MedicalResearch.com Interview with:
Kristin Ray, MD, MS
Health Policy Institute
University of Pittsburgh School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We were interested in understanding how nurse practitioners and physician assistants are working with specialist physicians to provide specialty care. Much has been described and studied about nurse practitioners and physician assistants providing primary care, but the literature about their role in specialty care is more sparse. There have been many concerns over time about the supply of specialist physicians, heightening our interest in the role of nurse practitioners and physician assistants in working with specialist physicians.
We focused on examining whether care to physician specialist’s patients by nurse practitioners and physician assistants has increased over time as well as examining characteristics of patients seen by nurse practitioners and physician assistants.
We found that visits with NPs and PAs for specialty care have increased over time, but remains a small fraction of specialty care overall.
MedicalResearch.com: What should readers take away from your report?
Response: We found that nationally nurse practitioners and physician assistants are part of an increasing percentage of outpatient visits to specialist physicians, including both new and return patient visits and also including visits for a range of reasons. Among visits with nurse practitioners and physician assistants, the percentage of visits where the patient did not also see the specialist physician increased over time. After adjusting for patient and visit characteristics, nurse practitioners and physician assistants were disproportionately involved in specialist visits for patients with greater medical complexity. Overall, we found that nurse practitioners and physician assistants providing care to specialist physician patients is a growing trend, suggesting we should seek to understand the impact of this trend on patients and on the specialty care workforce.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Given this growing trend, it would be interesting to understand how incorporation of PAs and NPs into specialist physician practices impacts access for patients as well as the specialty care workforce. Does this trend improve how quickly patients can get specialty care? Does it allow for specialty care closer to the patient’s home? What is the impact on job satisfaction, burn-out, and workforce for specialist physicians, nurse practitioners, and physician assistants? How is this trend interacting with other innovations in specialty care delivery, such as the use of telemedicine? What are the best ways to incorporate nurse practitioners and physician assistants into specialty care delivery to improve access and outcomes for patients?
We have no conflicts of interest to disclose.
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Ray KN, Martsolf GR, Mehrotra A, Barnett ML. Trends in Visits to Specialist Physicians Involving Nurse Practitioners and Physician Assistants, 2001 to 2013. JAMA Intern Med. Published online June 05, 2017. doi:10.1001/jamainternmed.2017.1630
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