Scope of Practice and Patient Panel Size of Family Physicians Who Work With Nurse Practitioners or Physician Assistants

Dai, Mingliang; Ingham, Richard C; Peterson, Lars E.

doi:10.22454/fammed.2019.438954

Cited by 21 publications

(33 citation statements)

References 32 publications

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“…1 It has been increasingly embraced by family physicians (FPs) as a way to achieve the nation's quadruple aim while facing workforce shortages. [2][3][4][5] Multidisciplinary teams have the potential to help meet the country's growing primary care needs. 6 Innovative care delivery models, including accountable care organizations and patient-centered medical homes, rely on integration of care across team members to achieve better patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Team Configurations, Efficiency, and Family Physician Burnout

et al. 2020

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Introduction: The delivery of team-based care relies on team structure and teamwork. Little is known about the landscape of team configurations in family medicine practices in the United States. Teamwork between diverse team members likely impacts both performance and physician well-being. We examined team configuration and teamwork and whether they are associated with family physician (FP) well-being.Methods: We used data from practice demographic questionnaires completed by FPs who registered for the American Board of Family Medicine Family Medicine Certification Examination in 2017 and 2018. We grouped 14 types of health care professionals into medical assistant (MA)/nurse, nurse practitioner (NP)/physician assistant (PA), and specialist, and we characterized 3 common team configurations. We used FPs' subjective ratings to measure perceived teamwork efficiency and a validated singleitem measure to identify FPs who were burned out.Results: Among 2575 FPs in our sample, 22% worked collaboratively with MA/nurse only; 40% with MA/nurse and NP/PA or specialist; and 38% with MA/nurse, NP/PA, and specialist. The distribution of perceived teamwork efficiency was not statistically different across team configurations. In teams with greater perceived teamwork efficiency, FPs were less likely to be burned out. For FPs working with expansive teams, optimal perceived teamwork efficiency was associated with significantly reduced odds of burnout after controlling for practice and physician characteristics.Conclusion: Most FPs practice in multidisciplinary teams. Regardless of the team structure, FPs who perceived their teams as having greater efficiency were less likely to be burned out. We found that optimal perceived teamwork efficiency was associated with significantly reduced odds of burnout for FPs in all types of team configurations. Improving teamwork efficiency may be an effective strategy for practice organizations to support not only team functioning but also physician well-being.

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Section: Introductionmentioning

confidence: 99%

Team Configurations, Efficiency, and Family Physician Burnout

et al. 2020

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“…The perceived benefit of PAs to the health care team has also been noted by a survey of surgical residents [13]. A study of family medicine found that having a PA increased the family practice physician panel by 410 patients [14]. Further research is needed to quantify the impact that PAs have in psychiatric care both in patient access to care and patient outcomes.…”

Section: Discussionmentioning

confidence: 89%

Physician Assistant Utilization in Inpatient Psychiatry: A Qualitative Study

Curran

Boyette

Callison-Burch

et al. 2020

Cureus

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There is a national shortage of psychiatric care providers, with approximately 1% of physician assistants (PAs) working in psychiatry. The study aimed to understand the utilization of PAs in inpatient psychiatry. Methods A qualitative study was performed utilizing semi-structured interviews focusing on PA autonomy, reimbursement, specialized certifications, training structure, and overall satisfaction with PAs in inpatient psychiatric care. Results Of the nine locations interviewed, four are currently using PAs, and five have never utilized PAs. All facilities utilizing PAs reported a decrease in physician workload with varying structures for training and billing, and required specialized certifications. Conclusion Most facilities surveyed do not utilize PAs and either preferred physicians or were unaware of the qualifications of PAs. Of the facilities utilizing PAs, there is wide variation in their utilization and reimbursement models; however, they reported a high level of satisfaction, reinforcing that PAs can provide high-quality care in inpatient psychiatric settings.

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“…Combining NPs and PAs into a single category may be a limitation, as some studies have found differences between these roles. 30 Roles of NPs and PAs may differ in other settings, identified as the primary provider for the patient vs part of a team with the physician as the primary or whether or not they perform acute care only, chronic disease care only, or a combination of acute and chronic care. The decision in our practice to set different panel sizes for physicians and NPs/PAs was made to acknowledge the difference in training between these 2 groups and to allow acute capacity for the care team.…”

Section: Study Limitationsmentioning

confidence: 99%

“…The NPs and PAs are often viewed as interchangeable; it is important to recognize the differences in training and previous experience requirements. 30,35,36 Hospital care and transition of patients from the hospital was not assessed in this study. When patients required hospitalization, the providing service varied.…”

Section: Study Limitationsmentioning

confidence: 99%

Clinician Care Team Composition and Health Care Utilization

Bernard

Laabs

Nagaraju

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To test the hypothesis that a greater proportion of physician time on primary care teams are associated with decreased emergency department (ED) visits, hospital admissions, and readmissions, and to determine clinician and care team characteristics associated with greater utilization. Patients and Methods: We retrospectively analyzed administrative data collected from January 1 to December 31, 2017, of 420 family medicine clinicians (253 physicians, 167 nurse practitioners/physician assistants [NP/PAs]) with patient panels in an integrated health system in 59 Midwestern communities serving rural and urban areas in Minnesota, Wisconsin, and Iowa. These clinicians cared for 419,581 patients through 110 care teams, with varying numbers of physicians and NP/PAs. Primary outcome measures were rates of ED visits, hospitalizations, and readmissions. Results: The proportion of physician full-time equivalents on the team was unrelated to rates of ED visits (rate ratio [RR] ¼ 0.826; 95% confidence interval [CI], 0.624 to 1.063), hospitalizations (RR ¼ 0.894; 95% CI, 0.746 to 1.072), or readmissions (RR ¼ e0.026; 95% CI, 0.364 to 0.312). In separate multivariable models adjusted for clinician and practice-level characteristics, the rate of ED visits was positively associated with mean panel hierarchical condition category (HCC) score, urban vs rural setting, NP/PA vs physician, and lower years in practice. The rate of inpatient admissions was associated with HCC score, and 30-day hospital readmissions were positively associated with HCC score, lower years in practice, and male clinicians. Conclusion: Care team physician and NP/PA composition was not independently related to utilization. More complex panels had higher rates of ED visits, hospitalization, and readmissions. Statistically significant differences between physician and NP/PA panels were only evident for ED visits.

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Scope of Practice and Patient Panel Size of Family Physicians Who Work With Nurse Practitioners or Physician Assistants

Cited by 21 publications

References 32 publications

Team Configurations, Efficiency, and Family Physician Burnout

Team Configurations, Efficiency, and Family Physician Burnout

Physician Assistant Utilization in Inpatient Psychiatry: A Qualitative Study

Clinician Care Team Composition and Health Care Utilization

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