title: Physician assistants in medical ward care: a descriptive study of the situation in the Netherlands.
abstract: OBJECTIVE
  Medical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs.
  
  
  METHODS
  In this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n = 179) were asked to complete a questionnaire to measure workload, supervision and tasks performed.
  
  
  RESULTS
  We distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P = 0.000), while MDs spend more time on scientific research (P = 0.030).
  
  
  CONCLUSIONS
  Across different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care.
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Marijke J C
authors.initials: MJ
authors.lastname: Timmermans
authors.affiliation: Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Anneke J A H
authors.initials: AJ
authors.lastname: van Vught
authors.affiliation: Department of Surgery, Scheper Hospital, Emmen, The Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Van den Berg
authors.affiliation: Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.
authors.forename: Erik D
authors.initials: ED
authors.lastname: Ponfoort
authors.affiliation: Department of Surgery, Van Weel Bethesda Hospital, Dirksland, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Riemens
authors.affiliation: Department of Surgery, Laurentius Hospital, Roermond, The Netherlands.
authors.forename: Jacco
authors.initials: J
authors.lastname: van Unen
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Wobbes
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Miranda G H
authors.initials: MG
authors.lastname: Laurant
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010823:Physician Assistants; D010819:Physician's Role; D011795:Surveys and Questionnaires
keywords: hospital medicine; medical doctor; medical ward care; physician assistant; task reallocation