Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis.

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UNLABELLED: BACKGROUND: Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA) has been a frontrunner in the use of nurse practitioners (NPs) and physician assistants (PAs). Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. METHODS: This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician). RESULTS: NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. CONCLUSIONS: This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.






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Morgan, Perri A, David H Abbott, Rebecca B McNeil and Deborah A Fisher (2012). Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis. Hum Resour Health, 10. p. 42. 10.1186/1478-4491-10-42 Retrieved from

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Perri Anne Morgan

Professor in Family Medicine and Community Health

Dr. Morgan is a health services researcher focusing on PAs and NPs in the health workforce and on outcomes associated with their use in different roles and settings.  As Director of Research in the Duke PA Division, she led the development of the PA Research section, which is one of only a few such groups nationally.  As a practicing PA for 25 years, Dr. Morgan has extensive knowledge of the PA profession from the perspective of a clinician.  As one of a very few national experts on education, practice, and workforce issues related to the PA profession, Dr. Morgan is regularly invited to serve in national and state level policy advisory positions.  Her research, linked below, addresses methodological problems of data sources for use in research on PAs and NPs, the effect of PA use on health resource utilization, and use and roles of PAs and NPs in various settings.


Deborah Anne Fisher

Associate Professor of Medicine

1) Clinical interests and focus: I am a general gastroenterologist with a particular interest in colorectal cancer screening/surveillance and quality improvement.  I recently served on the ASGE Assessment of Quality in Endoscopy committee and currently serve on the AGA Clinical Practice Updates committee.

2) Research focus: Outcomes, big data, and health services research as applied to a variety of GI areas including weight-loss devices, NAFLD, colorectal cancer screening, choledocholithiasis.  I conduct clinical research (outcomes, clinical trials, diagnostic studies) in colorectal cancer screening and have collaborated with the School of Engineering on GI clinical applications of new technology.

3) Educational activities:  Clinical teaching in gastroenterology and endoscopy, directing the Department of Medicine MENTORS program for research fellows, mentoring trainees and junior faculty in research.  I am faculty of the GI T32 training grant and of the Duke Clinical Research Training Program. In my role as the GI Director of Social and Digital Media, I train and advise in using social media for medical education and professional development.

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