians who are specialty board certified in their area of instruction or

c) other licensed health care providers experienced in their area of instruction. ANNOTATION: It is expected that the program will provide supervised clinical practice

experiences with preceptors who are prepared by advanced medical education or by experience. The ARC-PA will only consider supervised clinical practice experiences occurring with physician preceptors who are not board certified or with other licensed health care providers serving as

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B3.07Supervised clinical practice experiences should occur with preceptors practicing in the following disciplines: a) family medicine, b) internal medicine, c) general surgery, d) pediatrics, e) ob/gyn and

f) behavioral and mental health care.

ANNOTATION: PA education requires a breadth of supervised clinical practice experiences to help students appreciate the differences in approach to patients taken by those with varying specialty education and experience. Supervised clinical practice experiences used for required rotations are expected to address the fundamental principles of the above disciplines as they relate to the clinical care of patients. Subspecialists serving as preceptors might, by advanced training or current practice, be too specialty focused to provide the fundamental principles for

required rotations in the above disciplines. Reliance on subspecialists as preceptors in the above disciplines is contrary to the intent of this standard.

ARC-PA SECTION C: EVALUATION

It is important for programs to have a robust and systematic process of ongoing self-assessment to review the quality and effectiveness of their educational practices, policies and outcomes. This process should be conducted within the context of the mission and goals of both the sponsoring institution and the program, using the Accreditation Standards for Physician

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Assistant Education (Standards) as the point of reference. A well-developed process occurs throughout the academic year and across all phases of the program. It critically assesses all aspects of the program relating to sponsorship, resources, students, operational policies, curriculum and clinical sites. The process is used to identify strengths and weaknesses and

should lead to the development of plans for corrective intervention with subsequent evaluation of the effects of the interventions.

C1 ONGOING PROGRAM SELF-ASSESSMENT

C1.01 The program must implement an ongoing program self-assessment process that is designed to document program effectiveness and foster program improvement.

ANNOTATION: A well designed self-assessment process reflects the ability of the program in collecting and interpreting evidence of student learning, as well as program administrative functions and outcomes. The process incorporates the study of both quantitative and qualitative performance data collected and critically analyzed by the program. The process provides

evidence that the program gives careful thought to data collection, management and

interpretation. It shows that outcome measures are used in concert with thoughtful evaluation about the results, the relevance of the data and the potential for improvement or change.

C1.02 The program must apply the results of ongoing program self-assessment to the curriculum and other dimensions of the program.

C2 SELF-STUDY REPORT 5

Programs applying for provisional accreditation must complete a descriptive report, as opposed to a self study report, as described in section D and the application for provisional accreditation.

C2.01 The program must prepare a self-study report as part of the application for continuing accreditation that accurately and succinctly documents the process and results of ongoing program self-assessment. The report must follow the guidelines provided by the ARC-PA and, at

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a minimum, must document:

a) the program process of ongoing self- assessment,

b) results of critical analysis from the ongoing self-assessment,

c) faculty evaluation of the curricular and administrative aspects of the program, d) modifications that occurred as a result of self-assessment,

e) self-identified program strengths and areas in need of improvement and f) plans for addressing areas needing improvement.

ANNOTATION: The ARC-PA expects results of ongoing self-assessment to include critical analysis

of student evaluations for each course and rotation, student evaluations of faculty, failure rates for each course and rotation, student remediation, student attrition, preceptor evaluations of students’ preparedness for rotations, student exit and/or graduate evaluations of the program, the most recent five-year first time and aggregate graduate performance on the PANCE, sufficiency and effectiveness of faculty and staff, faculty and staff attrition.

C3 STUDENT EVALUATION

C3.01 The program must conduct frequent, objective and documented evaluations of students related to learning outcomes for both didactic and supervised clinical education components. ANNOTATION: Student assessment is both described and applied based on clear parallels between what is expected, taught and assessed. Thorough assessment includes both formative

and summative evaluations and involves multiple assessment approaches with multiple observations by multiple individuals. Performance is assessed according to the program’s pre-specified criteria. Evaluation products designed primarily for individual student self-assessment, such as PACKRAT are, not to be used as an instrument that results in a passing or failing grade for students in any course(s) in the program.

