Primary Care Physician Assistants Research Articles

Commentaries on health services research

Box 1Obtaining a medical appointment with a PA or an NP in the United States is not difficult. After a half-century of development and deployment, about 200,000 PAs and NPs are clinically active in the 56 US jurisdictions. Not surprisingly, their presence is greatest in the ambulatory setting, where 98% of medical care takes place. Of an estimated 1.2 billion annual ambulatory visits, almost 20% are managed by a PA or NP.1 Perhaps more important is the duration in time. PAs and NPs have been present in American society for three generations. Many patients are seeing a PA or NP as a health professional who can take a history, order appropriate tests, arrive at a diagnosis, develop a treatment plan, and prescribe an appropriate regimen. In the end, like most of us, what patients want is to have their needs met, and they are largely indifferent as to who delivers it. Commentary by Roderick S. Hooker REFERENCE 1. Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2006. National health statistics reports; No 8. Hyattsville, MD: National Center for Health Statistics. 2008.Box 2Although the idea of a systematic review of the roles and contributions of PAs in primary care is appealing, this paper fails to deliver. The authors perpetuate inaccurate information, such as the proportion of PAs in active primary care practice. Coplan showed that no more than a third of American PAs work in primary care.1 The fundamental error: inappropriate criteria for the selection of articles to be analyzed. Specifically, only 46 papers from the US literature were deemed worthy of inclusion, a number that is misleadingly low. The authors use definitions of general practice/family medicine proposed by the European Region of the World Organization of Family Doctors rather than conventional US definitions, which resulted in distortion of the findings and/or the exclusion of relevant papers. In addition, many of the papers analyzed are old. The major inaccuracy: The paper's abstract states, “half of PAs are reported to work in primary care.” Closer examination of this figure reveals that these percentages come from old reports (circa 1991 or older). Systematic reviews by others have used wider selection criteria, employed a more consistent framework, and therefore contain more useful and accurate information.2 Commentary by James F. Cawley REFERENCES 1. Coplan B, Cawley JF, Stoehr JD. Brief report: physician assistants in primary care: trends and characteristics. Ann Fam Med. 2013;11(1):75–79. 2. Hooker RS, Everett CM. The contributions of physician assistants in primary care systems. Health & Social Care in the Community. 2012;20:20–31.Box 3This financial modeling study is what medical and PA students with higher debt obligations may want to consider when entertaining a family medicine career. Working in a nonprofit facility or medically underserved area may put the PA or medical school graduate ahead in the loan debt game. The Association of American Medical Colleges (AAMC) study of 384 debt scenarios included living in high- or medium-cost areas and incorporated various loan forgiveness and loan repayment strategies. In the end, student debt may be a significant limiting factor in career choice and specialty for newly minted PAs.1 A matrix of interest rates and student loan decisions requires the consideration of numerous personal factors such as housing, living expenses, spousal income, level of retirement income, and even anticipated children. Whether crushing debt will affect the choices for PAs and physicians alike remains an area in need of study. Commentary by Jennifer M. CoombsBox 4REFERENCE 1. Student loan debt affects generations of Americans. US News and World Report. http://www.usnews.com/education/blogs/student-loan-ranger/2012/10/03/student-debt-affects-generations-of-americans. Accessed July 2013.

The contribution of Physician Assistants in primary care: a systematic review

BackgroundPrimary care provision is important in the delivery of health care but many countries face primary care workforce challenges. Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as Physician Assistants (PAs). Objective: This systematic review aimed to appraise the evidence of the contribution of PAs within primary care, defined for this study as general practice, relevant to the UK or similar systems.MethodsMedline, CINAHL, PsycINFO, BNI, SSCI and SCOPUS databases were searched from 1950 to 2010. Eligibility criteria: PAs with a recognised PA qualification, general practice/family medicine included and the findings relevant to it presented separately and an English language journal publication. Two reviewers independently identified relevant publications, assessed quality using Critical Appraisal Skills Programme tools and extracted findings. Findings were classified and synthesised narratively as factors related to structure, process or outcome of care.Results2167 publications were identified, of which 49 met our inclusion criteria, with 46 from the United States of America (USA). Structure: approximately half of PAs are reported to work in primary care in the USA with good support and a willingness to employ amongst doctors. Process: the majority of PAs’ workload is the management of patients with acute presentations. PAs tend to see younger patients and a different caseload to doctors, and require supervision. Studies of costs provide mixed results. Outcomes: acceptability to patients and potential patients is consistently found to be high, and studies of appropriateness report positively. Overall the evidence was appraised as of weak to moderate quality, with little comparative data presented and little change in research questions over time.Limitations: identification of a broad range of studies examining ‘contribution’ made meta analysis or meta synthesis untenable.ConclusionsThe research evidence of the contribution of PAs to primary care was mixed and limited. However, the continued growth in employment of PAs in American primary care suggests that this professional group is judged to be of value by increasing numbers of employers. Further specific studies are needed to fill in the gaps in our knowledge about the effectiveness of PAs’ contribution to the international primary care workforce.

