Satisfaction of physician assistants and other nonphysician providers in a managed care setting

Health maintenance organizations have employed physician assistants, nurse practitioners, and other nonphysician providers for decades, yet there is little information on how satisfied these providers are with this form of practice. This paper examines how physician assistants evaluate their experience practicing in a large group model health maintenance organization and compares their attitudes and satisfaction levels with those of other nonphysician providers-nurse practitioners, optometrists, mental health therapists, and chemical dependency counselors. The data source is a 1992 survey of 5,000 nonphysician employees of a health maintenance organization. The survey instrument was a self-administrated questionnaire that included both structured and open-ended questions. The response rate averaged 88 percent for physician assistants and the other non-physician providers. Physician assistants expressed the most satisfaction with the amount of responsibility, support from coworkers, job security, working hours, supervision, and task variety. They were less satisfied with workload, control over the pace of work, and opportunities for advancement. Most physician assistants were also satisfied with pay and fringe benefits. Compared with other nonphysician providers, chemical dependency counselors expressed the highest levels of satisfaction across the various dimensions of work and optometrists the lowest. Nurse practitioners, chemical dependency counselors, and mental health professionals also tended to be satisfied with most aspects of practice in this setting. In a number of instances, they were more satisfied than the physician assistants. The findings are consistent with other studies that found health maintenance organizations to be favorable practice settings for physician assistants. The limits of physician assistant involvement and their role satisfaction and efficient use in HMOs are more likely to relate to physician attitudes and acceptance than to lack of support by coworkers and other attributes of the work environment.