According to a research letter published June 5, 2017 in JAMA Internal Medicine, growth in NP/PA participation in specialist visits occurred not only for routine or return visits, but also for new patients and complex acute visits. The authors of the study also observed almost twice the percentage of NP/PA visits (21.4% up from 12.3%) where the patient does not see a physician at all during the visit but exclusively sees the NP or PA. The study compared NP/PA involvement in specialist visits during a recent three year time span versus a similar time span 10 years earlier. Though most specialties employ NPs and PAs throughout the U.S., otorhinolaryngology and dermatology were the specialties with the most NP/PA participation in this study, and the northeast was the region with the most NP/PA involvement.

The study results may even underestimate total involvement of NPs and PAs in specialty care as noted by the authors because their data reflects only care reported by NPs and PAs who share rosters with physicians. Though the authors couldn’t pinpoint the reason, NPs and PAs in their collected data “were disproportionately involved in care of patients with greater medical complexity.” This highlights the point that NPs / PAs are not just given the easy routine cases while the physicians handle more difficult decisions.

Conclusion
NPs and PAs don’t just play an important role in primary care, but they are also integral team members in specialty care and often sole treatment providers during visits to specialists. NPs/PAs are entrusted with the most difficult and complex medical cases.

 

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