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Member Research & Reports

Member Research & Reports

Kentucky: Presence of Nurse Practitioners and Physician Assistants Impacts Practice Capacity and Scope for Family Physicians

To date, little has been known about how the presence of nurse practitioners (NPs) and physician assistants (PAs) in a practice impacts family physicians’ (FPs) scope of practice. A new study from the American Board of Family Medicine (ABFM) and the University of Kentucky College of Public Health (UKCPH) sought to examine variations in family physicians’ practice associated with the presence of NPs and PAs. “Scope of Practice and Patient Panel Size of Family Physicians Who Work With Nurse Practitioners or Physician Assistants” appears in the current issue of Family Medicine. The authors are Dr. Mingliang Dai, ABFM, Dr. Richard Ingram, UKCPH, and Dr. Lars E. Peterson, ABFM.

The investigators used data from American Board of Family Medicine practice demographic questionnaires completed by FPs who registered for the Family Medicine Certification Examination during 2013-2016. Scope of practice score was calculated for each FP. Physicians self-reported patient panel size. Primary care teams were classified into NP only, PA only, both NP and PA, or no NP or PA. Researchers estimated variation in scope and panel size with different team configurations in regression models.

Of 27,836 FPs, nearly 70 percent reported NPs or PAs in their practice, but fewer than half (42.5 percent) estimated a panel size. Accounting for physician and practice characteristics, the presence of NPs and/or PAs was associated with significant increases in panel sizes and in practice scope.

The investigators found evidence that team-based care involving NPs and PAs was associated with higher practice capacity of FPs. Working with PAs seemed to allow FPs to see a greater number of patients and provide more services than working with NPs.