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C3.03 The program must monitor and document the progress of each student in a manner that promptly identifies deficiencies in knowledge or skills and establishes means for remediation.

C3.04 The program must conduct and document a summative evaluation of each student within the final four months of the program to verify that each student is prepared to enter clinical practice.

ANNOTATION: Evaluation products designed primarily for individual student self-assessment, such as PACKRAT are not to be used by programs to fulfill the summative evaluation of students within the final four months of the program. The ARC-PA expects that a program demonstrating compliance with the Standards will incorporate evaluation instrument/s that correlates with the didactic and clinical components of the program’s curriculum and that measures if the learner has the knowledge, interpersonal skills, patient care skills and professionalism required to enter clinical practice.

C3.05 The program must document equivalency of student evaluation methods and outcomes when instruction is:

a) conducted at geographically separate locations and/or

b) provided by different pedagogical and instructional methods or techniques for some students.

C4 CLINICAL SITE EVALUATION

C4.01 The program must define, maintain and document effective processes for the initial and ongoing evaluation of all sites and preceptors used for supervised clinical practice experiences to ensure that sites and preceptors meet program defined expectations for learning outcomes and performance evaluation measures.

ANNOTATION: An effective process or processes involves the program establishing criteria by which to initially evaluate new sites and preceptors as well as those that have an ongoing

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relationship with the program. The process(es) will focus on the established criteria and fit the individual program.

C4.02 The program must document that each clinical site provides the student access to physical facilities, patient populations and supervision necessary to fulfill program expectations of the clinical experience.

ANNOTATION: Site evaluation involves program faculty monitoring the sites used for supervised clinical practice experiences and modifying them as necessary to ensure the expected learning outcomes will be met by each student by program completion. It is expected that faculty document that differences in clinical settings do not impede the overall accomplishment of expected learning outcomes. Documentation shows that preceptors are providing observation and supervision of student performance while on supervised clinical practice experiences and that they are providing feedback and mentoring to students.

e) Program

Delivery

The Physician Assistant program requires both didactic and clinical teaching settings. The PA program will utilize the delivery of instruction that is most effective in producing the highest quality graduates, producing a 98% first time pass rate of the PANCE exam, and 99%

employment within the first 6 months of graduation. While this certainly includes traditional face-to-face instruction, it will most likely include the use of technology to assure that students are using the equipment and are familiar with the techniques needed to be successful in the profession. As faculty develop courses, the specific delivery methodologies will be identified and incorporated into the instruction.

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f)

Course and Program Requirements

The Pacific PA Program will propose a 24 month curriculum for PA education consisting of two phases: didactic and clinical education. The didactic phase will cover the Spring and Fall semesters and the First and Second Summer sessions (44 to 48 weeks). Instruction in the basic sciences (anatomy, physiology, biochemistry, pathology, microbiology, pharmacology), a course on the role of the physician assistant as a member of the health care team, pre-clinic practice in patient care and medical procedures, cultural and personal determinants of health and disease, and ethics and jurisprudence will be covered in the didactic phase. The clinical education phase will comprise 46-52 weeks of learning experiences in clinical settings ranging from hospitals, physician offices, clinics, etc., under the direct supervision and guidance of a physician and/or physician assistant.

g)

Program of Study

Fall Semester (August 2017 – December 2017) Course Number Credits ARC-PA Learning

Outcome

Anatomy MHS 701 4 Standard B1.02;

B2.02

Physiology MHS 702 2 Standard B1.02;

B2.02

Basic Medical Sciences MHS 703 2 Standard B1.02; B2.02

Clinical Medicine I (Cardiology, Infectious Diseases, Hematology/Oncology, Pulmonology)

MHS 710 5 Standard B2.03; B2.06

Diagnostic Methods I MHS 713 2 Standard B2.05

Pharmacology and Therapeutics I MHS 711 3 Standard B1.02; B2.02

History and Physical Diagnosis I MHS 704 3 B2.05

Professional Practice and the Health System I MHS 705 1 Standard B2.11; B2.14-17 Total credits 22

