A comparison of practice characteristics among physician assistants in HMO and non-HMO settings

Health maintenance organizations (HMOs) have continued to grow in both number and enrollment. A major goal of HMOs and other managed care structures is the containment of health care costs. The utilization of physician assistants (PAs) would seem to nicely mesh with these organizations. This study examines the roles, productivity, and clinical autonomy of PAs in HMO settings. In this examination, PAs working with HMOs are compared with PAs working in non-HMO settings, both urban and rural. The results of the study document that PAs working in HMO environments primarily focus on ambulatory care, with few inpatient or administrative responsibilities. Further, PAs working in HMO settings have a highly autonomous practice with approximately 70 percent of patient visits never being discussed with a supervising physician. Lastly, the results suggest that many of the attributes of an HMO practice are found in rural practice as well. Consequently, as HMOs reach out farther into rural America, PAs in rural settings will have fewer practice modifications to make than urban PAs in their transition to practice in an HMO modality.