Commentaries on health services research

Abstract

Box 1Studies such as this build upon an important body of literature to document what PAs and NPs do and how they do it in teams. Robust analyses of large sample sizes with a range of acuity and chronicity of disease are needed to measure the contribution of PAs and NPs and advance the concept of the patient-centered medical home approach to care. The authors have succeeded and set the stage for future research in differentiating various levels of team-based care. These findings reveal an interesting number of statistically significant differences in PA and NP panel complexity when compared to physician-only panels. For example, PAs and NPs saw fewer white patients; a greater proportion of patients with disabilities; and more with Medicaid buy-in, dementia, obesity, drug abuse, depression, or diabetic ulcers. These results were consistent with other research confirming the PA and NP contributions to underserved populations with indicators of social complexity. The three most significant panel differences were among patients with Medicare or Medicaid disability entitlement, dementia, and depression, confirming vital roles for PAs and NPs in providing supplemental mental health and care coordination services. Commentary by P. Eugene JonesBox 2If the founders of the PA and NP professions were to read this article, they would be pleased with the results; PAs and NPs are fulfilling their vision by providing quality care to patients who lack access to healthcare, thus permitting physicians to spend more clinical time focused on complicated patients. They would be encouraged to know that PAs and NPs are still providing a high proportion of the care provided to patients in rural areas. The strategy of extending physician services through collaborative care has been realized, with physicians providing more care to patients over 45 years old, and PAs and NPs seeing presumably less-complicated younger patients. A trend has emerged as well: PAs and NPs are providing 61% more clinical services in the nation's hospital outpatient departments as of 2010 than they were in 2001, and are responsible for more than 1.3 million patient visits annually. Such findings underscore how matching a workforce solution to a societal problem continues to be handled. Commentary by Tamara RitsemaBox 3The question of career satisfaction of healthcare providers is an important one. Decreasing satisfaction could lead to fewer high-quality applicants seeking to become PAs, as well as increasing attrition of those already in the profession, both which would be troublesome in an era of health professional shortages. The assumption is that high career satisfaction attracts highly qualified and talented individuals to become PAs. This study addresses the issue of PA career contentment in light of the observation that the profession has substantially feminized, and tries to measure whether lifestyle-career conflicts affect the career satisfaction of women. There are some troubling issues with the author's assertions. Historically, Marvelle and LaBarbera each investigated PA career satisfaction.1,2 The specific issue of gender salary discrepancies in the PA profession was reported by Carter in 1983 and Coplan in 2012; both reported that men's salaries were higher than women's.3,4 Although all of these preceded publication of this study, only LaBarbera is referenced. Biscardi and colleagues also assert that the feminization of the profession is a recent phenomenon—which is not supported by their data. In fact the 27th PAEA Annual Report shows that first-year PA student enrollments of about 60% women occurred in 1983 and continued through to 1999, before gradually rising to the 2010 rate of 72.5%.5 Although this study investigates important issues, it also suffers from methodologic problems. The data are not current, having been collected in 2008, and the response rate of 11% is very low for a national cross-sectional survey, so should not be presented as reflecting the population at large. This, combined with the fact that the respondent population (53% women) differs substantially in gender distribution from the population of certified PAs (64% women in 2011), indicates that the findings of this study are not generalizable to all PAs.6 Although the questions investigated in this study are important, additional research using higher response rates is needed before conclusions about the PA profession can be stated categorically. Commentary by Richard W. Dehn