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But it is reported to have been in use in North Carolina c. Take my advice and touch nothing in the shape of a prostitute when you come through Raleigh, for in honest truth the clap is there of luxuriant growth. Eliason, "Tarheel Talk," Perhaps related to hooker "thief, pickpocket" s , but most likely a reference to prostitutes hooking or snaring clients.

Hook in the figurative sense of "that by which anyone is attracted or caught" is recorded from early 15c. All of which makes the modern sense seem a natural step. French accrocheuse , raccrocheuse , common slang term for "street-walker, prostitute," literally "hooker" of men. The family name Hooker attested from c. Old English weodhoc "weed-hook". Synonyms for hooker noun prostitute. More words related to hooker Jezebel noun.

Example Sentences for hooker Nor does anybody, save here and there an antiquarian, read Shepard and Hooker and Mayhew. I do not need a bracer to get me going or a hooker to keep me under way. Hooker, because he alone is a captain, cannot be in command.

Stanton said to me that he believes in Hooker, p. And this from Hooker who accused his former chiefs of that very fault. If Hooker is in fault, then he ought not to survive this disaster. Butterfield was not even with Hooker, but at Falmouth at the telegraph. Hooker's action is by far worse, and thus Hooker deserves to be shot. Hooker's staff was worse than sham-science, and was not even empiricism.

Joseph S Hooker Junior in the Census | Ancestry

Physician assistants PAs have worked alongside surgeons since the s, yet little is known about their postgraduate education, roles, distribution, and compensation. In , an estimated 8, PAs were employed in orthopedics 9. Demand for PAs in orthopedics is expected to grow because of population growth, increasing incidence of musculoskeletal conditions, shortages of surgeons, and changing technology. Improved data acquisition and more detailed analyses are needed to better understand the nature of this specialized workforce.

The contributions of physician assistants and nurse practitioners in primary health care. Physician Assistant Job Satisfaction. To examine physician assistant PA job satisfaction and identify factors predicting job satisfaction and identify areas of needed research.

With a global PA movement underway and a half-century in development, the empirical basis for informing employers of approaches to improve job satisfaction has not received a careful review. A narrative review of empirical research was undertaken to inform stakeholders about PA employment with a goal of improved management. The a priori criteria included published studies that asked PAs about job satisfaction.

Articles addressing PA job satisfaction, written in English, were reviewed and categorized according to the Job Characteristics Model. Of 68 publications reviewed, 29 met criteria and were categorized in a Job Characteristics Model.

Most studies report a high degree of job satisfaction when autonomy, income, patient responsibility, physician support, and career advancement opportunities are surveyed. Age, sex, specialty, and occupational background are needed to understand the effect on job satisfaction.

Quality of studies varies widely. Employers may want to examine their relationships with PAs periodically. The factors of job satisfaction may assist policymakers and health administrators in creating welcoming professional employment environments.

PAs seem to experience job satisfaction supported by low attrition rates and competitive wages. Contributing factors are autonomy, experienced responsibility, pay, and supportive supervising physician. A number of intrinsic rewards derived from the performance of the job within the social environment, along with extrinsic rewards, may contribute to overall job satisfaction.

PA job satisfaction research is underdeveloped; investigations should include longitudinal studies, cohort analyses, and economic determinants. Response to Iannuzzi et al. We read with interest the article by Iannuzzi et al,1 which, in staffing a large academic health center internal medicine service, presents a financial comparison of direct patient care costs and length of stay between the hospitalist-resident teams and the hospitalist-physician assistant PA teams.

In this letter, we would like to make 3 points. Roller derby is one of the fastest-growing women's sports in America. Known for its aggressive nature as a full-contact sport, no concussion studies have been undertaken on these athletes. Increasing awareness of head injury in all sports has drawn attention that brain trauma in roller derby athletes needs evaluating. An exploratory study was undertaken to assess the occurrence of concussion to enable further preventive research of brain trauma in this sport.

Adult female athletes attending the Roller Con international roller derby conference were surveyed about roller derby related concussion rates. Additional information included league protocols, competition level, and demographics.

