Date of Award

January 2016

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Mark Schlesinger

Abstract

Purpose: Graduate level student indebtedness is a growing concern for various healthcare professions. This study describes the anticipated financial burden of Physician Assistant (PA) education as reported by newly matriculated students. We aim to provide the most comprehensive look to date at student and educational program characteristics associated with anticipated student debt and financial stress when starting PA studies.

Methods: We conducted a secondary cross-sectional analysis of de-identified data from the 2014 Physician Assistant Education Association (PAEA) Matriculant Survey and merged it with publicly available data abstracted from PA Programs’ websites. Our final dataset has 5081 unique PA students’ responses (average response rate 87%) from 151 PA Programs. Our main dependent variables were “high anticipated student debt” defined as debt over $100,000 and “financial stress” defined as high or moderate level of financial concern as reported by survey respondents. For our exploratory analysis, we selected the possible independent variables at the student and program level through a review of the literature on student financial burden. We used standard frequency analyses, odds ratios, χ2 statistics, and multivariate logistic cluster modeling to identify student and program level associations.

Results: At the student level, the strongest statistically significantly factor associated with high anticipated PA student debt was having prior student loans greater than $75,000 [adjusted odds ratio 6.76; 95% CI 4.82-9.48] when compared to those with no prior loans. The strongest statistically significantly factor associated with financial stress was having consumer debt under $5,000 [adjusted odds ratio 1.98; 95% CI 1.46-2.70] when compared to those with no consumer debt.

After adjusting for confounders and cluster effect, attending PA programs with tuition greater than $100,000 was the strongest statistically significantly factor associated with anticipated high debt when compared to programs with tuition less than $49,999 [adjusted odds ratio 3.67; 95% CI 2.02-6.66]. Attending a private for profit PA program was the strongest factor associated with financial stress when compared to PA programs with public sponsorship status [adjusted odds ratio 2.43; 95% CI 1.00-5.94]

Conclusions: Our findings suggest that a combination of factors contribute to the financial stress reported by more than half of students (61.6%) recently undertaking PA education. This underscores the need for a more granular analysis of both student indebtedness and financial stress in graduate level education. Moreover, the findings can inform professional organizations about the need to monitor financial burden over time and advise policy makers considering opportunities for intervention.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/07/2018

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