Physician Assistants in Primary Care: Trends and Characteristics

Physician assistants (PAs) have made major contributions to the primary care workforce. Since the mid-1990s, however, the percentage of PAs working in primary care has declined. The purpose of this study was to identify demographic characteristics associated with PAs who practice in primary care. We obtained data from the 2009 American Academy of Physician Assistants' Annual Census Survey and used univariate analyses, logistic regression analyses, and χ(2) trend tests to assess differences in demographics (eg, age, sex, race) between primary care and non-primary care PAs. Survey respondents had graduated from PA school between 1965 and 2008. Of 72,433 PAs surveyed, 19,608 participated (27% of all PAs eligible to practice). Incomplete questionnaires were eliminated resulting in a final sample of 18,048. One-third of PAs reported working in primary care. Female, Hispanic, and older PAs were more likely to work in primary care practice. Trend tests showed a decline in the percentage of PAs working in primary care in the sample overall (average 0.3% decrease per year; P <.0001). In the cohort of 2004-2008 graduates, however, the percentage of primary care PAs increased slightly by an average of 0.9% per year (P = .02). Nonetheless, the low response rate of the census limits the ability to generalize these findings to the total population of PAs. Demographics associated with an increased likelihood of primary care practice among PAs appear to be similar to those of medical students who choose primary care. Knowledge of these characteristics may help efforts to increase the number of primary care PAs.

CME ARTICLE Maximizing oral health in children: A review for physician assistants

Too many children do not have access to dental care, but primary care physician assistants can easily add an oral health assessment to their usual examinations.

Anatomy for physician assistants: how we tackle this beast

Although Physician Assistants (PA) are dependent medical practitioners, they practice medicine with a degree of autonomy requiring a knowledge base of sufficient breadth and depth to function as primary care providers. Factual knowledge in the basic sciences must at a minimum allow for effective examination of patients, performance of common technical skills, interpretation of common imaging studies, and of course, safe medical practice. The USC Primary Care PA Program of the Keck School of Medicine delivers a 6 unit integrated Basic Medical Sciences (BMS) course to first year PA students during the first semester of a six‐semester program. Anatomy (33% of BMS) covers regional and radiographic anatomy, and introductory histology. Learners also rotate through four, 2‐hour prosection‐driven cadaver laboratory sessions. The remainder of the BMS course is comprised of systems physiology (52%), and adjunct topics (15%) (eg. introductory genetics and pathology). Course objectives for anatomy were derived from a mix of published standard‐setting documents for medical students and the course director's clinical and academic experience. Learning strategies include lecture, assigned readings, audiovisual resources, and cadaver laboratory. The course is taught by a PA‐PhD, and laboratory sessions are taught by Biokinesiology and Physical Therapy anatomy faculty.

Predictive modeling the physician assistant supply: 2010-2025.

A component of health-care reform in 2010 identified physician assistants (PAs) as needed to help mitigate the expected doctor shortage. We modeled their number to predict rational estimates for workforce planners. The number of PAs in active clinical practice in 2010 formed the baseline. We used graduation rates and program expansion to project annual growth; attrition estimates offset these amounts. A simulation model incorporated historical trends, current supply, and graduation amounts. Sensitivity analyses were conducted to systematically adjust parameters in the model to determine the effects of such changes. As of 2010, there were 74,476 PAs in the active workforce. The mean age was 42 years and 65% were female. There were 154 accredited educational programs; 99% had a graduating class and produced an average of 44 graduates annually (total n=6,776). With a 7% increase in graduate entry rate and a 5% annual attrition rate, the supply of clinically active PAs will grow to 93,099 in 2015, 111,004 in 2020, and 127,821 in 2025. This model holds clinically active PAs in primary care at 34%. The number of clinically active PAs is projected to increase by almost 72% in 15 years. Attrition rates, especially retirement patterns, are not well understood for PAs, and variation could affect future supply. While the majority of PAs are in the medical specialties and subspecialties fields, new policy steps funding PA education and promoting primary care may add more PAs in primary care than the model predicts.

