title: Financial and organizational factors affecting the employment of nurse practitioners and physician assistants in medical group practices.
abstract: This study examines the financial and organizational factors that are associated with the employment of nurse practitioners (NPs) and physician assistants (PAs) in medical group practices. The source of the data is a survey of 128 medical group practices in Minnesota. The findings suggest that the employment of NPs and PAs and their ratios to primary care physicians (PCPs) in practices that employ them are influenced by the organizational characteristics of the group practice but not by the degree of financial risk sharing for patient care. Although neither the number of years of experience in financial risk sharing nor more revenue from capitation payment contracts were related to employment of these midlevel practitioners (MLPs), large practices, those located in rural locations, not-for-profit practices, and those that scored low on cohesive cultural traits were more likely to employ MLPs. The data provide insights into the market for MLPs and the potential for these clinicians in the future health care system. As medical group practices become larger and have more organizational capacity, they can likely be expected to increase the employment of MLPs and integrate them into their organizations.
authors.affiliation: Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, USA. kais0072@umn.edu
authors.forename: Amer
authors.initials: A
authors.lastname: Kaissi
authors.forename: John
authors.initials: J
authors.lastname: Kralewski
authors.forename: Bryan
authors.initials: B
authors.lastname: Dowd
mesh_terms: D002204:Capitation Fee; D004470:Economics, Medical; D004651:Employment / Q000706:statistics & numerical data*; D006123:Group Practice / Q000191:economics / Q000458:organization & administration*; D006302:Health Services Research; D006280:Health Workforce; D006801:Humans; D008511:Medicine / Q000458:organization & administration; D008910:Minnesota; D015999:Multivariate Analysis; D009722:Nurse Practitioners / Q000706:statistics & numerical data / Q000600:supply & distribution*; D015279:Organizational Culture; D010067:Ownership; D010823:Physician Assistants / Q000706:statistics & numerical data / Q000600:supply & distribution*; D010821:Physicians, Family / Q000706:statistics & numerical data / Q000600:supply & distribution; D017009:Professional Autonomy; D011365:Professional Practice Location; D012051:Reimbursement Mechanisms; D020414:Risk Sharing, Financial; D013038:Specialization