A sample of 75 participants, stratified by age and sex, was theorized to reach information saturation as an explorative study. In total, 75 out of 97 randomly approached athletes consented response rate Mean age of athletes surveyed was 32, with over 3 years' experience playing roller derby and represented four countries. Twenty-two athletes changed their concussion history after reading medical concussion criteria The mean concussion history was 1. Concussion occurrences in adult female roller derby athletes represent a serious risk when playing this sport.

Pre-season head trauma evaluation for leagues is recommended to raise awareness of properly identifying and treating concussion. More in-depth studies are needed to correlate if on-track observations agree with recall. Nurse practitioners NP and physician assistants PA serve as independent or semiautonomous providers and as fundamental members of healthcare teams. Differentiating roles of health professionals is needed for optimal employment utilization. Data included wage and workforce projections to Health delivery establishments employed 88, PA and , NP clinicians in A significant number of them practiced in physi-cians' offices or in acute care hospitals.

Adaptability to changing roles, especially in primary care and underserved areas, makes them facile responders to market demands in a continuously evolving healthcare environment. The White House Conference on Health: Inspiring the physician assistant movement. The authors explore the conference proceedings, link them with other historical documents and events, and suggest that this conference was a contributing factor to the contemporary PA movement. The White House Conference on Health.

The White House Conference on Health brought together the best minds and the boldest ideas to deal with the nation's pressing health provider needs. Physician assistant hospitalist on a rural island. Concussion in Female Roller Derby Athletes. So the subsitution factor is in place. The other is the role in rural health. Research on this matter is in short supply.

Globalizing Physician Assistant Education. If the American version of PA education is a compelling one to promote then perhaps more can be done to advance this notion in other countries that want to develop such. No country seems to have reached a critical mass of PAs to move policy as much as the US. If 2 places per PA program were set aside for overseas applicants to come to the US and graduate then they could act as anchors and stimuli for further development back home.

Canada, Australia, and the UK are examples where there is a skeleton cadre of American trained PAs have returned or relocated and now serve as program directors and educators. Others are needed - especially in the UK. The history of training international medical graduates and nurses in the US and seeing them return to continue their work is a long one. This editorial makes the case to PA educators to expand seats for international applicants.

The physician assistant hospitalist: The role of hospital-based physician assistants PAs is in need of delineation. To learn more about their activities, an administrative research project compared the tasks of hospitalists. A priori a survey of hospitalist activities was administered to four providers in a medium sized hospital 3 MDs and 1 PA. This was followed by time-motion documentation that involved shadowing each member of the MD-PA hospitalist teams over a three-month period.

A univariate analysis of activity patterns perceived and observed assessed what was perceived and what actually occurred on the wards. The mean, standard deviation, and difference in means for each task were calculated. In the survey the PA reported she spent one-half of her hospitalist workdays on direct patient care and the physicians spent less time on direct patient care.

Physicians believed they spent half days on direct patient care and believed the PA spent less time on direct patient care than they did. In summary, the perception of what each provider thought they did and what they in fact did differed significantly when actually observed. Task activity was similar for all providers except MDs attended more administrative meetings than the PA.

The perception that physicians have of PA roles and what a PA actually does has been a reoccurring observation. A lack of understanding of PA role delineation by physicians may contribute to employment reluctance.

The state of Alabama was used as a case study because it is one of a handful of states with restrictive legislation affecting PA and NP scope of practice.

Changing PA and NP scope of practice legislation in Alabama to match states in the upper quartile of collaborative legislation, such as Washington and Arizona, would increase the employment and distribution of PAs and NPs. Underuse of PAs and NPs due to restrictive licensure reduces the cost benefits of increasing the supply of PAs and NPs and reducing the reliance on a stagnant supply of primary care physicians to meet society's healthcare needs.

Physician assistant wages and employment, This study sought to assess physician assistant PA wages, make comparisons with other healthcare professionals, and project their earnings to The Bureau of Labor Statistics PA employment datasets were probed, and wages were used to explore median wage differences between large employer categories and 14 years of historical data Median wages of PAs, family physicians and general practitioners, pharmacists, registered nurses, advanced practice nurses, and physical therapists were compared.

Linear regression was used to project the PA median wage to This suggests that demand exceeds supply, a finding consistent with similar clinicians such as family physicians. A predictive model suggests that PA employment opportunities and remuneration will remain high through Access and Innovation in a Time of Rapid Change: Physician Assistant Scope of Practice.

