Midlevel Providers in Hand Surgery: The Patient’s Perspective

Abstract

Royalty: Integra (Cohen) Midlevel providers (ie, physician assistants [PAs] and nurse practitioners [NPs]) are being integrated into health care systems owing to the exponentially increasing demand for care. There is a lack of studies regarding patients’ perspectives toward midlevel providers in hand surgery. Despite the paucity of literature on this topic, we hypothesize that hand patients will have distinct preferences regarding midlevel provider involvement in their hand care. 939 consecutive first-time patients of 3 hand surgeons were administered an anonymous survey before their new patient visit. Content included patient perspectives toward midlevel providers, including: ideal scope of clinical practice, importance of midlevel provider credentials when initially choosing a hand surgeon, and reimbursement equity between hand surgeons and midlevel providers for provision of the same clinical services. Patient responses were tabulated, with means and percentages reported. Of 939 consecutive patients, 784 (84%) responded. 46% were female and 54% male with an average age of 44.1 ± 17.1 years. Most (65%) patients considered the training background of the midlevel provider when initially choosing a new hand surgeon (Figure 16-1). Patients responded that certain clinical services should be physician-provided (Figure 16-2), such as: advanced diagnostic studies (eg, MRI) (69%), follow-up for abnormal tests or imaging (68%), and new patient visits (67%). Patients were amenable to other specific services being midlevel-provided (Figure 16-2), including: minor in-office procedures (64%), preoperative teaching (63%), and long-term postoperative clinic visits (61%). Patient perspectives toward reimbursement equity for hand surgeons and midlevel providers were variable, despite 72% of patients responding that the hand surgeon provides a higher-quality consultation (Figure 16-1). These findings are pertinent to providers, patients, and payors, as the midlevel workforce increases to address the rising demand for care. •As health care becomes increasingly consumer-centric and value-driven, a data-based approach in midlevel staff utilization will allow hand surgeons to optimize efficiency, quality, and patient satisfaction.•In clinical staff planning, hand surgeons may consider our results regarding which services patients prefer be physician-provided or midlevel-provided.•It may be beneficial to include the midlevel provider in marketing efforts, as most patients considered the training background of the surgeon’s midlevel provider when initially choosing a hand surgeon.•Patients lacked a consensus toward reimbursement equity for hand surgeons and midlevels providers, despite reporting that the hand surgeon provides a higher quality exam and consultation.Figure 16-2Midlevel Providers' Scope of Practice in Hand Surgery. Survey participants were asked "In a hand clinic, who should provide …?" with each respective clinical service subsequently listed. Response options were "Should be provided by hand surgeon only" or "Can be provided by either midlevel provider or hand surgeon."View Large Image Figure ViewerDownload Hi-res image Download (PPT)