PAs and NPs in Primary Care – One Part of the Care Delivery Solution

Lisa P. Shock, MHS, PA-C

Physician AssistantsPhysician Assistants (PAs) and Nurse Practitioners (NPs) are skilled medical professionals who play an integral part in health care delivery.  The health care system is facing a shortage of primary care clinicians. Current definitions of primary care include family medicine, internal medicine, pediatrics and obstetrics/gynecology.  Currently, there is a shortage of primary care physicians and the American Academy of Family Physicians predicts that, if current trends continue, the shortage of primary care physicians will reach 40,000 within 10 years. This is critical when looking at health reform and examining the concept of increasing numbers of patients seeking access to medical care under a reformed system.  Increasing utilization of PAs and NPs is part of the solution.  Studies suggest that the addition of a PA or NP to a medical practice may offer enhanced patient satisfaction, improved physician work-life balance, improved revenues and greater access to care for patients.

As health care delivery is transformed, the implementation of the Patient Centered Medical Home (PCMH) as a vehicle for patient care is rapidly expanding.  Primary care delivery in both internal medicine and family practice is shifting toward this system of population management of chronic disease.  Recent studies from the American College of Physicians and the American College of Family Physicians state that PAs should be recognized as primary care providers in the PCMH model.  Accrediting bodies such as (NCQA) and the Utilization Review Accreditation Commission (URAC) support the PCMH as a proven model for delivering high quality, cost-effective patient care and encourage the inclusion of Physician Assistants within the delivery model.

Nationally, the American Academy of Physician Assistants (AAPA) supports the fundamental premise that standards used to define PCHM and care delivery models are not limited to physicians. Approximately 30,000 PAs practice in primary care of the nearly 80,000 PAs nationwide. Many PAs will practice in health care PCMHs; lead patient care teams and will participate in and be an integral component of quality performance reporting.

Robin P. Newhouse, PhD, RN, NEA-BC, and her co-authors compared advanced practice registered nurse (APRN) processes and outcomes to those of physician providers in a recent article in Nursing Economics. Sixty-nine studies published between 1990 and 2008 were analyzed and 28 outcome metrics were summarized and examined for nurses practicing in APRN roles.  Newhouse and her co-authors describe patient outcomes for each of three groups: nurse practitioners, certified nurse-midwives and clinical nurse specialists. Outcomes for NPs examined metrics including:  glucose control, lipid control, patient satisfaction, functional status, and mortality. Study results indicated that APRNs provide safe, effective, quality care and play a significant role in promoting health and health care.

Utilization of PAs and NPs in the PCMH model may exist in several ways.  In some settings, PAs may be focused on acute care or on management of chronic conditions, while in other communities, PAs/NPs may maintain their own panels of patients alongside physicians, and in rural communities, PAs may practice alone with a physician located off site.  Optimal utilization supports the patient to choose a PA/NP as a primary care provider, ensuring and increasing access to care while the physician maintains oversight of the PA scope of practice.  This utilization model allows for continuity of care, fosters patient/provider relationships, and underscores chronic disease management efforts for challenging care conditions including diabetes and asthma.  Ultimately, the role of the PA/NP within the PCMH will depend on the clinical setting, patient population, clinical competency and experience, and the professional relationship between the PA/NP and the physician(s).

Implementing a strategy to incorporate PAs and NPs into existing primary care practice models will offer measurable, demonstrated improvement in quality metrics and management of chronic disease populations.


About the author:

Lisa P. Shock, MHS, PA-C, is a seasoned PA who has practiced in primary care and geriatrics since her days at the Duke PA program in the late 90s. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs in the health care system.  Contact her with questions at




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