Physician Assistant and Nurse Practitioner Roles in Patient-Centered Medical Homes

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February 2015

Christine M. Everett, PhD, MPH, PA-C; Brandt Leach, MS; Perri Morgan, PhD, PA-C

 

Executive Summary: 

Team‐based care involving physician assistants (PAs) and nurse practitioners (NPs) is one recommended strategy for improving access and quality and reducing cost in the patient‐centered medical home (PCMH). PAs and NPs can, and do, perform a variety of roles on primary care teams. This suggests that there is plasticity within the professions and between PAs, NPs, and physicians.

 

Key Findings/Policy Implications: 

1) The finding that PAs and NPs perform different patterns of clinical tasks in primary versus supplemental provider roles may be useful for workforce modeling of the task substitution potential of PAs and NPs.
2) PCMH PA and NP roles seem to be well suited to current training, but since PAs and NPs report not maximally using their training up to 30% of the time, team modifications and training that promote task delegation by PAs and NPs to staff with less training might increase efficiency of care.
3) Few PAs and NPs report performing tasks for which they are underqualified, but since these situations are potentially dangerous, provisions for back‐up should be available to these PAs and NPs.
4) Few PAs and NPs are spending significant time performing some newer PCMH functions such as population health management and quality improvement. Increased training in these areas may improve the likelihood of performing some of these functions.
5) Additional investigation is warranted to find potential causes and solutions to the dissatisfaction reported by the PAs and NPs who did experience role changes associated with PCMH implementation.

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