The physician assistant profession is an American labor innovation designed to improve the reach and efficiency of the physician workforce. Laws were created to ensure this role was safe and effective. PAs practice medicine in teams with physicians, with both the PA and physician being responsible for the work of the PA. States control the licensing, scope of practice and discipline of PAs.

As state laws governing PA practice evolve, more states are determining that scope of practice should be determined at the practice level, as a function of PA education and competence, physician and facility preference and population requirements. As state laws for PAs are harmonized and states recognize the dramatic potential of PAs to ease workforce burdens, states are moving toward broad licensing laws, enabling PAs to diagnose, treat, prescribe and manage a wide range of medical conditions.

Scope of practice being determined by the team of professionals at the practice has much to recommend it — most importantly the ability of the team members involved to assure best fit for the patient population served. This model allows PA-physician teams to rapidly and efficiently adapt to changes in workforce needs, medical knowledge and technological advances, payment systems and standard of care. Payment source and provider type in the US healthcare system. Greater use of physician assistants PAs and nurse practitioners NPs to meet growing demand for healthcare in the United States is an increasingly common strategy to improve access to care and control costs.

Evidence suggests that payment for services differs depending on the type of provider. This study sought to determine if the source of payment for a medical visit varies based on whether care is provided by a physician, PA, or NP. Physicians were proportionally more likely than NPs or PAs to provide care for medical visits compensated by private insurance or Medicare.

Conversely, PAs and NPs were more likely to serve as providers of care for services with other payment sources such as Medicaid and out-of-pocket. Mental health physician associates in the National Health Service. Data regarding effectiveness and benefit of employing physician associates, along with some misconceptions and limitations, are described.

One conclusion is that physician associates are effective in increasing the workforce and providing continuity of care. As of , physician associates in the United Kingdom are not licensed to prescribe or order radiographs or tests. Inpatient physician assistants and nurse practitioners. PAs and NPs are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. Daily caseload was reported to be similar with few significant differences between tasks.

The presence of PAs and NPs was not associated with patient or nurse manager satisfaction. Presence of NPs was associated with greater overall inpatient and discharge coordination ratings; the presence of PAs was associated with lower overall inpatient coordination ratings by nurse managers.

NPs and PAs work on inpatient medicine services with broad, yet similar, scopes of practice, and few differences between their roles and perceptions of care. Is physician assistant autonomy inevitable? A Physician Assistant Institute.

An institute focused on physician assistant economic, social, and organizational research is proposed. This think tank idea takes its cue from similar institutions where policy research and benefits to society are explored with a cadre of scholars and students.

A quadruplet of organizations would underwrite this entity and serve on the board of governors. Funding sources would be government and foundation grants. A purposeful name that would permit flexibility in activity is important. Additionally, a center where visiting scholars can bring their skills to a global stage would be an objective. Increasing demand for rheumatology PAs and NPs.

The demand for rheumatology services will outstrip the supply of rheumatologists. A nationwide survey of rheumatology NPs and PAs contained questions about demographics, training, practice independence, responsibilities, prescribing, use of objective outcome measures, and knowledge and use of treat-to-target TTT strategies. Almost two-thirds reported having their own panel of patients. Mandated work-hour restrictions have hurt many areas of clinical care, including management of burn patients, who require intensive monitoring, resuscitation, and procedural interventions.

As surgery residents become less available to meet service needs, new models integrating PAs and NPs into the burn team must emerge. This article looked at 18 articles related to PA and NP involvement in critical care, selected from a systematic review of the literature. Throughput and financial models were developed to examine provider-staffing patterns. Various models of PA and NP participation in the critical care team were identified. When PAs and NPs were involved in care delivery, patient outcomes were similar or slightly improved to other staffing models.

Several studies also pointed to considerable cost savings related to decreased length of stay, decreased ventilator days, and fewer urinary tract infections. This article reviews use of PAs and NPs in critical care units and proposes a new model for burn centers. The census of licensed physician assistants. A census of physician assistants in the United States is necessary to help legislators make policy decisions about the profession.

