Issues confronting the new health professionals

New health practitioners (NHPs) is a generic term referring to mid-level health workers such as physician's assistants and nurse practitioners who perform tasks traditionally within the purview of physicians. In the little over ten years since the first program to train physician assistants was initiated at Duke University, 6,500 physician's assistants (PAs) have completed formal training programs. Similarly, programs to train nurses for extended roles have prepared more than 8,500 nurse practitioners over the same decade. This paper considers the comparative achievements of these two major new health professions during the last decade and identifies eight crucial issues which may influence new health professionals in the ten years which lie ahead: (1) How many NHPs are enough? (2) What impact are NHPs making on distribution? (3) Do we know what clinical difference NHPs make? (4) Are NHPs bringing about cost control in health care? (5) What is the status of the controversy between organized medicine and nursing with regard to NHPs? (6) Are there differences between nurse practitioners and physician's assistants? (7) How are NHPs certified? and (8) Finally, can a better name than "new health practitioners" be found?