Patient care by physician assistants and by physicians in an emergency department

Decreasing health care dollars have resulted in increased utilization of so-called midlevel practitioners. We compared emergency physicians with emergency department physician assistants (PAs) to determine whether PAs are an appropriate option for providing services rendered by physicians in this setting.

We undertook an observational retrospective review of a hospital database (July 1995 to June 1996) from an urban urgent-care facility. Collection of data was restricted to times of single-provider coverage. Every patient who visited the clinic was seen by the sole provider (physician or PA) on duty; no one was turned away. If a patient needed emergency care, he (or she) was transferred to the main emergency department at the hospital, as deemed appropriate by either provider after evaluation. Physicians and PAs were compared in regard to length of visit and total charges in 14 diagnostic groups. Adverse outcomes were not evaluated. Age, sex, race, and multiple diagnoses were controlled for by regression analysis.

A total of 9,601 patient encounters were analyzed. PAs and physicians had a similar distribution of diagnostic groups. Respiratory infection and musculoskeletal disorders accounted for approximately 36% of visits; lacerations, gastrointestinal disorders, and otitis each accounted for 5% of visits. Overall, visits were 8 minutes longer and total charges $8 less when a patient was treated by a PA. Patients who had headache, otitis, respiratory infection, asthma, gastrointestinal or genitourinary disorder, cellulitis, laceration, or other musculoskeletal disorder had a longer visit when seen by a PA; the difference ranged from 5 to 32 minutes longer. In no diagnostic group was there a statistically significant greater length of visit or total charge because patients were seen by a PA.

Despite a few large differences in some diagnostic groups, the two types of provider had, overall, small but clinically insignificant differences in length of visit and total charges. The magnitude of difference in length of visit and total charges strongly suggests that PAs, when compared with physicians, are a viable staffing option in an urgent care facility.