In , a PA status analysis was undertaken using a novel data source derived from state licensure. The Provider Database was probed for all licensed PAs, and 84, were identified. Duplicates, sanctioned, deceased, and dual-licensed were reconciled. Statewide distribution per capita ranged from 60 per , in Alaska to 3. The robustness of this database draws on active licensure data to identify clinically active PAs.

Such refinements and details contribute to health workforce research such as census, modeling, retirement trends, and labor participation rates.

Caring for the disadvantaged: The role of physician assistants. We evaluated 10 CHCs in Texas 5 urban and 5 rural , using an ethnographic approach to examine attitudes and beliefs of PAs, medical staff, and patients. Nine of the 10 clinics used PAs interchangeably with physicians, and most medical staff and patients perceived few differences between them.

Patients view all providers as highly effective and genuinely concerned for their patients. We found that clinicians and staff believe in the work they do, report that they function as a team, and seem to like their roles. It appears that working with the medically underserved and economically disadvantaged enables PAs to thrive.

Physician Assistants in American Medicine: The concept of the physician assistant PA was developed by US physicians in the s as a workforce strategy to improve the delivery of medical services. Then as now there is an anticipated shortage of physicians, particularly in primary care. Use of PAs is viewed as 1 possible strategy to mitigate this growing gap in provider services. To describe the PA in US medicine for policy background and analysis.

In January , approximately 89, PAs were licensed: Four-fifths were under the age of 55 years. PAs are trained in 2. Popular specialties are family medicine, emergency medicine, surgery, and orthopedics. PAs are revenue producers for employers and expand access and clinical productivity in most practice settings. Roles for PAs have expanded into hospital settings and graduate medical education programs.

About PAs graduate annually, and this number is expected to grow to by the end of the decade. Predictive modeling suggests that demand for medical services will grow faster than the combined supply of physicians, PAs, and nurse practitioners, particularly in primary care. PA quality of care appears indistinguishable from that of physician-delivered services.

Optimal organizational efficiency and cost savings in health services delivery will depend on how well the PA can be utilized.

A history of the Alaska physician assistant, In , the Alaska Board of Medical Examiners ratified the first set of regulations and began issuing licenses the following year. Throughout the s and following pipeline completion, more PAs were employed by private, state, and federal agencies to meet the needs of a growing population.

Forty years later, Alaska has one of the richest legacies in PA deployment of any state. This article is based on the authors' memories, communications with those involved in the program, and historical documents archived at the MEDEX Northwest Physician Assistant Program at the University of Washington in Seattle, along with Alaskan archival sources.

Little is known about the benefits to society of the educational development of health personnel in the military who return to civilian life and continue their careers. The Texas Medical Board dataset of licensed PAs was examined to identify program attended, practice specialty by supervising physician designation, practice location, and primary care or specialty care practice designation.

Primary care was defined as family medicine, general pediatrics, or general internal medicine. All other designations were classified as specialty practice. Of licensed Texas PAs, 7. Of the PAs in full-time civilian clinical practice, With the average military officer retirement age of 47 years and the average U.

We estimated over 47, outpatient visits are provided per PA following military service. The care provided can be measured as a positive return-on-investment of taxpayer-provided education. As the US population increases and ages, more patients require care. A reengineered health care system relies on physician assistants and nurse practitioners; however, the extent to which they care for medical conditions is marginally known.

We analyzed ambulatory visits by provider type and diagnosis focusing on chronic diseases to identify differences in patients seen by each type of provider. The distribution of visits for chronic disease diagnoses appears to be similar for all 3 providers physicians, nurse practitioners, and physician assistants.

These findings may improve organizational efficiency in ambulatory systems. Are PAs valued in primary care? This systematic review aimed to appraise the evidence of PAs' contribution to primary care; 2, publications were identified, of which 49 met the inclusion criteria 46 were American. The majority of PAs' workload is managing patients with acute presentations. PAs tend to see younger patients and a different caseload than physicians do and require supervision.

Studies of costs provide mixed results. Outcomes of the review identified that acceptability to patients and potential patients is consistently high, and studies of appropriateness report positively.

Overall, the evidence was appraised as of weak to moderate quality, with little comparative data presented and little change in research questions over time. The research evidence of the contribution of PAs to primary care was mixed and limited.