Dermatology diagnoses among rural and urban physician assistants.

Dermatology is not heavily covered in the curricula of physician assistant (PA) programs or on the certification examination, even though patient visits to PAs for skin complaints are very common. If significant on-the-job training is thus required for dermatology care, then practice setting differences likely impact the quality of that informal training. This study sought to identify differences in the ability of rural and urban PAs to diagnose skin disorders. An Internet-based survey of rural and urban primary care PAs (n = 295) was conducted. The survey collected demographic information and provided case scenarios with questions related to diagnosis of a skin disease or complication. Average quiz score was higher for rural PAs than for urban PAs (61.6% versus 55.4%, P = .024). Rural PAs more commonly treated the majority of their patients seen for skin complaints. Rural PAs reported a greater comfort level in diagnosing and treating skin disease than did urban PAs (91% versus 80%, P < .05). Both groups referred a comparable percentage of patients to skin specialists. Regression analysis identified several factors that accounted for the ability to predict success scores for both the rural (P < .05) and urban (P < .05) groups. The stronger overall ability of rural PAs to diagnose a variety of skin diseases is likely impacted by the higher number of dermatologic cases they see. PA educators should re-evaluate the curricula devoted to skin conditions and consider elective opportunities for students with an interest in a dermatology career.

Psychosocial Issues in Primary Care Physician Assistant Practice: A Descriptive Study

Purpose: Physician assistant (PA) educators must prepare their students to effectively manage psychosocial issues. Designing a curriculum that attends to these issues presents challenges to PA faculty since study of PA involvement in patients’ psychosocial issues has been sparse. This study examines the frequency of psychosocial issues seen in primary care PA practice and the degree and manner in which PAs respond to the psychosocial issues seen. Methods: A randomly selected national sample of primary care PAs logged information about psychosocial issues encountered in their first eight patient visits on appointed dates. Information logged included psychosocial issues encountered, the PA’s level of response to each issue encountered, and referrals made to specialists. PA respondents returned study materials anonymously. Results: Study response rate was 12% (162 respondents from 1,328 randomly selected PAs). Of the 1,270 primary care visits recorded, 67.8% included at least one psychosocial issue. Behavioral health was the category of psychosocial issues most frequently logged (58%), and five issues together accounted for 41.3% of all identified issues (coping with own illness, anxiety/nerves/tension, depression, pain, and worry about health). PAs provided help in response to 93.2% of psychosocial issues identified and referred nearly a quarter of patients who presented with psychosocial issues to specialists for evaluation or treatment. Conclusions: A variety of psychosocial issues are frequently seen in primary care PA practice. Consequently, PA curricula must prepare students to recognize and respond to a wide range of psychosocial issues. Further study is warranted to confirm and build on the results of this study.

Prescribing trends by nurse practitioners and physician assistants in the United States

As an important step in analyzing the role of nurse practitioners (NPs) and physician assistants (PAs), we examined their prescribing behavior. The intent is to study the characteristics of providers and patients, and the type of prescriptions written by NPs and PAs in primary care and to compare these activities to physicians. The National Ambulatory Medical Care Survey (NAMCS) database was examined for prescriptions written by primary care clinicians (family and general medicine, internal medicine, and general pediatrics). A representative sample of 88,346 primary care visits over a 6-year period (1997-2002) was analyzed in which a prescription was written by an NP, a PA, or a physician in an urban or rural setting. The characteristics of all the patients seen were similar for geographical region of visit, age, and gender, but differed by ethnicity and race. An NP or a PA was the provider of record for 5% of the primary care visits in the NAMCS database. The three clinician types were likely to write at least one prescription for 70% of all visits, and the mean number of prescriptions was 1.3-1.5 per visit (range 0-5) depending on the provider. PAs were more likely to prescribe a controlled substance for a visit than a physician or an NP (19.5%, 12.4%, 10.9%, respectively). Only in nonmetropolitan settings did differences emerge. In rural areas, NPs wrote significantly more prescriptions than physicians and PAs. We suggest that NPs and PAs may provide a role that is similar to that of physicians in primary care based on prescribing behavior. The prescribing behavior of PAs and NPs parallels that of physicians by the number of medications per visit, the types of therapeutic classes, and the type of patient. However, in nonmetropolitan areas, prescribing differences emerge between the three types of providers that bear further exploration.

