Abstract
This study empirically examines the practices of non-physician providers (NPPs) within three large competitive health maintenance organizations (HMOs), as well as the physicians' and NPPs' views regarding the ideal role of NPPs. These roles are compared with NPP delegation patterns incorporated in the modeling methodology developed by the Graduate Medical Education National Advisory Committee (GMENAC). GMENAC recommended relatively high levels of delegation by physicians to NPPs. One of the HMO sites made use of NPPs at rates even higher than GMENAC's national ideals, while the rates at the other two were lower. The normative ideals for pediatric NPPs developed at each HMO were consistently higher than their actual roles. Concerns with acceptance and the role of NPPs are clearly no longer issues. Instead, the limits on NPP involvement appear to relate to considerations of costs, availability, and the increasing numbers of physicians competing for similar opportunities.
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Selected References
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- Bowman M. A., Walsh W. B., Jr Perspectives on the GMENAC Report. Health Aff (Millwood) 1982 Fall;1(4):55–66. doi: 10.1377/hlthaff.1.4.55. [DOI] [PubMed] [Google Scholar]
- Cawley J. F., Golden A. S. Nonphysicians in the United States: manpower policy in primary care. J Public Health Policy. 1983 Mar;4(1):69–82. [PubMed] [Google Scholar]
- Cawley J. F. The physician assistant profession: current status and future trends. J Public Health Policy. 1985 Mar;6(1):78–99. [PubMed] [Google Scholar]
- McNutt D. R. GMENAC: its manpower forecasting framework. Am J Public Health. 1981 Oct;71(10):1116–1124. doi: 10.2105/ajph.71.10.1116. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Record J. C., McCally M., Schweitzer S. O., Blomquist R. M., Berger B. D. New health professions after a decade and a half: delegation, productivity and costs in primary care. J Health Polit Policy Law. 1980 Fall;5(3):470–497. doi: 10.1215/03616878-5-3-470. [DOI] [PubMed] [Google Scholar]
- Spitzer W. O. The nurse practitioner revisited. Slow death of a good idea. N Engl J Med. 1984 Apr 19;310(16):1049–1051. doi: 10.1056/NEJM198404193101610. [DOI] [PubMed] [Google Scholar]
- Steinwachs D. M., Weiner J. P., Shapiro S., Batalden P., Coltin K., Wasserman F. A comparison of the requirements for primary care physicians in HMOs with projections made by the GMENAC. N Engl J Med. 1986 Jan 23;314(4):217–222. doi: 10.1056/NEJM198601233140406. [DOI] [PubMed] [Google Scholar]
- Yankauer A., Sullivan J. The new health professionals: three examples. Annu Rev Public Health. 1982;3:249–276. doi: 10.1146/annurev.pu.03.050182.001341. [DOI] [PubMed] [Google Scholar]