Undergraduate Grade Point Average Mediates the Relationship Between Childhood Socioeconomic Indicators and Likelihood of Physician Assistant/Associate Matriculation

INTRODUCTION: Socioeconomic status (SES) is a complex construct that includes social factors that influence one's access to economic, environmental, and educational resources. Physician assistant/associate (PA) programs often use undergraduate grade point average (GPA), one measure of academic achievement, to assess applicants for admission, but the extent to which SES impacts undergraduate academic achievement remains unexplored. This study examines the relationship between SES and matriculation into PA programs and the extent to which undergraduate academic achievement mediates that relationship. METHODS: Using data from 3 application cycles of the Centralized Application Service for Physician Assistants, ten self-reported indicators of environmental and economic disadvantage (EED) were analyzed. Mediation analyses assessed whether and to what extent undergraduate academic achievement mediates the association between EED indicators and odds of PA program matriculation. RESULTS: In unadjusted logistic regression models, applicants who reported EED indicators had lower odds of matriculation than those who did not. In adjusted models, many EED indicators that initially appeared disadvantageous became nonsignificant or advantageous. Grade point average was a significant mediator of the relationship between SES and matriculation likelihood for most (80%) EED indicators and substantially mediated the relationship between the first-generation college student indicator and decrements in odds of matriculation. DISCUSSION: Our study is the first to examine the relationship between multiple markers of SES and PA program matriculation and, notably, identifies undergraduate GPA as a significant mediator of this relationship. Our findings highlight how childhood EED detrimentally impacts opportunity later in life and identifies intervention targets to improve equity in access to PA education.