SAN FRANCISCO — Medical education programs should know which procedural skills to include in physician assistant and nurse practitioner training programs to best prepare students for the job market they will encounter, but relatively little data is available on the topic.
“We talk about provider mix and teams, but in many ways we’re not sure what folks are doing out there day-to-day, patient-to-patient,” said Richard Dehn, MPA, PA-C, founding chair and professor of the PA Program at Northern Arizona University in Flagstaff. “I started to think, with the interchangeability and substitutional role of PAs and NPs increasing, is there some way we can document if they are do more procedures than others?”
To better understand the specific work performed by primary care physician assistants, nurse practitioners, and physicians, Dehn and colleagues analyzed CPT codes from a community health center that administers dozens of separate clinics, spread over hundreds of miles distance in Northern Arizona for 12 months.
Dehn and Kristine Himmerick, MS, MPAs, PA-C, PhD-candidate, also at Northern Arizona University, presented the research at the American Academy of Physician Assistants 2015 meeting.
The study included data from 93 providers — 48 physicians, 29 advance practice register nurses (APRNs) and 16 PAs — who saw 59,674 patients during 174,587 total visits. A total of 45,690 procedures were performed.
The amount of work being done by all three professions was similar, with PAs performing an average of 573 procedures, APRNs performing an average of 469 and physicians performing an average of 478, the researchers found.
Respiratory procedures and fetal monitoring were among the top five most common procedures among all three professions. The five most common procedures (from most to least) by profession were as follows:
- Physician assistants: Respiratory procedures, fetal monitoring, dermatologic procedures, cerumen removal, and simple wound closure
- Nurse practitioners: Respiratory procedures, microscopy, fetal monitoring, physical contraception and cerumen removal
- Physicians: Fetal monitoring, respiratory procedures, joint injections, microscopy, dermatological procedures.
Ob/gyn procedures are common among all three professions, whereas dermatologic procedures are more common among PAs and physicians than NPs, the researchers found.
Study limitations included the single center study design and inability to analyze patient outcomes.
The next phase is to explore different procedures by rural and urban locations, include more clinic sites and analyze data over multiple years to be able to evaluate changes over time, as well as to look out the association between procedure by profession and patient outcomes.