title: Offers of appointments with nurse practitioners if a requested physician is unavailable.
abstract: OBJECTIVE
  Access to primary care remains a problem for a substantial portion of the U.S. population, and is predicted to worsen due to an aging population and the increasing burden of chronic diseases. Better integration of nurse practitioners (NPs) into the primary care workforce is a possible solution. We examine offers of appointments with NPs if a requested primary care physician is unavailable.
  
  
  METHODS
  Data are from a 2013 audit (simulated patient) study requesting appointment information from a national random sample of primary care physicians. Outcome variables include appointment offers, wait-to-appointment times, and appointment offers with alternate providers, including NPs.
  
  
  CONCLUSIONS
  Of 922 calls to primary care physicians serving the general adult population, 378 (41%) offered appointments with the requested physician. Alternate providers were offered by 63 (7%), including nine offers with NPs (<1%). Mean wait-to-appointment for NPs (3.6 days) was statistically significantly shorter (p-values < .01) than for requested physicians (22.5 days) or non-NP alternate providers (23.9 days).
  
  
  CONCLUSIONS
  NPs are an important part of the primary care workforce, and new patients seeking primary care physicians may substantially reduce their wait times if an NP is offered.
authors.affiliation: Department of Economics, Portland State University, Portland, Oregon.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tinkler
authors.affiliation: Department of Economics, Portland State University, Portland, Oregon.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Economics, Portland State University, Portland, Oregon.
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Pal
authors.affiliation: Department of Economics, Portland State University, Portland, Oregon.
authors.forename: Raven
authors.initials: R
authors.lastname: Susu-Mago
authors.affiliation: Department of Economics, Oakland University, Rochester, Michigan.
authors.forename: Miron
authors.initials: M
authors.lastname: Stano
mesh_terms: D001071:Appointments and Schedules; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010820:Physicians / Q000600:supply & distribution; D011320:Primary Health Care / Q000379:methods; D013997:Time Factors; D014850:Waiting Lists; D000078329:Workforce
keywords: Nurse practitioners; healthcare delivery; physicians; primary care