Does the Employment of Physician Assistants and Nurse Practitioners Increase Liability?

Abstract

ABSTRACT We assessed whether physician assistant (PA) and nurse practitioner (NP) utilization increases liability. In total, 17 years of data compiled in the United States National Practitioner Data Bank (NPDB) was used to compare and analyze malpractice incidence, payment amount and other measures of liability among doctors, PAs and advanced practice nurses (APNs). From 1991 through 2007, 324,285 NPDB entries were logged, involving 273,693 providers of interest. Significant differences were found in liability reports among doctors, PAs and APNs. Physicians made, on average, malpractice payments twice that of PAs but less than that of APNs. During the study period the probability of making a malpractice payment was 12 times less for PAs and 24 times less for APNs. For all three providers, missed diagnosis was the leading reason for malpractice report, and female providers incurred higher payments than males. Trend analysis suggests that the rate of malpractice payments for physicians, PAs and APNs has been steady and consistent with the growth in the number of providers. There were no observations or trends to suggest that PAs and APNs increase liability. If anything, they may decrease the rate of reporting malpractice and adverse events. From a policy standpoint, it appears that the incorporation of PAs and APNs into American society has been a safe and beneficial undertaking, at least when compared to doctors.