Nurse practitioners and physician assistants as primary care providers in institutional settings.
This paper describes the scope of primary care practice and autonomy of nurse practitioners (NPs) and physician assistants (PAs) at nine health maintenance organizations (HMOs) and multispecialty clinics (MSCs). We found that the larger an institution's managed care population, the greater the NPs' and PAs' scope of practice and autonomy, although patients with complex illnesses or multisystem problems usually were referred directly to a physician. Alternative policies to increase the number of primary care physicians might slow the growth in hiring new NPs and PAs, but are unlikely to reduce their primary care role in managed care settings. Further research is needed to consider whether these results are applicable to a broader range of practice settings.
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA.
P D
PD
Jacobson
L E
LE
Parker
I D
ID
Coulter
D003365:Costs and Cost Analysis; D006279:Health Maintenance Organizations; D006801:Humans; D007325:Institutional Practice / Q000191:economics / Q000706:statistics & numerical data; D007407:Interviews as Topic / Q000379:methods; D007587:Job Description; D009722:Nurse Practitioners / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D010823:Physician Assistants / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D011320:Primary Health Care; D017009:Professional Autonomy; D011787:Quality of Health Care; D009626:Terminology as Topic; D014481:United States; D000078329:Workforce