Consumer Preferences Toward Non-Physician Providers
Linda H. Aiken, PhD, FAAN, FRCN, RN, is the Claire M. Fagin Leadership Professor in Nursing, a professor of sociology, and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Aiken is a research manager supporting the Future of Nursing: Campaign for Action and a National Advisory Committee member for the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. This is cross-posted on the Leonard Davis Institute Voices blog.
All too often, the debate about expanding the role of nurse practitioners (NPs) and physician’s assistants (PAs) takes place in a vacuum, as though these practitioners do not already deliver significant amounts of primary care. But they do, and existing evidence indicates that quality of care and patient satisfaction are good as a result.
Even before the passage of the Affordable Care Act, the nation had a shortage of primary care providers. The shortage is likely to intensify when the demand for primary care increases as millions become insured. The numbers of and roles assumed by NPs and PAs have been growing steadily, and allowing these providers to take on an even greater role could address the increased demand for primary care.
In the RWJF Human Capital Blog in July, I noted the need for better data on consumer preferences about an expanded role for non-physician providers. A study recently published in Health Affairs, “Survey Shows Consumers Open To A Greater Role For Physician Assistants And Nurse Practitioners” is an encouraging step forward. It documents the extensive experience consumers already have with NPs and PAs, with 81 percent having seen a NP or PA for their care at some point in time, and 40 percent having seen one during their most recent medical care visit.
The study asked respondents what their preference would be if they needed to find a new provider. Only about half opted for a physician, while just over one-fifth (23 percent) expressed a preference for a NP or PA, and a quarter indicated no preference. Even more revealing were consumers’ responses to two clinical scenarios to assess how consumers might weigh time and access trade-offs with the type of provider. In the first scenario, respondents chose between seeing a NP or PA today or a physician tomorrow for a worsening cough. The study found:
Nearly 60 percent preferred the physician assistant or nurse practitioner today, with only 25 percent preferring to wait a day to see a physician. Those with recent exposure to a physician assistant or nurse practitioner were more likely to want to see one again than to wait a day for the physician. Those who had never seen one showed a slight preference for waiting for the physician visit, 43.0 percent, compared to 39.5 percent who preferred a physician assistant or nurse practitioner.
In the second scenario, respondents chose between a visit with a NP or PA in one day or with a physician in three days for frequent severe headaches. This scenario elicited more pronounced preferences for the NP or PA:
Two out of three preferred to see one of these providers in a day instead of waiting three days to see the physician. In this scenario, even those with no prior visits with a physician assistant or nurse practitioner more often wanted to see one sooner (48.0 percent) rather than the physician later (38.3 percent).
This is a valuable contribution to the debate. A majority of consumers are open to being seen by NPs and PAs, with some even stating a preference for seeing these providers over a physician. Those respondents cite better access, lower cost, and positive past interactions as reasons for their preference. And respondents clearly value the timely access these practitioners could provide when medical care is needed.
As policymakers consider regulatory changes to expand the scope of practice for NPs and PAs, they should consider the present experiences and preferences of consumers for timely access to care. As I noted in July, 16 states and DC have already granted full legal scope of practice to advanced practice registered nurses, and the National Governors Association is recommending expanded scope of practice in other states to address access and cost issues. Recently the Veterans Health Administration has recommended that its advanced practice registered nurses be allowed to practice independently in all of its clinical settings in all states, acting upon existing federal authority that preempts state practice acts. The VA recommendation, if enacted as planned early next year, will be an important step towards reducing consumer waiting time for access to qualified primary care providers. Consumer perspectives on timely access to primary care will be important to resolving scope of practice debates as the Affordable Care Act moves toward full implementation.