title: Nurse practitioners and physician assistants are complements to family medicine physicians.
abstract: Controlling the overall cost of medical care requires controlling the number of physician visits. Nurse practitioners and physician assistants (NPs/PAs) may function as lower-cost substitutes for physicians or they may complement physician services. The association between NP/PA and physician visits when NPs/PAs are not working as primary care providers (PCPs) has not been thoroughly studied. A sample of 400 family medicine patients drawn from 1 large multisite practice was studied using multiple logistic regression analysis. NPs/PAs did not function as PCPs during the study period. Patients were defined as outliers if they visited physicians more than 5 times in a year. Patients who visited NPs/PAs in non-retail clinics were significantly more likely to be physician visit outliers. Visits to NPs/PAs in retail clinics were not related to physician visits. NP/PA visits in standard medical office settings complement physician visits when the NPs/PAs were not working as PCPs in this large multisite practice. Health care reform proposals relying on increased use of NPs/PAs may be more cost-efficient if NPs/PAs are located in retail settings or function as PCPs.
authors.affiliation: Department of Family Medicine, Mayo Clinic-Rochester, Rochester, Minnesota 55905, USA. rohrer.james@mayo.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Rohrer
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Angstman
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Garrison
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pecina
authors.forename: Julie A
authors.initials: JA
authors.lastname: Maxson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D009819:Office Visits / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000458:organization & administration*; D014481:United States; D055815:Young Adult