Rural Health Research: Do Advanced Practice Nurses and Physician Assistants Benefit Small Rural Hospitals?

Abstract

Advanced practice nurses and physician assistants have offered small, rural hospitals an alternative to scarce primary care physicians for 30 years. This paper uses survey data from 285 small rural hospitals and case studies of 36 of these hospitals to answer questions about the extent to which advanced practice nurses and physician assistants provide primary care in small, rural hospitals, the benefits that might bring to the hospitals as well as the reactions of the public. The study used survey data collected as part of an evaluation of 285 hospitals, which received a Rural Health Care Transition grant from the Health Care Financing Administration in 1993 and 1994. Most of the hospitals used the practitioners; 70 percent used nurse practitioners; 30 percent used physician assistants; and 20 percent used both. There were some negative reactions to the use of the practitioners, but, overall, there was acceptance and benefits to the hospitals in the form of reduced recruitment costs, increased revenues and increased service offerings. These practitioners are beneficial to rural hospitals, and mechanisms to encourage their acceptance should be developed and implemented.

The Effects of Clinical Decision Making on Nurse Practitioners’ Clinical Productivity

“…For instance, in a large randomized trial designed to compare patient outcomes for NPs and physicians functioning equally as primary care providers, and where NPs had the same authority, responsibilities, productivity and administrative requirements, and patient populations as primary care providers, Mundinger et al (2000) found no significant differences in terms of the patients' health status and use of health services. Furthermore, over the past 30 years, NPs have offered many small, rural hospitals an alternative to scarce primary care physicians (Bergeron, Neuman, & Kinsey, 1999). In a study that surveyed 285 small, rural hospitals, 70% of the hospitals indicated that they used NPs and reported acceptance and benefits in the form of reduced recruitment costs, increased revenues, and increased service offerings (Bergeron et al, 1999).…”

“…Furthermore, over the past 30 years, NPs have offered many small, rural hospitals an alternative to scarce primary care physicians (Bergeron, Neuman, & Kinsey, 1999). In a study that surveyed 285 small, rural hospitals, 70% of the hospitals indicated that they used NPs and reported acceptance and benefits in the form of reduced recruitment costs, increased revenues, and increased service offerings (Bergeron et al, 1999). With this introduction and implementation of NPs, issues such as independent clinical decision making and clinical productivity have become increasingly imperative.…”

Utilization and Scope of Practice of Nurse Practitioners and Physician Assistants in Montana

“…Both physician assistants (PAs) and nurse practitioners (NPs) are referred to in the literature as midlevel practitioners, non-physician providers and limited-license practitioners (Rogers, 1994). Many studies lump NPs and PAs together for the purpose of discussing physician attitudes toward working with midlevel practitioners, cost containment, and access to care for rural consumers (Bergeson, Cash, Boulger, & Bergeron, 1997;Anderson, & Hamptom, 1999;Bergeron, Neuman, & Kinsey, 1999). However, the two professionals receive different training and, in theory, have different scopes of practice.…”

Editorial: Special People for Special Places

“…In the case of physician assistants, one of the original reasons for developing the profession was to relieve While many national policy-makers are concerned The lournal of Rural Health the burdens on house officers and residents in teaching hospitals. They have now found a place in the hospitals less likely to be involved in teaching-rural hospitals (Bergeron, et al, 1999)-but there remain issues about to how they are paid in relation to other professionals and how they are used in different settings (Anderson & Hampton, 1999).…”