Physician's extenders' performance in Air Force clinics

We evaluated the quality of care of physician's extenders (PEs: 23 physician's assistants, 7 primary care nurse practitioners) in Air Force primary medicine clinics, as part of an evaluation of PEs' assuming a considerable portion of the care, formerly provided by physicians in the military medical system. Physician's assistants performed at least as well as physicians on 25 out of 28 nonredundant process-of-care criteria; nurse practitioners met the physicians' standard on 14 of 19 criteria. In a comparison of physician's assistants with nurse practitioners, the two groups' performance was not significantly different. No major differences were found in PEs' and physicians' use of ancillary services (laboratory, x-ray, physical therapy) or orders for further care. As expected, PEs consulted physicians infrequently, but more often for serious complaints and at rates similar to those found in a civilian HMO setting. We conclude that the Air Force can deliver the same quality of care when PEs treat a sizable proportion of patients formerly treated by physicians.