Nonphysician providers in hospital medicine: Not so fast

The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol

“…The studies indicate that they provide care that is comparable to that of MDs, with high levels of patient satisfaction [15-18]. Although there is international evidence for both efficacy and effectiveness supporting the reallocation of care from MDs to PAs, current research does not cover all settings and professions [2,13]. Many studies concern primary and critical care settings, while studies assessing the effects of substitution of non-acute inpatient medical care are limited.…”

Learning needs of physician assistants working in hospital medicine

“…7 Several articles describe experiences using midlevel providers (including PAs) in general surgery, primary care medicine, cardiology, emergency medicine, critical care, pediatrics, and hospital medicine settings. 5,[8][9][10][11][12][13][14][15][16][17][18][19][20] Many of these articles reported favorable results showing that using midlevel providers was either superior or just as effective in terms of cost and quality measures to physician-only models. Many of these papers alluded to the ways in which PAs have enabled graduate medical education training programs to comply with residents' duty-hour restrictions.…”

“…Finally, our survey instrument was developed based on the Core Competencies in Hospital Medicine, which is a blueprint to develop standardized curricula for teaching hospital medicine in medical school, postgraduate training programs (ie, residency, fellowship), and continuing medical education programs. It is not clear Interested and willing to pay tuition 1 (2) Interested even if there was no stipend, as long as I didn't have to pay any additional tuition 3 (5) Interested ONLY if a stipend of at least 25% of a hospitalist PA salary was offered 4 (7) Interested ONLY if a stipend of at least 50% of a hospitalist PA salary was offered 21 (38) Interested ONLY if a stipend of at least 75% of a hospitalist PA salary was offered 21 (38) Interested ONLY if 100% of a hospitalist PA salary was offered 4 (7) Not interested under any circumstances 1 (2) whether the same competencies should be expected of PA hospitalists who may have different job descriptions from physician hospitalists.…”

“…5 The rationale for this strategy is that there is thought to be a steep learning curve that requires much time to overcome before these providers feel comfortable across the breadth of clinical cases. Before they become experienced and confident in caring for a highly complex heterogeneous patient population, they cannot operate autonomously and are not a cost-effective alternative to physicians.…”

“…In recent years, despite an increase in the number of PAs in Hospital Medicine, some medical centers have chosen to phase out the use of midlevel hospitalist providers (including PAs) with the purposeful decision to not hire new midlevel providers. 5 The rationale for this strategy is that there is thought to be a steep learning curve that requires much time to overcome before these providers feel comfortable across the breadth of clinical cases. Before they become experienced and confident in caring for a highly complex heterogeneous patient population, they cannot operate autonomously and are not a cost-effective alternative to physicians.…”