According to research published in JAMA Internal Medicine, growth in NP/PA participation in specialist visits occurred not only for routine or return visits, but also for new patients and complex acute visits. The authors of the study also observed almost twice the percentage of NP/PA visits (21.4% up from 12.3%) where the patient does not see a physician at all during the visit but exclusively sees the NP or PA.
The study compared NP/PA involvement in specialist visits during a recent three year time span versus a similar time span 10 years earlier. Though most specialties employ NPs and PAs throughout the U.S., otorhinolaryngology and dermatology were the specialties with the most NP/PA participation in this study. The authors couldn’t pinpoint the reason, but the NPs and PAs in their collected data “were disproportionately involved in care of patients with greater medical complexity.” The study results may even underestimate total involvement of NPs and PAs in specialty care as noted by the authors because their data reflects only care reported by NPs and PAs who share rosters with physicians.
Numerous other studies and surveys also conclude that NPs/PAs frequently practice independently. For example, in an analysis in the International Journal of Emergency Medicine, 40% of U.S. NP/PA Emergency Room visits studied did not involve physicians at all. The results of an unrelated survey of 218 rheumatologists by RheumNow indicated 72.7% of NPs/PAs are independent in their practice of rheumatology, and 72% of rheumatologist physicians are comfortable with assigning any or all patients to the care of the NP or PA with whom they work. A fourth study by the Health Care Cost Institute (HCCI) analyzed claims data from 2012 to 2016 and found visits to NPs and PAs increased by 129% over those four years. These studies highlight the point that NPs / PAs in many specialties are not just given the easy routine cases while physicians oversee or handle more difficult decisions. Over the last few years, many states have removed NP/PA practice resitrictions, and the Veterans Administration recently granted full practice authority to NPs, allowing veterans to receive medical care from NPs without physician supervision.
Conclusion
NPs and PAs don’t just play an important role in primary care, but they are also integral team members in specialty care and often sole treatment providers during visits to specialists. NPs/PAs are entrusted with the most difficult and complex medical cases.
About the Author: Jay Levenson is immersed in the world of Advanced Practice Providers (NPs and PAs) and has been helping pharma marketers reach this prescriber segment for the past seven years at RNsights, the leader in reaching NPs/PAs/RNs. Contact Jay with any questions about marketing to Advanced Practice Providers. JayL@RNsights.com.