The physician assistant (PA) and nurse practitioner (NP) professions began in the 1960s as part of a strategy to cope with a lack of primary care medical providers in rural and underserved areas. PAs and NPs filled gaps in primary care services that were created as more physicians moved into specialty and subspecialty areas of medicine.1-5 However, recent employment trends in the PA and NP professions indicate movement away from primary care and into specialty fields.6-9
Over the past few years, a change in resident physician staffing regulations in hospitals has created additional employment opportunities for PAs and NPs. On July 1, 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted standards for all residency programs nationwide limiting the hours worked by a resident physician to no more than 80 hours per week averaged over 4 weeks. As a result of these limitations, teaching hospitals throughout the United States were faced with potential staffing shortages.10-12 Surgical resident coverage at trauma centers was one specialty affected by the new residency work hour standards. Thus, hospitals have increased utilization of PAs and NPs to fill practitioner gaps.12-19
According to the American Academy of Physician Assistants (AAPA) annual census data, the number of PAs working in trauma centers has increased.9 The purpose of this study was to determine the prevalence of PA/NP utilization in major trauma centers in the United States. It was anticipated that results of this survey would provide additional information about the role of PAs/NPs on a trauma service and identify the potential for future employment growth. Increasing awareness of the responsibilities that have been entrusted to PAs/NPs may stimulate their utilization by trauma centers faced with staffing shortages.
ABSTRACT
Objective: Census data published by professional organizations indicate an upward trend in the number of physician assistants (PAs) working in many specialty fields, including the subspecialty of trauma surgery. As the role of hospital-based PAs and nurse practitioners (NPs) continues to evolve, greater understanding of these roles will help identify future employment trends for these professions. The purpose of this study is to determine the prevalence of PAs and NPs in US trauma centers, to document their roles, and to identify their potential future utilization by trauma centers.
Methods: A survey was mailed to 464 directors of major trauma centers in the United States. The survey was designed to evaluate trauma centers' utilization of PAs/NPs. Respondents were asked to identify specific daily tasks of PAs/NPs and to indicate potential for their future utilization.
Results: Two hundred forty-six (246) of 464 surveys were returned, for a response rate of 53%. Approximately one-third of reporting major trauma centers reported utilizing PAs/NPs. More American College of Surgeons (ACS)- verified trauma facilities utilized PAs/NPs than did nonverified facilities; and Level I trauma centers used significantly more PAs/NPs than did Level II trauma centers. Nineteen percent (19%) of respondents who did not currently utilize PAs/NPs indicated that they intended to do so in the future. The majority of facilities utilized PAs/NPs to assist with trauma resuscitation and in performing traditional tasks, including obtaining and dictating histories and physical findings, participating in rounds on the general medical floor, and dictating discharge summaries. Fewer than half of reporting facilities indicated that PAs/NPs performed more invasive procedures, such as inserting arterial lines, central lines, chest tubes, and intracranial pressure monitors.
Conclusions: PAs and NPs are increasingly utilized as clinicians in the surgical subspecialty of trauma. In most trauma centers, PAs/NPs are utilized to complete the traditional duties of a surgical PA/NP, with fewer performing invasive procedures. Finally, 19% of responding trauma centers who do not currently utilize PAs/NPs state that they intend to in the future, indicating the potential for continued job growth for PAs/NPs in trauma care. This evaluation of the utilization of PAs/NPs in direct care to trauma patients indicates acceptance of PAs/NPs in trauma staffing models.
METHODS
This descriptive, cross-sectional survey was conducted by the Department of Physician Assistant at Wichita State University from March 2007 through June 2007 following approval by the Institutional Review Board at Wichita State University. A listing of trauma centers (1,334) in the United States was obtained from the American Trauma Society. This listing was then narrowed to hospitals designated by their state or region and/or verified by the American College of Surgeons (ACS) as a Level I (186) or Level II (245) trauma center (providing highest levels of trauma care). The remaining trauma centers were designated as Level III/IV/V or unspecified and excluded from the survey population. A cover letter, a nine-item survey, and a stamped return envelope were then mailed to the directors of trauma care for each of the remaining 464 facilities.
Survey questions were designed to determine current utilization of staff members (PAs, NPs, and surgical residents) and their typical responsibilities, as well as PA/NP participation on other rapid-response teams (code blue, critical illness, etc.). If PAs/NPs were not currently utilized, respondents were asked to indicate if they anticipated future utilization of PAs/NPs as a part of their trauma team. Questions regarding institution demographics, specifically level of verification, were also included.
Results are reported in percentages. Pearson's chi-square test of association analysis was used to evaluate the relationships between trauma center verification/designation and use of PAs/NPs. Data were analyzed using SPSS Version 15.0 for Windows.