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Nurses And Physician Assistants Are Increasing Their Market Share Of Outpatient Medicine

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.

Visits to physician assistants or advanced practice nurses are more common in nonteaching hospitals and in smaller hospitals. The more urban the hospital location, the lower the percentage of visits seen only by physician assistants or advanced practice nurses, decreasing from 36% in nonmetropolitan areas to 6% in large, central metropolitan areas.

General medical and obstetrics or gynecology clinics have higher percentages of physician assistant or advanced practice nurse visits than either pediatric or surgery clinics. Percentages for specialties included general medicine (21%), obstetric or gynecology (19%), pediatrics (8%), and surgical clinics (5%).

Physician assistants and advanced practice nurses saw a higher percentage of visits where a new problem was the major reason for the visit (22%) compared with visits for a chronic condition [routine (11%) or flare-up (14%)], or pre- or postsurgery care (6%).

“Physician assistants or advanced practice nurses continue to provide a critical health care function by providing care in settings with fewer physicians, such as rural locations, small hospitals, and nonteaching hospitals,” the authors concluded.

All estimates are from the 2008 and 2009 National Hospital Ambulatory Medical Care Survey, an annual, nationally representative survey of visits to nonfederal, general, and short-stay hospital emergency and outpatient departments. Outpatient department data in this study were limited to visits seen by a physician, physician assistant, or advanced practice nurse (n=59,165), of which 52,718 were seen by a physician (including 3,016 seen by both physician and physician assistant or advanced practice nurse) and 6,447 were seen only by physician assistants or advanced practice nurses.

An estimated 10% of visits in 2008-2009 did not involve a physician, physician assistant, or advanced practice nurse (n=8,294) and were attended by a registered nurse or licensed practical nurse, mental health provider or some other provider. These visits were excluded from the report.

*This blog post was originally published at ACP Hospitalist*

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