MedicalResearch.com Interview with:
Timothy M. Capstack, MD, FACP, SFHM
Regional Medical Director, Physicians Inpatient Care Specialists, LLC (MDICS)
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hospitalists—medical providers who provide medical care to hospital inpatients—have become a pervasive part of American medical care. Hospitalists with internal medicine training earn, on average, a little over twice as much as do physician assistants (PAs). The researchers studied the hospitalist staffing model of Physicians Inpatient Care Specialists (MDICS) hospitalists at a 384-bed community hospital in Annapolis, Maryland. MDICS used specifically trained and supported PAs working collaboratively with their physicians to see a large proportion of their patients rather than relying mainly or exclusively on physicians, as many groups do. MDICS believed that their model would provide equal quality of care while saving on salary costs.
The MDICS expanded-PA model was compared with a conventional group of hospitalists who used mostly physicians to care for their inpatients. 16,964 inpatient hospitalizations were identified for study; 6,612 expanded-PA and 10,352 conventional patients were seen by the groups over the 18 months that were included.
The PAs in the conventional group saw 9 patients a day on average, while the expanded-PA groups saw 14 patients each per day. Both groups organized their collaboration with their physician assistants similarly: all PA patients were discussed with the physician daily, and were seen by a physician at least every third day. The MDICS group had a written protocol to guide the interaction between their physicians and PAs, as well as a formal education and onboarding process for their PAs. Nearly six percent of patient visits by the conventional group were conducted only by their PA, while 35.73% of the expanded-PA groups’ visits had that structure. After adjusting for variables like patient age, insurance status, severity of illness, risk of mortality, and consultant use, no statistically significant differences in measures like mortality, readmissions, consultant use, or length of stay was found between the groups. The exception was cost of treatment, which was less in the expanded-PA group.
MedicalResearch.com: What should readers take away from your report?
Response: PAs who are well trained and function cooperatively under a collaboration arrangement with hospitalist physicians can provide safe, effective inpatient treatment. The expanded-PA model could free up physicians’ time to focus on more complex cases or allow hospitalists to provide additional or different services. In addition, well-trained and supported PAs can see more patients than previous studies have demonstrated. The desirability of inpatient collaboration and cooperation between physicians and PAs is highlighted, and the need for specific hospitalist PA training and support is emphasized.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: This was a single institution, observational, retrospective study, so while our results are legitimate, more studies should be conducted to solidify that this sort of result is generalizable to a broader subset of inpatient care programs. Ideally, similar studies should be done to confirm what we found, particularly the ability of PAs to see as many patients as ours did and do it without any impact on quality.
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Timothy M. Capstack, MD, Cissy Segujja, MSc, MA, Lindsey M. Vollono, PA-C, Joseph D. Moser, MD, Barry R. Meisenberg, MD, and Henry J. Michtalik, MD, MPH, MHS. A Comparison of Conventional and Expanded Physician Assistant Hospitalist Staffing Models at a Community Hospital. Journal of Clinical Outcomes Management, October 2016, Vol. 23, No. 10
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