Many Americans are willing to accept treatment for primary care needs from nurse practitioners and physician assistants, particularly if it means they can see a healthcare provider faster, study results indicate.

“[A]s scope-of-practice battles continue to be waged and new reforms for care delivery and reimbursement roll out, our findings provide early evidence that health care consumers in the United States are open to the idea of seeing physician assistants and nurse practitioners in the future—and in many cases prefer it,” Michael J. Dill, a senior data analyst at the Association of American Medical Colleges Center for Workforce Studies, and colleagues reported in Health Affairs.

Although the NP and PA professions are expected to grow to meet the needs of impending primary-care physician shortages in the United States, few studies have assessed how willing American’s are to accept this change.

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To better understand the attitudes of healthcare consumers, Dill colleagues surveyed more than 2,000 adults who sought medical care in the previous 12 months. 

When asked whether they would prefer to see a NP/PA or a physician if looking for a new health care provider, 50.3% chose the physician, whereas 22.8% opted for an NP or PA. The remainder of respondents indicated they either did not know or had no preference. 

Although physicians are still preferred at a significantly higher rate overall, it seems that NPs and PAs have an advantage in certain clinical scenarios.

When given the option of seeing a NP/PA today or a physician tomorrow for a worsening cough, 59.6% of those surveyed chose to see the NP/PA as opposed to waiting.  Moreover, when given the option of seeing a NP/PA in one day or a physician in three days for frequent headaches, 66.6% chose the NP/PA. Evidently, fast relief is a major determining factor when it comes to primary care.

Yet timeliness is only one reason patients seek care from NPs and PAs.  When asked to explain their choices, respondents cited conveniences like “lower cost [and] greater accessibility” and qualities such as “more personalized and compassionate care, greater comfort levels in communicating, and good experiences” from past encounters with NPs and PAs. 

Indeed, familiarity with NPs and PAs proved to correlate with a greater inclination to rely on them again. Conversely, patients who had never received treatment from an NP or PA — approximately 19% — were much less likely to seek care from one, 39.5% vs. 59.6%  in the coughing scenario.

Finally, the survey shows that Americans are becoming increasingly open to the idea of being treated by a NP or PA, with younger generations more likely to choose NPs and PAs for primary care health needs than older generations. Among respondents aged 18 to 34 years, 41.2% stated a preference for NPs and PAs when seeking a new healthcare provider compared with 5.8% of patients aged 65 years and older. 

The discrepancy might be explained by a mere lack of exposure to NPs and PAs for the elderly, as the NP/PA professions did not expand considerably until the 1980s, the researchers noted. Perhaps the equivalent demographic will be more receptive to NP and PA care in the future as their practice becomes more established, and patients become more familiar with their services.

The survey findings paint a tentative solution to the deficit of available U.S. primary care physicians as the Affordable Care Act extends access to healthcare to millions of Americans.

“Efforts to standardize scope of practice for physician assistants and nurse practitioners at [the state] level that enables them to take full advantage of their training and skills have the potential to improve access, especially for underserved populations,” Dill and colleagues concluded.

by Walker Harrison, an undergraduate student at Columbia University and editorial intern with Clinical Advisor.


  1. Dill MJ et al. Health Aff. 2013;30(6): 1135-1142.