title: The National Ambulatory Medical Care Survey: PAs and NPs in outpatient surgery.
abstract: BACKGROUND
  This study aimed to determine the prevalence and occupational characteristics of physician assistants (PAs) and nurse practitioners (NPs) in outpatient surgical subspecialty clinics.
  
  
  METHODS
  The 2007 and 2008 National Ambulatory Medical Care Survey (NAMCS) databases were queried for the number and characteristics of office visits seen by different provider types (PAs or NPs, physicians, or both) in various surgical subspecialties.
  
  
  RESULTS
  More than 250 million weighted sample visits were analyzed. PAs or NPs were involved in 5.9% of visits, though the percentage of patients seen by them alone (1.1%) was significantly lower (P<0.0001). PAs and NPs were more likely to be involved in pre- or postoperative visits, and often saw the same diagnoses alone as physicians only. The most common procedures performed by PAs and NPs varied according to subspecialty.
  
  
  CONCLUSIONS
  PAs and NPs have a minor prevalence in the ambulatory surgical workforce during the time period studied. Further integration of these providers into the outpatient setting may help optimize efficiency in ambulatory surgical care.
authors.affiliation: At the time this article was written, Ara A. Salibian was a medical student at the University of California at Irvine. He now is a resident in the Department of Plastic Surgery at New York (N.Y.) University. Hossein Mahboubi is a resident in the Department of Otolaryngology-Head and Neck Surgery at the University of California at Irvine. Madhukar S. Patel is a resident in the Department of Surgery at Massachusetts General Hospital in Boston, Mass. Edward C. Kuan is a resident in the Department of Head and Neck Surgery at the University of California at Los Angeles. Darren J. Malinoski is section chief in Surgical Critical Care at the Portland (Ore.) Veterans Affairs Medical Center and an associate professor of surgery at Oregon Health and Science University. Parsia A. Vagefi is associate surgical director of liver transplantation at Massachusetts General Hospital. Hamid R. Djalilian is director of the Division of Neurotology and Skull Base Surgery in the Department of Otolaryngology-Head and Neck Surgery at the University of California at Irvine. The authors have disclosed no potential conflicts of interest, financial or otherwise.
authors.forename: Ara A
authors.initials: AA
authors.lastname: Salibian
authors.forename: Hossein
authors.initials: H
authors.lastname: Mahboubi
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.forename: Edward C
authors.initials: EC
authors.lastname: Kuan
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Malinoski
authors.forename: Parsia A
authors.initials: PA
authors.lastname: Vagefi
authors.forename: Hamid R
authors.initials: HR
authors.lastname: Djalilian
mesh_terms: D000553:Ambulatory Care; D000556:Ambulatory Surgical Procedures; D019538:Health Care Surveys; D006801:Humans; D009722:Nurse Practitioners; D009819:Office Visits; D010823:Physician Assistants; D014481:United States