The Supply of Primary Care Physician Assistants and Nurse Practitioners in Underserved North Carolina

In the debate about a pending physician shortage it is timely to turn policy attention to the effect that the growing supply of physician assistants (PAs) and nurse practitioners (NPs) will have on physician workforce projections. The only comprehensive national data set on the nursing workforce in the United States is the National Nursing Sample Survey and data from that survey reveal that the number of NPs in the US has more than tripled over the past 20 years, increasing 223% from 15,443 in 1980 to 49,876 in 2000.1 Nationally, the number of PAs in practice has grown 354% over the same period from 8,916 PAs in 1980 to 40,469 in 2000.2 By contrast, during the same period, the number of physicians in the US increased 47%, from 519,000 in 1983 to 761,000 in 2001.3 Data from North Carolina tend to mirror these national workforce trends. Since the early 1990s, the growth in physician supply has been modest compared to that of NPs and PAs. Between 1990 and 2003, the ratio of physicians to population increased 26%, while the ratio of PAs and NPs to population increased 132% and 214%, respectively. Much of the growth of NP and PA supply has been in rural and underserved areas of the state. For every 100 physicians practicing in a county designated as a whole county persistent health professional shortage area (PHPSA) in 2003, there were 20 NPs, a substantial increase from 1990 when only 7 NPs per 100 physicians were practicing. Similarly, 21 PAs for every 100 physicians were practicing in whole county PHPSAs in 2003, up from 7 per 100 physicians in 1990. This increase in NP and PA supply relative to physicians in counties that consistently face difficulties recruiting health professionals suggested that a considerable portion of primary care in North Carolina is provided to patients by NPs or PAs.4 National data supported this supposition. Findings from an analysis of the 1995-1999 National Ambulatory Medical Care Surveys indicated that approximately 25% of primary care office-based physicians use PAs and NPs and that both are more greatly utilized in rural areas.5 Although a few studies have cited the growing supply of NPs and PAs relative to physicians, little research exists specifically on the supply and distribution of primary care PAs and NPs on the state level. The difficulty in estimating the percentage of NPs and PAs engaged in primary care has hindered attempts to model the primary care workforce, particularly in nonmetropolitan areas. Nationally, approximately half of all PAs report a primary care specialty.6 In North Carolina, 41% of PAs and 56% of all actively practicing NPs report a primary care specialty. This brief report focuses on the supply, geographic distribution, and specialty and employment characteristics of primary care NPs and PAs in North Carolina, with a specific focus on rural and health professional shortage areas. The Abstracts and Brief Reports section publishes short, focused communications on a research endeavor relevant to PA education or behavior. Submissions should be limited to approximately 1,500 words and one or two exhibits (tables or illustrations). The intent of this feature is to promulgate new information and provide a platform for additional research. Authors desiring to contribute to Abstracts and Brief Reports should forward submissions (with a copy to journal staff at jpae@PAEAonline.org) to:

Confirmatory Factor Analysis of the NCCPA Physician Assistant National Recertifying Examination

Purpose: The purpose of this study was to apply confirmatory factor analysis (CFA) methodology to support the structure of the Physician Assistant National Recertifying Examination (PANRE) for both primary care and surgical physician assistant (PA) examinee populations. Method: Examinee data from 950 first-time takers (680 primary care and 270 surgical PA examinees) of PANRE were selected. LISREL 8 software was used to determine whether one general ability factor (ie, ability to apply general, primary care knowledge) accounted for most of the variability in both the task and organ system scores. Results: Results indicated that one general ability factor accounted for most of the variability in scores obtained from both the task and organ system dimensions of the test blueprint. Invariance tests indicated that the general ability factor structure was equivalent across the two populations, indicating that PANRE scores are interpretable in a way that is consistent with the specifications defined in the content blueprint. While the surgical PA examinees on average did not score as high on PANRE as the primary care PA examinees, the difference should not be attributed to the structural design or content specifications of the PANRE. Conclusions: The present study demonstrated the applicability of factor analysis for validating the structural design and scoring model for the PANRE across populations of specialized PA examinees; only a single general ability primarily explains variation in responses to individual test questions, and subsequently explains overall PANRE performance. Even though PANRE is designed to measure application of general medical knowledge in primary care, recertifying surgical PA examinees do not appear to be at a disadvantage when taking PANRE.

