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Nurse practitioners and physician assistants employed by general and subspecialty pediatricians
Gary L Freed1, Kelly M Dunham, Carol Loveland-Cherry
1Child Health Evaluation and Research Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, School of Medicine, University of Michigan, Ann Arbor, Michigan 48109-0456, USA. gfreed@med.umich.edu
Insights
Pediatric practices have limited current use of nurse practitioners (NPs) and physician assistants (PAs), but plan to hire more. Competition for these professionals may increase, impacting pediatric care delivery.
Area of Science:
- Pediatric healthcare workforce analysis.
- Advanced practice provider utilization in medicine.
Background:
- Limited national data exists on how nurse practitioners (NPs) and physician assistants (PAs) function in pediatric settings.
- Understanding the current roles and activities of NPs and PAs in pediatric care is essential.
Purpose of the Study:
- To assess the current employment and scope of work for NPs and PAs in US pediatric practices.
- To identify trends and future intentions regarding NP and PA hiring by pediatricians.
Main Methods:
- A national survey of 498 pediatric generalists and 1696 subspecialists was conducted.
- A structured questionnaire addressed practice settings, employment, and professional activities of NPs and PAs.
Main Results:
- 55% of general pediatricians and one-third of subspecialists currently do not work with NPs or PAs.
- Most pediatric practices plan to increase their employment of NPs and PAs within five years.
- Variability exists in NP and PA utilization and scope of work across general and subspecialty pediatric practices.
Conclusions:
- Planned increases in NP and PA hiring may lead to competition between general pediatricians and subspecialists for a limited workforce.
- Potential shortages could impact the recruitment and hiring of new pediatric NPs and PAs.
Objective:
There is little nationally representative information describing the current manner in which nurse practitioners (NPs) and physician assistants (PAs) work in pediatric practices and their professional activities. To understand better the current NP and PA workforce in pediatric primary and subspecialty care, we conducted a national survey of pediatricians.
Methods:
A survey study of a random national sample of 498 pediatric generalists and 1696 subspecialists in the United States was performed by using a structured questionnaire administered by mail. The survey focused on practice settings, employment, and scope of work of NPs and PAs.
Results:
Response rates were 72% for generalists and 77% for subspecialists. More than one-half (55%) of generalists reported that they do not currently work with NPs or PAs, compared with only one-third of subspecialists who do not. Many generalists and subspecialists intend to increase the number of NPs and PAs in their practices in the next 5 years. More generalist and subspecialty practices work with NPs than with PAs. There was great variability between generalists and subspecialists and among different subspecialties in the proportions that worked with NPs and PAs. The scope of work of NPs and PAs also varied between generalists and subspecialists.
Conclusions:
Planned increases in the number of NPs hired and expansion of their scope of work might put subspecialists and general pediatricians in competition with regard to recruitment and hiring of a limited pool of new pediatric NPs. Similar issues might arise with PAs.
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