However, the continued growth in PAs' employment in American primary care suggests that PAs are considered valuable. Further specific studies are needed about the effectiveness of PAs' contributions to the international primary care workforce. Who's minding the store? Retail clinics have experienced an exponential growth since The majority are freestanding, venture-backed companies affiliated with retail stores. Also, an increasing number of hospital systems have decided to develop their own retail clinics or partner with existing national companies.

The author conducted eight in-depth interviews with administrative and clinical leaders in seven hospital systems that had a relationship with retail clinics in the last 3 years. Hospital systems are increasing relationships with retail clinics to grow market share through enhanced referrals to physician offices and hospitals, to become closer to consumers, and to experiment with nontraditional ways of delivering healthcare.

Operational challenges included physician resistance and skepticism, poor financial performance, the public's perception of retail clinics, staffing issues, and the newness of the business model. Most respondents thought that hospital affiliation with retail clinics is a trend here to stay.

Little is known about the benefits to society in the educational development of health personnel in the military who return to civilian life to continue their career.

Of 6, licensed Texas PAs, 7. With the average military officer retirement age of 47 years and the average US retirement age of 64 years for men and 62 for women, and estimated 16 years of community workforce productivity is provided per veteran PA following completion of military service. The changing physician assistant profession: The physician assistant PA movement originally served as an avenue for male veterans to transition into the civilian workforce.

After a half-century of development, the profession in the United States is now predominantly female and nonveteran. Using archival data and other resources, this article documents the influences on gender and age shifts in the PA profession with related policy perspectives. Now entering its sixth decade, the profession continues to evolve as demand for PA services outpaces supply.

Dental practitioners and dental therapists. The use of midlevel dental providers MLDPs, per the study authors is being debated as a means of reducing oral health disparities and increasing access to care among underserved populations.

Dental providers include the advanced dental hygiene practitioner, community dental health coordinator, dental health aide therapist, and dental therapist. These providers are new to the US dental profession, although medicine has used similar positions for years. Medical literature has shown mixed results as to whether these providers improve access to care and increase practice efficiency; however, studies have demonstrated clearly that the quality of care outcomes of these providers is comparable to those of physicians.

Studies of MLDPs suggest potential practice and public health benefits. With appropriate training, licensure, supervision, and deployment to geographical areas with significant need, MLDPs could increase access to care to underserved populations and help prevent deaths attributable to untreated dental disease. Looking at national health workforce planning. Healthcare systems around the globe are struggling to identify the adequate mix of healthcare professionals necessary to meet the needs of current and future patient populations.

The United States is no exception. The United States consistently spends more on healthcare per capita than other developed countries. But the available data make it difficult to offer both a complete forecast of the nation's healthcare workforce supply and assess its adequacy for meeting the demand for services in coming years. Traditional supply-demand analyses for the healthcare industry workforce fall short. Fragmented and inconsistent data collection, variance in methodological assumptions and rigor, mistrust between professional groups, and wide differences in regulatory and educational context contribute to an incomplete understanding of workforce supply and demand.

This report emphasizes the importance of developing a new national approach to workforce planning. A national, consistent strategy for data collection and research, in addition to providing states with a common approach to workforce measurement and forecasting methodologies, will enable policy makers and educators to develop a stronger long-term strategy for planning the US healthcare workforce. Although this methodology does not yet exist, it is necessary to capture an accurate picture of healthcare workforce needs moving forward.

Physician Assistants and Their Intent to Retire. To determine predictors of physician assistants PAs to retire or to permanently leave clinical practice. The intent was to create a measure of retention and attrition for purposes of forecasting PA supply. All PAs 55 years or older who were nationally certified in were surveyed. Statistical analysis included descriptivemeasures utilizing means, standard deviations, range, and proportions for all survey questions.

A studentized t test analysis for continuous variables was used to compare differences across genders. The estimated time interval until retirement was calculated using reported values from participants and then subtracting their projected retirement age from current age. The same calculation was used for estimating PA career length from date of graduation to retirement. The mean age was 60 years and the years in clinical practice was When asked to predict a retirement date or age, the mean duration of working beyond age 55 years was 12 years range 5 to Most respondents reported being confident they were on track to retire with an adequate income.

