The Substitution of Physician Assistants and Nurse Practitioners for Physician Residents in Teaching Hospitals

Abstract

This study documents features of clinical departments in teaching hospitals that are using physician assistants (PAs) and nurse practitioners (NPs) to perform some tasks previously done by medical or surgical residents. More than 60 percent of teaching hospital medical directors surveyed reported experience with substitution in their hospitals. The experience overall appears to be positive; one-third of the departments are planning to increase the number of PAs and NPs they use. The results imply that some of the services lost in house-staff reductions called for in many physician workforce reform proposals could be provided by alternative health professionals.

Implementation of a physician assistant/hospitalist service in an academic medical center: Impact on efficiency and patient outcomes

“…Despite this, reductions in house officer duty hours as mandated by the Accreditation Council on Graduate Medical Education (ACGME) 11 have resulted in academic centers increasingly using midlevel providers to decrease house staff workload on inpatient services. 12,13 In general, midlevel practitioners on general medicine services have been deployed to: (1) care for a population of patients separate from and in parallel with house staff; this population may be narrowly defined (eg, patients with chest pain) or not; (2) assist with the management of patients cared for by house staff by performing certain tasks (eg, scheduling appointments, discharging patients). Even as midlevel providers become more prevalent on academic general medicine services, the best model of care incorporating them into clinical care remains unclear, and few studies have rigorously examined the care provided on services that use them.…”

Disruptive Innovation

“…As policy makers are undertaking what will be the largest overhaul of the health sector in recent history, use of mid-level providers arouse considerable interest. NPs are a good illustration of DI for several reasons: they are not a new concept, NPs are already involved in primary care and in role substitution in hospitals 6,7,8 and nurses are the largest group of healthcare professionals in the US. 9 Evidence suggests that NPs provide an equivalent quality of care compared to physicians in a number of settings.…”

“…NPs already provide a range of services that are traditionally given by physicians 8,9 and are utilized in a number of medical settings with equivalent results. 7,8,19 New technologies and the development of clinical algorithms mean that NPs can fully deal with a variety of routine clinical scenarios.…”

“…7,8,19 New technologies and the development of clinical algorithms mean that NPs can fully deal with a variety of routine clinical scenarios. For instance, current diagnostic kits for Group A Streptococcus pharyngitis allow for easy diagnosis, and evidence-based treatment protocols almost "automate" management of uncomplicated pharyngitis.…”

“…9 Anecdotal evidence and some research even suggests that physicians working with NPs report greater job satisfaction. 8,20 Under this model, physicians and NPs do not compete but tackle tasks more suited to their training and experience; doctors work on "solution shop" problems that fall outside the realm of strict protocolized care and NPs perform in a "value added" task role. This emphasis on multi-disciplinarianism is something that few would consider unhealthy in medical care, even though it challenges some older physicians' notions of themselves as "lone healers.…”