Patient Willingness to Be Seen by Physician Assistants, Nurse Practitioners, and Residents in the Emergency Department: Does the Presumption of Assent Have an Empirical Basis?

Abstract

Physician assistants (PAs), nurse practitioners (NPs), and medical residents constitute an increasingly significant part of the American health care workforce, yet patient assent to be seen by nonphysicians is only presumed and seldom sought. In order to assess the willingness of patients to receive medical care provided by nonphysicians, we administered provider preference surveys to a random sample of patients attending three emergency departments (EDs). Concurrently, a survey was sent to a random selection of ED residents and PAs. All respondents were to assume the role of patient when presented with hypothetical clinical scenarios and standardized provider definitions. Despite presumptions to the contrary, ED patients are generally unwilling to be seen by PAs, NPs, and residents. While seldom asked in practice, 79.5% of patients fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider. Patients are more willing to see residents than nonphysicians.

Parents' willingness to have their child receive care by physician assistants in a pediatric emergency department

“…10 Studies of health care users' willingness to be treated by PAs have shown conflicting results. In an American study, only 57% were willing to be treated by a PA, 11 whereas a study in Australia found that over 99% of respondents were willing to be treated by a PA. 12 A similar survey to the Australian study, in Vancouver, British Columbia, 13 found that when faced with hypothetical injury scenarios and a 4-hour wait to see a physician, adults chose to be treated by the PA 85 to 99% of the time, depending on a time to PA that ranged from 30 minutes to 2 hours. When asked about an injury scenario involving their child, however, only 67 to 96% of parents chose to be seen by a PA.…”

Patient willingness to be seen by a physician associate in Ireland

“…[23] Strategies to expand the scope of medical providers who are not doctors, should first consider the willingness of patients to be treated by them. [5] On the other hand, incorporating a PA in an acute setting may have advantages which are not fully appreciated by patients. In a New Zealand pilot project, the presence of a PA was seen to result in safer patient care.…”

“…Studies on patient willingness to be seen by a PA reveals that Americans, Australians, Canadians and Dutch citizens are willing to access new models of care over traditional options, as long as their care needs are met. [2][3][4][5] An opportunity to explore the question of the societal benefits of PAs is important prior to people having the experience of being cared for by a PA. This work takes advantage of other exploratory studies which have examined the concept of "willingness to be seen" and with which these findings concur.…”

“…This work takes advantage of other exploratory studies which have examined the concept of "willingness to be seen" and with which these findings concur. [2][3][4][5] …”

Nurse Practitioners: What Does the Public Need to Know?

“…While the empirical article by Larkin and Hooker (2010) should be applauded for this fact alone, the lack of clarity on the role of nurse practitioners (NPs), in particular, perpetuates the belief that these providers are not qualified to meet the unprecedented demands of acutely and chronically ill patients. Without a clear definition on the role of nurse practitioners, it is not surprising that members of the public would feel more comfortable with medical residents providing their care.…”