The significant differences that emerged were that men were more confident than women in preparing to retire, having enough money for medical expenses, and being able to live comfortably in retirement. Men more than women stated that, if forced to retire, they were more confident in the preparation to do so.

PAs 55 years and older report they are likely to delay retirement from practice until age 67 years, on average. Women were less confident than men in retirement preparation. This age prediction expands career projections and refines forecasting models for the profession. Correlations based on expectation-action chain of events should be developed by periodically measuring how often intent and reality coalesce.

A physician assistant rheumatology fellowship. A rheumatology postgraduate fellowship for physician assistants was inaugurated in as a pilot initiative to supplement shortages in rheumatologists. An administrative analysis documented that each PA trainee achieved a high level of rheumatology exposure and proficiency. Classes in immunology, rheumatology, and internal medicine augmented clinical training. Faculty and trainees considered PA postgraduate training in rheumatology worthwhile.

Physician Assistants Working with the Medically Underserved. In a qualitative analysis of providers working with medi-cally underserved patients, Li and colleagues identified a group of health professionals committed to working with the poor. These providers revealed a strong sense of service to humanity and pride in making a differ-ence. Each appeared to thrive on the challenge of creatively dealing with patients' complex human needs with limited health care resources.

The authors identified the factors critical to survival in an urban underserved setting: The camaraderie and synergy of teams generate personal support and opportuni-ties for continuing professional development.

Only a few research studies have outlined the role and dynamics of PAs and NPs working with the underserved. Grumbach and colleagues found that PAs and NPs in primary care and family physicians have a greater propensity to care for underserved populations than do physicians in other specialties. Knowing the role they play requires knowing who they are and why they are there.

F ollowing WWII, the percentage of people who were poor and lacked health insurance rose, and access to care became problematic. Half a century ago, the federal gov-ernment decided that a compassionate society had a mission to serve the poor and launched a series of strategies to address their health care needs.

One notable effort was community health centers CHCs , created in to provide health and social services access points in poor and medically underserved communities across the nation. CHCs were born in an era of significant social change and designed to offset limited access to care for poor and marginalized populations. PAs and NPs were born in this same era along with the revival of the certified nurse-midwife.

That these three providers have been an inte-gral part of CHC teams since the s is no coincidence. The mission includes meeting health needs of low-income populations, the uninsured, those with limited English proficiency, migrant and seasonal farmworkers, indi-viduals and families experiencing homelessness, and those living in public housing.

CHCs are recognized both for the critical role they play in caring for growing numbers of job-less and uninsured and as model primary care clinics in their communities. Given the local focus of CHCs, a large amount of diversity within the centers is reflected in patient demo-graphics, service provider composition, staff relationships, and resources. No two CHCs are the same. Unfortunately, little is known about PAs working with the indigent.

Anecdotally, we know PAs work with the home-less, in migrant camps, on Indian reservations, and in inner-city and free clinics. No survey has assessed PAs working with the poor, but various reports indicate that they are well-represented in these settings.

Some PAs have turned to working in volunteer roles after a period of retirement. The patterns of PA and NP care are similar to that of physicians. Rabinowitz and colleagues identified four independent predictors of physicians pro-viding care to underserved populations: Working with the medically underserved. Physician assistants working with the medically underserved.

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"prostitute," often traced to the disreputable morals of the Army of the Potomac (American Civil War) under the tenure of Gen. "Fighting Joe" Hooker (early ), and the word might have been popularized by this association at that time (though evidence is wanting). But it is reported to have been in use in North Carolina c ("[I]f he comes by way of Norfolk he will find any number of. Family Owned and Friendly Eastern Carolina Storage DBA Hooker Road Self Storage is a division of Wellons Enterprises, Inc. in Carteret County, NC. Wellons Enterprises, Inc. was originally established by Mr. Calvin G. Wellons in in the Eastern Coastal Carolina area. Mr. Wellons was raised on a family farm in Johnston County, NC. Asheville, North Carolina, is fortunate to have one of the most dramatic displays of fall foliage in the country. Extreme elevations, and more than species of deciduous (leaf shedding) trees, give the Blue Ridge Mountains one of the longest and most vibrant leaf seasons.