Essary Alison C, Green Ellen P, Gans David N
School for the Science of Health Care Delivery, Arizona State University, Phoenix, AZ, USA.
Industry Affairs, Medical Group Management Association, Englewood, CO, USA.
Health Serv Res Manag Epidemiol. 2016 Jan 28;3:2333392815624111. doi: 10.1177/2333392815624111. eCollection 2016 Jan-Dec.
The increasing focus on high performance, patient-centered, team-based care calls for a strategy to evaluate cost-effective primary care. The trend toward physician practice consolidation further challenges the primary care health care system. Productivity measures establish provider value and help inform decision making regarding resource allocation in this evolving health care system. In this national survey of family medicine practices, physician assistant (PA) productivity, as defined by mean annual patient encounters, exceeds that of both nurse practitioners (NPs) and physicians in physician-owned practices and of NPs in hospital or integrated delivery system-owned practices. Total compensation, defined as salary, bonus, incentives, and honoraria for physicians, is significantly more compared to both PAs and NPs, regardless of practice ownership or productivity. Physician assistants and NPs earn equivalent compensation, regardless of practice ownership or productivity. Not only do these data support the value and role of PAs and NPs on the primary care team but also highlight differences in patient encounters between practice settings. Rural and underserved community practices, where physician-owned practices persist, also merit further consideration. Further research is needed to inform both organizational and policy decisions for the provision of high-quality, cost-effective, and accessible primary health care.
对高性能、以患者为中心的团队式医疗的日益关注，需要一种评估具有成本效益的初级医疗的策略。医师执业合并的趋势给初级医疗保健系统带来了进一步挑战。生产力衡量标准确定了医疗服务提供者的价值，并有助于为这一不断发展的医疗保健系统中的资源分配决策提供信息。在这项针对家庭医学执业的全国性调查中，以年均患者诊疗次数定义的医师助理（PA）生产力，在医师拥有的执业机构中超过了执业护士（NP）和医师，在医院或综合医疗服务系统拥有的执业机构中超过了执业护士。医师的总薪酬，定义为工资、奖金、激励措施和酬金，与医师助理和执业护士相比都显著更高，无论执业机构的所有权或生产力如何。医师助理和执业护士的薪酬相当，无论执业机构的所有权或生产力如何。这些数据不仅支持了医师助理和执业护士在初级医疗团队中的价值和作用，还凸显了不同执业环境下患者诊疗次数的差异。医师拥有的执业机构仍然存在的农村和服务不足的社区执业机构，也值得进一步考虑。需要进一步开展研究，为提供高质量、具有成本效益且可及的初级医疗保健的组织和政策决策提供信息。
