The Attitudes of Rural Minnesota Family Physicians Toward Nurse Practitioners and Physician Assistants

Abstract

Increased use of nurse practitioners and physician assistants has been promoted as a possible solution to the shortage of primary care providers in rural locations. If the use of nonphysician providers is to be optimized in these areas, awareness and acceptance of their capabilities by rural family physicians is essential. This study surveyed the attitudes of rural Minnesota family physicians toward the use of physician assistants and nurse practitioners. Forty-six percent of the 600 rural family physicians surveyed responded to the questionnaire. Approximately 90 percent of responding physicians indicated a high degree of confidence in the abilities of nonphysician providers in the areas of preventive and routine care; some concern was expressed about the proficiency of nonphysician providers taking call, covering the emergency room, and doing hospital rounds--activities that involve a broader base of clinical knowledge and diagnostic skills. Other concerns were an increased workload for physicians due to their assumed supervisory roles, an increase in complexity of cases seen by physicians, increased physician liability, job competition between nonphysician providers and physicians, and the lack of educational opportunities and supervisory guidelines for physicians regarding collaborative relationships. Appropriate roles for family physicians, nurse practitioners and physician assistants are not well-defined in the minds of respondents, and it appears future acceptance and practice patterns will depend on how these roles are established and accepted.

Perceived Barriers to Nurse Practitioner Practice in Rural Settings

“…The public and other providers lack knowledge about NPs' education, responsibilities, scope of practice, supervision requirements, and payment issues. [16][17][18][19] Some physicians are resistive or view NPs as unwelcome competition. 16,20 Structural barriers (eg, lack of office and examination room space) pose important problems.…”

The Effects of Clinical Decision Making on Nurse Practitioners’ Clinical Productivity

“…They have completed additional course work and clinical study, typically at the master's level, to become NPs. In many states, NPs are able to work independently, but the majority of them seek collaborative practice arrangements with physicians (Bergeson, Cash, Boulger, & Bergeron, 1997;Pickwell, 1997). Autonomy of practice is defined as the extent to which NPs can determine independently the range of tasks they will perform (Aprile, 1998;Cooper, Henderson, & Dietrich, 1998;Jacobson, Parker, & Coulter, 1998).…”

Attitudes of Registered Nurses Toward Nurse Practitioners

“…Studies have documented physicians' attitudes toward nurse practitioners (NPs), as well as physicians' acceptance of NPs (Bergeson, Cash, Boulger, & Bergeron, 1997;Betancourt, Valmocina, & Grossman, 1996;Carr, Bethea, & Hancock, 2001;McMullen, Alexander, Bourgeois, & Goodman, 2001). The same can be said of patients, with both qualitative and quantitative studies measuring their knowledge and perceptions of the NP role (Barr, Johnston, & McConnell, 2000;Betancourt et al;Knudtson, 2000;Larrabee, Ferri, & Hartig, 1997;McLain, 1999;McMullen et al;Mundinger, 2001;Nauman, 1999;Phillips & Brooks, 1998;Pinkerton & Bush, 2000).…”