The employment and use of nurse practitioners and physician assistants by rural hospitals.

Nurse practitioners and physician assistants are both important resources for the delivery of health care services in rural areas. Nevertheless, little is known about the demand for their services by rural employers. The purpose of this study was: (1) to describe and compare the employment and use of nurse practitioners and physician assistants by rural hospitals in an eight-state region in the northwestern United States (Minnesota, North Dakota, South Dakota, Iowa, Montana, Idaho, Oregon and Washington); and (2) to examine how different market and organizational factors influence the employment of nurse practitioners and physician assistants by rural hospitals. Data for the study were collected through telephone interviews of rural hospital administrators (N = 407) and analyzed using both descriptive tables and logistic regression. Study results show that rural hospitals are important employers of both nurse practitioners and physician assistants, although there is a greater demand for than supply of both types of practitioners. Moreover, there are several differences in the characteristics of hospitals that employ the different types of practitioners. Rural hospitals use nurse practitioners and physician assistants to enhance their delivery of outpatient services, and a major factor related to the employment of nurse practitioners and physician assistants by rural hospitals is the Rural Health Clinic program. The majority of hospitals that use nurse practitioners, as well as those that use physician assistants, indicate that nurse practitioners and physician assistants can prescribe medications and order lab tests and X-rays, but considerably fewer report that nurse practitioners and physician assistants have admitting or discharge privileges. Physician assistants appear to provide a more expanded scope of services in rural hospitals. Nonetheless, rural hospitals seem to employ nurse practitioners and physician assistants for similar reasons: (1) to extend care, assist physicians, or increase access to primary care; (2) because physicians are unavailable or too difficult to recruit; (3) because nurse practitioners or physician assistants are considered cost-effective or more economical for rural areas; and, (4) for Rural Health Clinic certification.