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Spring Semester (January 2018 – May 2018)

Course Number Credits ARC-PA Learning

Outcome

Clinical Medicine II (Nephrology, Neurology, HEENT, Endocrinology, Obstetrics/Gynecology)

MHS 720 6 Standard B2.03; B2.06

Fundamentals of Surgery MHS 724 3 Standard B2.03; B2.06

Patient Assessment I MHS 722 2 Standard B2.04; B2.05

Diagnostic Methods II MHS 723 3 Standard B2.05 Pharmacology and Therapeutics II MHS 721 3 Standard B1.02;

B2.02

Behavior Medicine MHS 725 2 Standard B2.06

Evidence Based Medicine I MHS 726 2 Standard B2.10 Professional Practice and the Health System II MHS 725 1 Standard B2.11;

B2.14-17 Total credits 22

Summer Session I (June 2018) Course Numbers Credits ARC-PA Learning

Outcome

Clinical Medicine III (Pediatrics, Geriatrics) MHS 730 3 Standard B2.03 Pharmacology and Therapeutics III MHS 731 1 Standard B1.02;

B2.02

Patient Assessment II MHS 732 1 Standard B2.04; B2.05

Total credits 5

Summer Session II (July 2018) Course Numbers Credits ARC-PA Learning

Outcome

Clinical Medicine IV (Orthopedics, Dermatology) MHS 740 3 Standard B2.03 Pharmacology and Therapeutics III MHS 741 1 Standard B1.02;

B2.02

Patient Assessment III MHS 742 1 Standard B2.04; B2.05

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Course of Study: Year 2- Supervised Clinical Practice/Rotations

Fall 2018 Course Numbers Credits ARC-PA Learning

Outcome

MHS 601 Family Practice I 4 B3.03 through

B3.07

MHS 602 Family Practice II 4 B3.03 through

B3.07

MHS 603 Internal Medicine I 4 B3.03 through

B3.07

MHS 605 General Surgery 4 B3.03 through

B3.07 Total Credits 16

Spring 2019 Course Numbers Credits ARC-PA Learning

Outcome MHS 606 Emergency Medicine 4 B3.03 through B3.07 MHS 607 Pediatrics 4 B3.03 through B3.07

MHS 608 Women’s Health 4 B3.03 through

B3.07

MHS 604 Internal Medicine II 4 B3.03 through

B3.07 Total Credits 16

Summer 2019 Course Numbers Credits ARC-PA Learning

Outcome MHS 609 Behavioral Medicine 4 B3.03 through B3.07 MHS 610 Elective I 4 B3.03 through B3.07 MHS 611 Elective II 4 B3.03 through B3.07 MHS620 Summative Evaluation 4 B3.03 through B3.07 MHS621 Capstone II 2 Total Credits 18

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Total Hours for Year 1: Didactic: 54

Total Hours for Year 2: Supervised Clinical Practice/Rotations: 50

Total Hours for entire curriculum: 104

h)

Admission Requirements

Admission requirements will include a bachelor’s degree, 1,000 or more hours of experience in a medical setting and GRE scores. Determination of the minimum GRE scores will be set by the Program Director in consultation of PA faculty once those individuals are in place. Additionally, some pre-requisites may be required including 9 semester hours of biologic science (to include 3 credits of anatomy and physiology), 6 semester credits of chemistry (of which 3 credits must be either biochemistry or organic chemistry), 3 semester credits in psychology, 3 semester hours of microbiology, and 3 semester credits in statistics. Further and final determination of Program pre-requisites and overall admissions requirements will occur once the faculty has designed and refined the curriculum.

IV. Program

Budget

a) Enrollment

Projections

The size of a PA program and its growth is prescribed by the ARC-PA standards. The target enrollment for the Pacific PA program is 30 students in the first two years of the program, with a projected growth rate of ten additional new students in year three, and an additional five more students added to the starting cohort in the year four. By the fifth year, both new and returning student cohorts will be capped at 45 students, allowing a total enrollment of 90 in 2021. PA

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V.

