Primary Care

Primary care patients who see physician assistants and nurse practitioners are as complex as those who see doctors

Nonphysician providers such as physician assistants (PAs) and nurse practitioners (NPs) have been used to improve care access and reduce health care costs since 1967. Approximately 110,000 PAs and NPs currently practice in the U.S., with half of the PAs and 85 percent of NPs practicing in primary care. Their primary care patients are more likely than those of doctors to be rural, uninsured or publicly insured (other than Medicare), younger, less extroverted, and to be women. Their patients are also more likely to perceive less access to care and make less use of some preventive services such as complete health exams or mammograms. Despite these differences in care use, there were no differences in difficulties/delays in care or self-rated health between primary care patients of physicians and those of PAs and NPs.

However, the patients of the PAs and NPs did not differ in medical complexity from the patients of doctors. These findings suggest that PAs and NPs are acting as primary care providers to underserved patients with a range of disease severity. This has important implications for policy, including clinician workforce and reimbursement issues, note the University of Wisconsin researchers. They point out that PAs and NPs typically work under the supervision of or in collaboration with doctors, and that their roles and level of autonomy are dictated by their State medical statutes and negotiated agreements with their supervising/collaborating doctor. Yet clear operational definitions of the potential roles of PAs and NPs is lacking, as is evidence of their potential to contribute to the functions of primary care within each role.

The findings were based on analysis of data from the Wisconsin Longitudinal Study, a long-term study of over 10,000 graduates from Wisconsin high schools that started in 1957. Data for 6,803 respondents taken from the 1993-1994 and the 2004-2005 surveys were used in the present project. The study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00083).

See "Physician assistants and nurse practitioners as a usual source of care," by Christine M. Everett, M.P.H., Jessica R. Schumacher, M.S., Alexandra Wright, M.S., and Maureen A. Smith, M.D., M.P.H., Ph.D. in the Fall 2009 The Journal of Rural Health 25(4); pp. 407-414.

Return to Contents
Proceed to Next Article