Quantified estimates of the total contribution of nurse practitioners (NPs) and physician assistants (PAs) to primary care made by these non-physician clinicians (NPCs) are rare. This study used productivity data from the NPC and physician populations in Washington State to assess the contribution to generalist care made by NPCs, the role of NPCs in rural and underserved areas, and the role of women NPCs in the female provider population. Data on demography, medical specialty, place of practice and outpatient visits from license renewal surveys were used to estimate the productivity of generalist physicians and generalist NPCs. Head counts of physicians, NPs and PAs were adjusted for missing specialty and productivity data and converted into family physician full-time equivalents (FTEs) to facilitate comparisons and estimation of total contribution to care made by each provider type. A total of 4,189 generalist physicians produced only 2,760 family physician FTEs (1 FTE = 105 outpatient visits per week). Overall, generalist NPCs made up 23.4% of the generalist provider population and performed about 21.0% of the generalist outpatient visits in Washington State. NPC contribution was higher in rural areas of the state, about 24.7% of all generalist visits, and a bit lower in urban parts of the state, about 20.1% of generalist visits. In rural areas, female physicians provided 49.3% of the visits provided by female providers; female NPCs provided the remaining 50.3%. In urban areas, female physicians provided about 63.5% of the generalist care provided by women and female NPCs provided 46.5%. NPCs made similar contributions to total care in rural Health Professional Shortage Areas compared to rural non-shortage areas, though PAs appeared to contribute somewhat more care in HSAs with severe shortages of providers. NPs and PAs provided over 20% of the generalist outpatient visits in Washington State. Accurate estimates of available generalist care must take into account the contribution of NPs and PAs. Funded by HRSA’s ORHP and BHPr.
|Larson E, Palazzo L, Berkowitz B, Pirani MJ, Hart LG||The contribution of nurse practitioners and physician assistants to generalist care in underserved areas of Washington State||PUBLICATION||01-01-2003||Article|
|Larson E, Palazzo L, Berkowitz B, Pirani MJ, Hart LG||The contribution of nurse practitioners and physician assistants to generalist care in underserved areas of Washington State||PUBLICATION||06-01-2001|
Full report Policy brief
|Grumbach K, Hart LG, Mertz E, Coffman J, Palazzo L||Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians||PUBLICATION||01-01-2003||Article|
|Larson E, Hart LG, Ballweg R||National estimates of physician assistant productivity||PUBLICATION||01-01-2001||Article|