The percentage of hospital outpatient department visits seen only by a physician assistant or advanced practice nurse rose from 10% to 15%, while the percentage of joint physician/nonphysician clinician visits remained at about 3%, health researchers found.
Among other findings in the Centers for Disease Control and Prevention report:
–About three-fourths of the more than 103 million hospital outpatient department visits in 2008-2009 were seen by a physician and 18% were seen by a physician assistant or advanced practice nurse;
–Among visits to a non-physician, 65% were seen by an advanced practice nurse and 35% were seen by a physician assistant;
–The percentage of outpatient department visits attended only by physicians declined from 77% in 2000-2001 to 72% in 2008-2009; and
–The percentage of visits not seen by a physician, physician assistant, or advanced practice nurse remained the same (10%).
Following previous trends, physician assistants or advanced practice nurses are the only provider for visits more often in rural areas, and with younger patients. Read more »
*This blog post was originally published at ACP Hospitalist*
“Physician Extender.” It sounds like the name of a male enhancement product. It’s a term often used to describe a nurse practitioner or a physician’s assistant. I hate it. It’s insulting.
A nurse practitioner is not an adjunct physician. They do not supplement the care of a physician. They provide essential advance-practice nursing services, services that include diagnosis and provision of medical care.
While some of these services overlap those of medicine, nurse practitioners are not extensions of another profession, they provide care in their own right — as educated, licensed practitioners. Sometimes the only care provider for a community is a nurse practitioner. Read more »
*This blog post was originally published at Emergiblog*
“Team care” has become a rallying cry for those who think the patient-centered medical home is bad for healthcare reform. Comments on a recent blog post in the New York Times provide a good example of this. When patients get sick, as the argument goes, they want to see their doctor — not some nurse or PA who they don’t know. I agree.
There are a whole bunch of things wrong with all the current focus on team care in the patient-centered medical home. Read more »
*This blog post was originally published at Mind The Gap*
Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.
— From A.A. Milne’s “Winnie the Pooh and the House at Pooh Corner.”
Internists, I expect, will identify with Edward Bear.
Richard Baron’s study in the NEJM on the amount of work he and his colleagues do outside of an office visit — the “bump, bump, bump” of a busy internal medicine (IM) practice — has resonated with many of his colleagues.
Jay Larson, who often posts comments on this blog, did a similar analysis for his general IM practice in Montana, and found that for every one patient seen in the office, tasks are done for 6 other unscheduled patients. Jay writes: “So really there [are] internists [who] are managing about 130 patients per day. Not much consolation when they only get paid for 18 per day.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
More unhealthy people are being herded into our healthcare system and more doctors are exiting. That’s the perfect formula for chaos.
I’d like to welcome the nursing profession here to save the day. Nurses have taken up the call for providing that missing link of access as doctors disappear. The expansion of nursing care to replace medical care in primary care is just the beginning of the next phase of American medicine. It all depends on how you define primary care. What can be cheaper must be done cheaper. Read more »
*This blog post was originally published at The Happy Hospitalist*