Relationship to Existing Programs and University Goals

Goal 1.1 of our Strategic Plan, Pacific 2020, calls for the University to “Expand and add new health-related programs,” specifically the Objectives state that:

x Pacific introduces multi-disciplinary programs in healthcare business, law, engineering, and other fields

x Pacific introduces pre-professional and professional programs in new, high-demand health-related fields and healthcare professions

The introduction of the Physician Assistant (PA) program is a high-demand healthcare program characterized by high market need in the growing healthcare sector and a way to “build the strength, relevance, and reputation of Pacific’s academic programs.” The PA program will offer a masters level degree that combines in-person didactic and clinical experiences. As part of the Arthur A. Dugoni School, it will also provide a unique opportunity for inter-professional education that is required by accrediting bodies throughout the healthcare education field. Where applicable, we will draw on faculty and resources from other schools within Pacific to teach courses in their designated field of expertise. This further integration will be part of the planning process as the founding director is on board.

VI.

Program Copy for Catalog

Master of Sciences in Physician Assistant Studies Arthur A. Dugoni School of Dentistry

Physician Assistants (PAs) are healthcare professionals licensed to practice medicine under physician supervision. In an inter-professional setting, Pacific PA students will become proficient in the full array of professional skills to conduct completing physicals, providing treatment, and

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counseling patients. During the first year of the program students build a strong academic foundation in preparation for clinical practice, as well as develop a compassionate, patient-centered approach to healthcare. During the second year of the program, students participate in clinical rotations in a variety of healthcare settings and in conjunction with a variety of healthcare disciplines working with patients and healthcare professionals who work with students as clinical preceptors.

As part of their comprehensive responsibilities, PA students will work with patients to:

x Obtain, compile and record patient medical data, including health history, progress notes and results of physical examination

x Perform or order diagnostic tests

x Instruct and counsel patients about prescribed therapeutic regimens, normal growth and development, family planning, emotional problems of daily living, and health maintenance

x Interpret diagnostic test results for deviations from normal

x Make tentative diagnoses and decisions about management and treatment of patients x Perform therapeutic procedures, such as injections, immunizations, suturing and wound

care, and infection management

x Prescribe therapy or medication with physician approval

x Provide physicians with assistance during surgery or complicated medical procedures x Supervise and coordinate activities of technicians and technical assistants.

x Visit and observe patients on hospital rounds or house calls, updating charts, ordering therapy, and reporting back to physician

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In addition to successfully completing their program, Pacific PA students are required to pass the PANCE exam as required by regulatory agencies in order to enter into practice.

VII. Marketing Plan

The marketing plan will involve promotion of the new PA program to students with an undergraduate degree that are currently working in a healthcare environment. An extensive university web page and promotional brochures will be developed in consultation with the University’s marketing department. The program will be marketed extensively to working health-care professionals in Northern California, as well as Nevada, Oregon, and Washington, where PA programs do not currently exist. Once the PA program achieves provisional

accreditation through the ARC-PA, it is eligible to join the Physician Assistant Education Association. This in turn, permits the Program to participate in the Centralized Application Service for the Physician Assistant (CASPA). Past experience has demonstrated that participation in the CASPA process results in a significant boost in applications, in the order of several

hundred applicants, annually. It can be anticipated that, if provisional ARC-PA accreditation is achieved by September 2016, entry into the CASPA service would aid in the generation of several hundred applicants for the entering class of 30 students in 2017.

VIII. Accreditation

Requirements

All programs seeking to graduate students that are eligible for PANCE certification exams must be accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). This independent accrediting body determines whether the program meets

established standards for function, structure, and performance. ARC-PA standards for PA education programs include provisions relating to administration, curriculum and instruction,

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evaluation, provisional accreditation, and accreditation maintenance.

