Patients open to greater role for physician assistants & nurse practitioners, survey finds

The shortage of primary care physicians in the U.S. is expected to worsen next year, as many newly insured patients enter the market under the Affordable Care Act.    

Some policy analysts have suggested expanding the roles of physician assistants (PA) and nurse practitioners (NP) as one potential way to help alleviate some of the burden on physicians, and a new study published in Health Affairs shows that consumers are open to that idea.

The study, which was part of the December 2011 – January 2012 Association of American Medical Colleges (AAMC) Consumer Survey, questioned 2,053 individuals who required medical care within the last 12 months.

In the survey’s first scenario, respondents said that when finding a new primary care provider, 50% preferred a physician, while 23% preferred a PA or NP and 26% indicated no preference.

But it was the second scenario that indicated timeliness likely influences a patient’s decision. Respondents were given the option of seeing a PA or NP today for a worsening cough or seeing a physician tomorrow. Nearly 60% preferred to see a PA or NP, while only 25% preferred to wait.

Clese Erikson, the director of the AAMC Center for Workforce Studies and a co-author of the study, said the survey results show that timeliness of care is an important factor for patients.

“[The results showed] those who had seen a physician assistant before were more willing to see one a second time, especially if it meant getting in to the office a day earlier,” said Erikson. “It’s consistent with what Americans are doing already. Many people have had that same experience when calling their physician’s office to make an appointment. We saw that the time trade played a big role. That’s going to be important avenue to ensuring access to care in future.”

The survey also examined which respondents were more likely to seek treatment from a PA or NP based on their sex, age, race, annual income and insurance status.

But many primary care physicians are reluctant to see NPs expand their scope-of-practice, citing concerns to patient safety and discrepancies in education.

A separate study released earlier this year by the New England Journal of Medicine showed that physicians see a difference in the quality of care that they provide. Nearly two-thirds of physicians in the study agreed with the statement that physicians provide a higher-quality examination and consultation than nurse practitioners during a primary care visit. In that same study, however, more than three-fourths of nurse practitioners disagreed with that same statement.

According to Health Affairs, 18 states and the District of Columbia allow NPs to practice without physician involvement, and that number could grow in the coming years as more state legislatures consider proposals.

The Health Affairs study concludes, “As scope-of-practice battles continue to be waged and new reforms for care delivery and reimbursement roll out, our findings provide early evidence that health care consumers in the United Stares are open to the idea of seeing physician assistants and nurse practitioners in the future – and in many cases prefer it.”