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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022
| Contributor Information
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
Physicians, physician assistants (PAs), and nurse practitioners (NPs) all enjoy high demand as the country deals with shortages of healthcare professionals. Meanwhile, expanded practice abilities for PAs and NPs is an idea that is gaining more traction. The need for doctors, PAs, and NPs to work effectively together constantly rises — but it seems like the difficulties do too.
Over 750 physicians who work with PAs and/or NPs told us about their working relationships with those professionals and how those relationships changed during the COVID-19 pandemic. They also evaluated the treatment capabilities of PAs and NPs and expressed their thoughts about both groups' expanding practice abilities. Separate reports on working relationships through the eyes of NPs and PAs will be published within a few days.
(Note: Some chart data in this presentation do not add up to 100% because of rounding or because neutral responses are not shown.)
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
The sheer numbers of medical professionals underscore the inevitability of close working partnerships between physicians and PAs:
The US has just over 1 million practicing physicians, according to the last data from the Federation of State Medical Boards. Nearly 70% of those doctors now work for hospital systems or other corporate entities, the Physicians Advocacy Institute reports. That means roughly 700,000 physicians are employed by health systems that also are likely to need PAs and NPs on staff.
Nearly 149,000 PAs are certified in the United States, according to the most recent report from the National Commission on Certification of PAs.
More than 355,000 NPs are currently licensed in this country, the American Association of Nurse Practitioners says.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
By an overwhelming margin, doctors are complimentary about how well they work with PAs. Those sentiments feelings are reciprocated; 94% of PAs we surveyed rate their working relationship with physicians as very good or good.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
Once again, the vast majority of doctors give high marks to how well they work with NPs, and once again, NPs return the assessment (92% of them said that the work relationship is very good or good.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
More than 7 in 10 physicians think that the strains of the pandemic — from scaled-back office hours to scrambling for PPE to mask policies — did not affect their working relationships with PAs or NPs at all. Doctors who did say the working partnerships changed were more likely to think that they got better than worsened.
For their part, PAs and NPs both were likelier than doctors to detect COVID impacts on working relationships. Somewhat greater shares of PAs and NPs than of physicians felt the professional partnership improved during the pandemic, and somewhat greater percentages said that it got worse.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
Doctors, on average, feel very similar about how PAs and NPs they work with act toward and treat patients. More than 7 in 10 of physicians are satisfied, to varying degrees, with PAs' and NPs' patient interactions. Those who aren't satisfied feel either neutral or dissatisfied roughly as often.
We asked the same question of PAs and NPs, and about three fourths of both groups said that they are satisfied with the way that they see doctors deal with patients.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
About three fourths of doctors said that they are satisfied, to varying degrees, with how well the PAs and NPs in their medical offices work with others on the healthcare team.
Flipping the microscope around, 79% of PAs are satisfied with how physicians work with the staff at work, and 11% are dissatisfied. For NPs, the percentages are 76% and 13%, respectively.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
Eight in 10 doctors said that they have felt justified in raising issues at least sometimes about a PA's calls on patient treatment. Given their roles, PAs less frequently find themselves questioning a physician's treatment decisions (57% answered "often" or "occasionally").
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
As they did with PAs, about 8 in 10 doctors told Medscape they often or occasionally had a problem with an NP's call on treatment. For their part, 63% of NPs said that they at least occasionally wondered about a physician's treatment decisions.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
Physicians are emphatic on this issue; about 9 in 10 said that their workplaces provide enough in the way of PPE, mental health programs, sufficient staffing, and other types of support. The PAs and NPs we surveyed emphatically agreed with doctors about getting enough PPE support, but smaller majorities said that mental health programs and staffing levels are enough.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
Medscape asked physicians about the optimal team practice (OTP) trend. Around 1 in 5 states now characterize the physician-PA relationship as collaborative rather than supervisory, according to the American Academy of Physician Associates.
Nearly 6 in 10 physicians were neutral on whether this trend is beneficial for the medical profession. Of the rest, a slightly greater share had a negative response vs a favorable one.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
.
How physicians feel about OTP for PAs comes into sharper focus on this question, to which 6 in 10 said that they oppose additional states expanding treatment abilities. As one would expect, PAs feel much differently, with 95% answering yes to this question.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
About three fourths of doctors told us they have experienced patients stating a clear preference to consult with a physician rather than with a PA. Seven in 10 PAs said that they've seen the same reaction, which helps validate the frequency of this reaction by patients.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
About half the states give NPs expanded patient treatment abilities or full practice authority (FPA). Medscape also asked doctors what they thought of this trend.
Similar to how they responded when asked about broader treatment capabilities for PAs, physicians often took a neutral stance. But they took that middle-of-the-road attitude less often and responded negatively more frequently with FPA for nurses.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
Physicians opposed more states granting FPA to nurses even more emphatically than they resisted the idea of more treatment expansions for PAs. Meanwhile, 96% of nurses answered yes to this question.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
About 7 in 10 doctors said that they have experienced a patient's expressed desire to consult with a physician rather than a nurse. Though a smaller share of NPs (62%) reported seeing this kind of patient insistence, strong majorities of physicians and nurses do experience it.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
What do patients think about expanded practice abilities? Physicians who treat patients and work with PAs and NPs told us that their patients respond positively to that treatment approach more often than they do unfavorably.
Perspectives differ here, however. Seventy-nine percent of PAs and 88% of NPs said that their patients reacted favorably, in varying degrees, to their practicing independently.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
Physicians firmly feel that when they are paired with a PA or NP, it's a more effective team than one with just PAs and/or NPs. Majorities (but smaller ones) of PAs and NPs feel the same way. Sixty-six percent of PAs and 57% of NPs answered no to this question.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
Just over half of physicians surveyed said that seeking a doctorate, residency, or fellowship could reap dividends both for a PA or NP (in career development) and for their patients (in quality care). Of note, doctors were significantly more positive about the benefits of advanced degrees than were PAs (25% of whom answered this question yes). Forty-seven percent of NPs were favorable.
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
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Evolving Scope of Practice: Physicians, NPs and PAs Weigh In
Jon McKenna | November 29, 2022 | Contributor Information
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Jon McKenna
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