Researchers examined data from the National Ambulatory Medical Care Survey for medical and surgical specialist visits from 2001 to 2013. They found overall involvement of NPs and PAs has increased 109 percent from 2001-2003 to 2010-2013 for surgical specialists (from 3.3 percent of visits to 6.9 percent of visits) and has increased nearly 142 percent for medical specialists over the same time period (from 2.4 percent to 5.8 percent). NP and PA involvement grew for both new and return visits, based on an unadjusted analysis of the data.
However, after adjusting for visit and patient factors that could make non-physician provider involvement more likely, the analysis showed the proportion of patient visits to a medical or surgical specialist involving an NP or PA between 2010 and 2013 was 10.6 percent among patients with four or more chronic conditions, compared to 5.6 percent for patients with no chronic conditions.
“In adjusted analysis, NPs or PAs were disproportionately involved in care of patients with greater medical complexity, requiring further work to understand if this reflects team-based care, coding artifact, or other explanations,” the authors wrote. “These findings are particularly notable given that NPs and PAs in specialty care receive shorter formal training than specialist physicians, with specialty-specific training entirely on-the-job in some fields.”
Among the specialties analyzed, ear, nose and throat physicians were the most likely to involve NPs or PAs in patient care (8.5 percent of visits 2010-2013), followed closely by dermatologists (8.3 percent of visits). General surgeons were the least likely to have NPs or PAs involved in patient care (4 percent of visits).
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