title: Patient willingness to be seen by physician assistants, nurse practitioners, and residents in the emergency department: does the presumption of assent have an empirical basis?
abstract: Physician assistants (PAs), nurse practitioners (NPs), and medical residents constitute an increasingly significant part of the American health care workforce, yet patient assent to be seen by nonphysicians is only presumed and seldom sought. In order to assess the willingness of patients to receive medical care provided by nonphysicians, we administered provider preference surveys to a random sample of patients attending three emergency departments (EDs). Concurrently, a survey was sent to a random selection of ED residents and PAs. All respondents were to assume the role of patient when presented with hypothetical clinical scenarios and standardized provider definitions. Despite presumptions to the contrary, ED patients are generally unwilling to be seen by PAs, NPs, and residents. While seldom asked in practice, 79.5% of patients fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider. Patients are more willing to see residents than nonphysicians.
authors.affiliation: Yale University School of Medicine, New Haven, CT 06519, USA. GLuke.Larkin@yale.edu
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Larkin
authors.forename: Roderick S
authors.initials: RS
authors.lastname: Hooker
mesh_terms: D000328:Adult; D001290:Attitude; D002755:Choice Behavior; D032882:Comprehension; D015986:Confounding Factors, Epidemiologic; D017046:Cost Savings; D004636:Emergency Service, Hospital; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D016017:Odds Ratio; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data*; D010823:Physician Assistants; D011369:Professional-Patient Relations / Q000941:ethics*; D012494:Sampling Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D014481:United States; D000078329:Workforce