The ARC-PA process to full accreditation is costly, lengthy, and complex. Recent modifications to the process, particularly the phase prior to the award of provisional accreditation, have placed additional requirements for on-board faculty and demonstration of clinical placement sites on sponsoring institutions. Sponsoring institutions must be prepared to demonstrate that they have the capability to educate accepted students in both the didactic coursework component of the program as well as in the clinical training phase. In, addition they must have hired the required number of faculty and have in place a fully developed curriculum. These components must be established by the time of the initial site visit for provisional accreditation. The provisional accreditation process is the pathway by which new PA programs enter the full accreditation process of the ARC-PA. The process for provisional accreditation is outlined below.

ARC-PA Provisional Accreditation Process

Senior institutional official submits a formal written request for entry into the process including confirmation of institutional eligibility

Submit feasibility study six months ahead of site visit and complete application materials received from ARC-PA.

Visit I: Initial Provisional Visit

Verifies an institution's ability to begin a program in compliance with ARC-PA standards and the program's readiness to matriculate students. Occurs approximately 6-12 months prior to matriculation of students. After this visit and commission review, program is eligible to receive "accreditation - provisional" status.

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Visit II: Provisional Monitoring Site Visit

Verifies the sponsoring institution's and provisionally accredited program's progress in delivering the program in compliance with ARC-PA standards and their ability to continue to do so. Occurs within six months of graduation of first cohort of students. After visit, program is eligible to continue status as "accreditation - provisional."

Visit III: Final Provisional Site Visit

Verifies the programs' demonstration of compliance with the ARC-PA standards including their ability to incorporate and report findings of self-assessment process. Occurs 18-24 months following the second provisional review by the commission. After final commission review, the program is eligible for an accreditation status of "accreditation - continued," the final step in the accreditation process.

IX.

Criteria for Evaluating Program Success or Continuation

PA educational programs are typically evaluated on the following criteria:

ͻϵϴйƉass rates on the PANCE

ͻƚƚĂŝŶŵĞŶƚŽĨƉƌŽǀŝƐŝŽŶal accreditation on the first try and maintenance of continuing accreditation beyond that point

ͻ99% employment within 6 months of graduation

ͻ&ĂĐƵůƚLJͬƐƚƵĚĞŶƚƌĂƚŝŽĂƚŽƌďĞůŽǁƚŚĞWďĞŶĐŚŵĂƌŬ;ϭϭͬϭŝŶϮϬϭϯͿ ͻ100% doctoral-prepared PA faculty

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X.

Teach Out Plan

The University of the Pacific and the Arthur A. Dugoni School of Dentisty leadership is fully committed to the success of the Physician Assistant program. While certainly not anticipated, were a failure to maintain accreditation occur, accepted students would remain eligible to sit for the PANCE examination. Such events have been quite rare in the field of PA education, but if such an event were to occur, there are additional PA programs in the region to which students may be able to transfer.

If a decision to terminate the program is made after student matriculation, it would take two years to completely close the program. Classes in the first year of the program would need to be taught, and both first and second year students would still need to complete monitored clinical rotations in their second year of the program. After the first year students move into the clinical phase of the program, salary costs and operating expenses would decrease as faculty members are dismissed.

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Notes and Sources

California Occupational Guides. Physician Assistants in California. Labor Market Information Division. California Employment Development Department.

http://www.labormarketinfo.edd.ca.gov/occguides/Detail.aspx?Soccode=291071&Geography=0

601000000.

http://www.pac.ca.gov/forms_pubs/what_is.shtml.

Department of Consumer Affairs. California Healthcare Jobs: Working for Tomorrow. Retrieved February 2014 from

http://www.dca.ca.gov/publications/healthcare_jobs.pdf.

California Occupational Guides. Physician Assistants in California. Labor Market Information Division. California

Employment Development Department.

http://www.labormarketinfo.edd.ca.gov/occguides/Detail.aspx?Soccode=291071&Geography=0

601000000.

Accreditation Review Commission on Education for the Physician Assistant, Inc. ARC-PA Accreditation Manual for Standards, 4th Edition. December 2013. Retrieved May 2014 from

http://www.arcpa.org/documents/AccredManual%204th%20edition%20Dec%202013%20FNL.p df

California Healthcare Foundation. California’s Health Care Workforce. Retrieved January 2014 from http://www.chcf.org/publications/2011/02/californias-health-care-workforce.

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References

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