Scheffler R M, Waitzman N J, Hillman J M
J Allied Health. 1996 Summer;25(3):207-17.
Managed care is spreading rapidly in the United States and creating incentives for physician practices to find the most efficient combination of health professionals to deliver care to an enrolled population. Given these trends, it is appropriate to reexamine the roles of physician assistants (PAs) and nurse practitioners (NPs) in the health care workforce. This paper briefly reviews the literature on PA and NP productivity, managed care plans' use of PAs and NPs, and the potential impact of PAs and NPs on the size and composition of the future physician workforce. In general, the literature supports the idea that PAs and NPs could have a major impact on the future health care workforce. Studies show significant opportunities for increased physician substitution and even conservative assumptions about physician task delegation imply a large increase in the number of PAs and NPs that can be effectively deployed. However, the current literature has certain limitations that make it difficult to quantify the future impact of PAs and NPs. Among these limitations is the fact that virtually all formal productivity studies were conducted in fee-for-service settings during the 1970s, rather than managed care settings. In addition, the vast majority of PA and NP productivity studies have viewed PAs and NPs as physician substitutes rather than as members of interdisciplinary health care teams, which may become the dominant health care delivery model over the next 10-20 years.
管理式医疗在美国迅速蔓延，并促使医师执业机构寻求医疗专业人员的最有效组合，以便为参保人群提供医疗服务。鉴于这些趋势，重新审视医师助理（PAs）和执业护士（NPs）在医疗劳动力中的角色是恰当的。本文简要回顾了关于医师助理和执业护士生产力、管理式医疗计划对医师助理和执业护士的使用，以及医师助理和执业护士对未来医师劳动力规模和构成的潜在影响的文献。总体而言，文献支持这样一种观点，即医师助理和执业护士可能对未来的医疗劳动力产生重大影响。研究表明，增加医师替代的机会很大，甚至对医师任务委托的保守假设也意味着可有效部署的医师助理和执业护士数量将大幅增加。然而，当前的文献存在某些局限性，使得难以量化医师助理和执业护士的未来影响。这些局限性包括，几乎所有正式的生产力研究都是在20世纪70年代的按服务收费环境中进行的，而非管理式医疗环境。此外，绝大多数医师助理和执业护士生产力研究将医师助理和执业护士视为医师的替代者，而非跨学科医疗团队的成员，而跨学科医疗团队可能在未来10至20年成为主导的医疗服务提供模式。
