Consumers' assessments of their medical providers are an important aspect of effective care because satisfied patients are more likely to follow through on a clinician's recommendations than are dissatisfied patients.1,2 PAs and NPs are increasingly providing patient services, especially primary care for vulnerable populations.3 For example, as of 2002, an estimated 110,000 PAs and NPs were clinically active, making them approximately one sixth of the medical workforce. Of this number, at least 5% of PAs and NPs were working in the specialty of geriatrics.4 Reasons postulated for the increased number of PAs and NPs practicing in geriatrics include an aging population with its increased demands for services and resources, coupled with a shortage of physicians willing to specialize in geriatrics. As a result, virtually all states, along with the federal government, have fashioned legislation that enables the PA and NP to work in traditional physician settings. This national health workforce policy has been a center of attention as the United States decides how many physicians will be needed in 2030, when the elderly population will be twice what it was in 2000.
While attention to how patients perceive their PA and NP providers is critical to the successful deployment of these providers, documentation of patient attitudes regarding PAs and NPs is sparse. These attitudinal differences are important to know because if consumers are not satisfied with PAs or NPs, no alliance with organized medicine will ensure the future of these clinicians.
One of the first studies examining patient expectations of PAs in dealing with a series of personal, social, psychological, and health-related items indicated that patients expected the PA to be involved in these areas but did not expect the PA to be an expert.5 A systematic review of the literature on NPs and how they compared to physicians concluded that the increasing availability of NPs in primary care is likely to lead to high levels of patient satisfaction and high-quality care.6
Few studies on patient satisfaction have simultaneously compared PAs, NPs, and physicians. In one study, patients assessed the confidence of primary care PAs and physicians after clinic visits for low back pain. Patients of providers who appeared confident in their overall rapport with patients and assessment were significantly more satisfied with the information they received than were patients of less confident providers. Differences could not be explained by years in practice, length of visit, patient demographics, or type of provider.7 In an HMO study, members in the Pacific Northwest region of Kaiser Permanente rated the “technical competence, skill, and ability” of physicians, PAs, and NPs as “satisfied or very satisfied” more than 75% of the time.8 Using a different instrument for validation purposes, the same population was reexamined over an 18-month period in the early 1990s with regard to how members view physicians, PAs, and NPs. A 57-item questionnaire asked specifically about satisfaction with a recent medical office visit and a specific provider. When health plan members were asked how satisfied they were with their latest encounter, adult practice PAs and NPs scored within 1% to 2% of physicians (88%-90% favorable globally). The technical skill of PAs and NPs rated within 3% to 4% of that of physicians. As for overall satisfaction, members regarded adult medicine physicians, PAs, and NPs almost the same and as statistically indistinguishable from each other, regardless of members' age or gender.9
From the literature, it appears that patients may hold NPs and PAs in the same regard as physicians, depending on the setting and how the study was undertaken. However, this information is limited to small studies and geographically isolated populations. The views expressed in attitude surveys may reflect patients' confidence in the ability of NPs and PAs to take care of their medical conditions in those settings, but a national study of patient satisfaction of PAs has never been conducted and few have compared PAs and NPs with physicians.
A number of factors point to the need for more patient satisfaction studies. The growing number of older Americans and the increasing demand for health services by all segments of the population will require a larger supply of health providers, especially among those trained in primary care and/or treatment of the elderly. However, as of 2005, a dwindling proportion of newly trained physicians is selecting primary care or geriatrics as a practice specialty. At the same time, the number of PAs and NPs assuming the roles of primary providers in American medicine is growing.4 With this in mind, we undertook a survey study in order to expand on the empirical evidence regarding older patients' experiences with PAs and NPs. With this type of survey, we could assist policy makers in shaping the next generation of health care providers.