By Michael J. Dill
AAMC’s Center for Workforce Studies recently published its study, “Survey Shows Consumers Open to a Greater Role for Physician Assistants and Nurse Practitioners” in Health Affairs. With rapidly rising health care demand in the United States necessitating a greater reliance on physician assistants (PAs) and nurse practitioners (NPs), and rising concern over possible pending shortages of physicians, particularly in primary care, our study examined provider preferences from the patients’ perspective using data from the AAMC’s most recent consumer survey. Our findings indicate an openness on the part of US consumers to receiving care from PAs and NPs. This understanding can and should inform policy makers as they shape solutions to shortages, especially in primary care.
I still recall my own first encounter with provider choice. During the uncertainty that enveloped my transition from full-time graduate student to full-time employee, I was faced with the need to choose a primary care provider that was not the university clinic. So I simply selected a practice down the street from where I lived. One day when I could not get in to see my physician, I was informed I could see her PA. My response was eloquent and well-informed: “OK, whatever. As long as I can see someone.”
At that moment, I became part of what would become, according to our study, one of the 25 percent of American adults who are less concerned with the type of provider they see than with just seeing someone. I also learned something about our health care system: It was evolving. I had grown up with a “family doctor,” just like everyone else I knew. Now here I was, trying something different.
That was 20 years ago. Our health care system is still evolving, though perhaps under greater strain.. Like me, most Americans still can get care. But the nation now faces physician shortages, especially for the medically underserved, and the implementation of the Affordable Care Act may exacerbate the problem. Given that physician shortages cannot be addressed in a timely fashion purely by producing more physicians, some policy analysts propose using other health care professionals, such as PAs and NPs, to fill the gap.
In our Health Affairs paper, we tried to evaluate those proposals from a consumer’s perspective, rather than those of pundits and policy analysts. What we found was that, unlike me all those years ago, most Americans (82.5 percent) now know what physician assistants and nurse practitioners are. When they imagined that they needed to find a new primary care provider, even though half (50.3 percent) opted for a physician, more than one-fifth (22.8 percent) expressed a preference for a PA or NP, and a quarter (25.9 percent) indicated no preference at all.
Our findings further suggest that having seen a PA or NP may lead to a preference for seeing one. My own experience is consistent with that message: The PA I agreed to see out of urgency became my primary care provider for the next five years. Not only was it easier to get an appointment with him, but he had more time for me and consequently got to know me better as a person as well as a patient. Now, given the growing presence of PAs and NPs, we can all expect to see more of them. Based on our findings, we believe that this increased exposure will lead to a greater willingness to be seen by them, and hence an increased role for them in ongoing as well as episodic care. At the very least, we believe that these relationships deserve more attention.
As we move forward with health care reform, we must keep our patients at the heart of all we do, and access is crucial. In the case of PAs and NPs providing primary care, at least, their growing role is crucial and welcome. So in this, though perhaps in little else, I like to believe I was ahead of the curve.
—Michael J. Dill is a Senior Data Analyst at the Association of American Medical Colleges. He can be reached at MDill@aamc.org.
The full study was authored by Michael J. Dill, Stacie Pankow, Clese Erikson and Scott Shipman of the AAMC’s Center for Workforce Studies.