The practices and attitudes of primary care nurse practitioners and physician assistants with respect to colorectal cancer screening

Although nurse practitioners and physician assistants form a large and growing portion of the primary care workforce, little is known about their colorectal cancer screening practices. The aim of this study was to assess the colorectal cancer screening practices, training, and attitudes of nurse practitioners and physician assistants practicing primary care medicine. All nurse practitioners (827) and physician assistants (1178) licensed by the Medical Board of the State of North Carolina were surveyed by mail. Both groups were further divided into primary care versus non-primary care by self-described roles. Self-reported practices, training, and attitudes with respect to colorectal cancer screening were elicited. Response rates were 71.4% and 61.2%, for nurse practitioners and physician assistants respectively. A total of 51.3% of nurse practitioners and 50.3% of physician assistants described themselves as adult primary care providers. No primary care nurse practitioners and only 3.8% of primary care physician assistants performed screening flexible sigmoidoscopy. However, 76% of primary care physician assistants and 69% of primary care nurse practitioners reported recommending screening flexible sigmoidoscopy. A total of 95% primary care physician assistants and 92% of primary care nurse practitioners reported performing fecal occult blood testing. Only 9.4% of physician assistants and 2.8% of nurse practitioners received any formal instruction in flexible sigmoidoscopy while in their training. Additionally, 41.4% of primary care physician assistants and 27.7% of primary care nurse practitioners reported that they would be interested in obtaining formal training in flexible sigmoidoscopy. Physician assistants and nurse practitioners are motivated, willing and underutilized groups with respect to CRC screening. Efforts to increase education and training of these professionals may improve the availability of CRC screening modalities.

The practices and attitudes of primary care nurse practitioners and physician assistants with respect to colorectal cancer screening

OBJECTIVES: Although nurse practitioners and physician assistants form a large and growing portion of the primary care workforce, little is known about their colorectal cancer screening practices. The aim of this study was to assess the colorectal cancer screening practices, training, and attitudes of nurse practitioners and physician assistants practicing primary care medicine. METHODS: All nurse practitioners (827) and physician assistants (1178) licensed by the Medical Board of the State of North Carolina were surveyed by mail. Both groups were further divided into primary care versus non–primary care by self-described roles. Self-reported practices, training, and attitudes with respect to colorectal cancer screening were elicited. RESULTS: Response rates were 71.4% and 61.2%, for nurse practitioners and physician assistants respectively. A total of 51.3% of nurse practitioners and 50.3% of physician assistants described themselves as adult primary care providers. No primary care nurse practitioners and only 3.8% of primary care physician assistants performed screening flexible sigmoidoscopy. However, 76% of primary care physician assistants and 69% of primary care nurse practitioners reported recommending screening flexible sigmoidoscopy. A total of 95% primary care physician assistants and 92% of primary care nurse practitioners reported performing fecal occult blood testing. Only 9.4% of physician assistants and 2.8% of nurse practitioners received any formal instruction in flexible sigmoidoscopy while in their training. Additionally, 41.4% of primary care physician assistants and 27.7% of primary care nurse practitioners reported that they would be interested in obtaining formal training in flexible sigmoidoscopy. CONCLUSIONS: Physician assistants and nurse practitioners are motivated, willing and underutilized groups with respect to CRC screening. Efforts to increase education and training of these professionals may improve the availability of CRC screening modalities.

Evaluating the potential of international medical graduates as physician assistants in primary care.

The need to increase the nation's primary care workforce, and the presence of large numbers of international medical graduates (IMGs) who encounter barriers to licensure as physicians, have led to consideration of ways that IMGs might practice as physician assistants (PAs). Several states have explored regulatory changes that would allow IMGs to obtain PA certification through equivalency mechanisms or accelerated educational programs. In California, surveys in 1980, 1993, and 1994 collected information about the interest and preparedness among IMGs seeking PA certification. These surveys revealed that few of the IMGs were interested in becoming PAs as a permanent career, and few could show a commitment to primary care of the underserved. Of the 50 IMGs accepted into California's PA programs in recent years, 62% had academic or personal difficulties. Only 34 IMGs became certified, and all accepted jobs in primary care specialties. Two preparatory programs in California have assessed the readiness of unlicensed IMGs to enter PA programs, and they have shown that the participants did not demonstrate knowledge or clinical skills equivalent to those expected of licensed PAs. Therefore, policymakers should not consider that IMGs are or can easily become the equivalent of PAs without additional professional training in accredited PA programs. Preparatory programs appear to lessen the barriers to PA training for a few IMGs. In times of scarce resources for training, however, these programs may not be the best use of public funds to increase the primary care workforce.

Determinants of specialty choice of physician assistants.

Although physician assistants (PAs) became part of the U.S. health scene in 1967 and have made important contributions to primary care, available information about the factors that may influence the career choices of this rapidly-growing group of health care providers is sparse. The intent of this analysis was to identify the main factors underlying the specialty-choice decisions of PAs in the first practice year after completing PA training and the reasons for their selections. Data were collected from a 1994 survey of 4,416 PAs who had graduated in 1991-1993. Usable responses were obtained from 1,472 PAs (33%). Each PA was asked to state the specialty he or she had entered in the first practice year and also to rate each of 33 possible reasons for this decision. Primary care specialties were defined as family medicine, general internal medicine, and general pediatrics. The ratings were subjected to a factor analysis. The 33 original variables were reduced to nine basic factors influencing the specialty-choice decisions of the PAs, accounting for 47.3% of the variance. The two most important factors were intellectual content of the specialty and a technical orientation. Then factor scores were computed for each PA and subjected to further examination, in which the PAs were divided into two groups: 776 who had entered primary care specialties, and 646 who had entered non-primary-care specialties (50 did not specify their specialties). For the PAs in non-primary-care specialties, the most influential factors were technical orientation and income/employment. For the PAs in primary care, the most influential factors were prevention, academic environment, debt/scholarship, intellectual content, and peer influence. For this recently graduated group of PAs, factors representing the kinds of activities they would be engaged in as health care providers were among the most influential, but the relative importances of the factors varied according to whether the PAs were in primary care or non-primary-care specialties, with the latter group being more strongly influenced by marker forces such as income and employment opportunities.

Doctors, dollars, and determination: making physician work-force policy.

Because managed care is likely to feature prominently in a reformed health care system, policymakers need to examine the impact managed care will have on medical practice, physician supply, and access to primary care providers. Goals for work-force reform should focus on five areas: (1) training physicians in the generalist disciplines of family practice, general internal medicine, and general pediatrics; (2) shaping the physician work force to reflect the nation's ethnic diversity; (3) distributing physicians in a geographically equitable way; (4) maintaining the current physician-to-population ratio rather than letting it continue to grow; and (5) establishing supply needs for nurse practitioners, primary care physician assistants, and certified nurse midwives.

The women's health care training project—An alternative for training midwives

The Women's Health Care Training Project is a midwifery education program designed for Family Nurse Practitioners and Primary Care Physician Assistants employed in publicly funded clinics in medically underserved areas of California. Developed through the collaborative effort of faculty of the Stanford University Medical Center-Foothill College Primary Care Associate Program and program consultants from the California State Department of Health Services, the program design permits the primary care practitioner to remain in her community during the student experience, traveling to Stanford for intensive didactic experiences and using local preceptor resources for clinical experience. This decentralized work-study model of education, which builds on the practitioner's skills in family medicine, expands the accessibility of additional midwifery education to students committed to practice settings in underserved areas. The American College of Nurse Midwives has given the registered nurse tract of the program preaccreditation status as an approved curriculum in nurse midwifery education.

Role of Physician Assistants in Primary Care.Judith G. Greenwood.

<b>Role of Physician Assistants in Primary Care.</b><i>Judith G. Greenwood.</i>

Book ReviewRole of Physician Assistants in Primary Care

Book ReviewRole of Physician Assistants in Primary Care

“Role of Physician Assistants in Primary Care”

“Role of Physician Assistants in Primary Care”