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Patient attitudes toward physician assistants

DEHN, RICHARD W. MPA, PA-C

Journal of the American Academy of PAs: October 2007 - Volume 20 - Issue 10 - p 58–60
Research Corner
Free
SDC

Rick Dehn is Clinical Professor and Assistant Director of the University of Iowa PA Program in Iowa City. He is a member of the JAAPA Editorial Advisory Board and chair of the PAEA Research Institute.

Acknowledgement: The author thanks Roderick Hooker for his help in preparing this article.

Surveys of patient attitudes toward physician assistants began early in the profession’s history. However, once the profession became established, the number of studies addressing the question of how patients regarded physician assistants decreased. With the reporting of polling data from a survey recently commissioned by the American Academy of Physician Assistants, the question of patient attitudes toward physician assistants has been rekindled. This installment of Research Corner examines four such surveys conducted over four decades.

Nelson EC, Jacobs AR, Johnson KG. Patients’ acceptance of physician's assistants. JAMA. 1974;228(1):63-67.

ABSTRACT: Patients of physicians using physician’s assistants in their practices were surveyed to determine attitudes toward these assistants. Fifty-four percent of the patients responded, and 12% of the nonrespondents were interviewed to insure that respondents were representative of the sample. Patients rate the physician’s assistants highly in terms of technical competence (89%) and professional manner (86%), and report improvements in the quality of care (71%) and access to services (79%) since the physician’s assistants began working. Eighty-seven percent of the patients who received physical examinations from physician’s assistants were very satisfied. Patient’s age, social class, and access to medical services are significantly related to certain attitudes toward physician’s assistants.

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ON THE WEB Please see the online version of Research Corner at www.jaapa.com for the accompanying Web-only article “The proper use of surrogate end points in research.”

Oliver DR, Conboy JE, Donahue WJ, et al. Patients’ satisfaction with physician assistant services. Physician Assistant. 1986;10(7):51-54, 57-60.

ABSTRACT: Research on patient satisfaction with physician assistants in rural primary care medical practices is lacking. This study attempted to determine patients’ satisfaction with family practice PAs in rural communities, assess patient perceptions of “comfort” with PAs in a range of hypothetical medial procedures, analyze patients’ reactions to PAs as a function of patient characteristics, and document perceptions of changes in medical practices after PAs are employed. Findings support reports that patients are highly satisfied with PA services and extend those observations to rural primary care practices. Reaction to PAs is more favorable among women, more favorable in patients with more education, and more favorable among those with greater contact with PAs.

Hooker RS, Potts R, Ray W. Patient satisfaction: comparing physician assistants, nurse practitioners, and physicians. The Permanente Journal. 1997;1(1):38-42.

OBJECTIVE: To evaluate patient satisfaction with care as managed by different types of providers: physician assistants (PAs), nurse practitioners (NPs), certified nurse midwives (CNMs), and physicians. METHODS: Questionnaires were mailed to members of a large health maintenance organization who visited medical offices in any of five medical specialties during 1995 or the first half of 1996. Patient-generated scores for eight provider attributes were combined to generate a mean score for each attribute by provider type. Scores were then compared. RESULTS: Satisfaction was reported by 89% to 96% of patients of PAs, NPs, CNMs, and physicians with regard to courtesy, understanding of problem, ability to explain, use of understandable words, listening, time spent, and confidence in provider. Clinicians in orthopedics and in obstetrics and gynecology scored slightly higher than did primary care clinicians. No statistically significant differences in scores were seen between providers by type, by age, by gender, or by length of employment. CONCLUSIONS: Patient satisfaction with interpersonal care appears to depend on communication and style and not on type of provider. These findings suggest that policy decisions to incorporate PAs, NPs, and CNMs into medical practice have gained patient acceptance.

American Academy of Physician Assistants. Majority of public say they are willing to be treated by PAs. www.aapa.org/majoritysays.html. Accessed September 11, 2007.

PURPOSE: In April 2007, AAPA commissioned a national survey managed by Fleishman-Hillard, an international communications company, and conducted by Opinion Research Corporation, which also conducts CNN polls. The national poll is the first step in a data collection effort to investigate the potential use of a public awareness campaign to advance understanding of the PA profession in response to a charge from the AAPA House of Delegates. METHODS: The questions were part of an omnibus poll using a nationally representative random sample. Just over 1,000 adults were interviewed by telephone between April 27 and April 30. RESULTS: The survey showed high awareness of and strong positive feelings toward the PA profession. Two out of three adults who responded to the nationwide poll said they are aware of the PA profession. Just over 80% of all respondents said they would be willing to be seen by a PA for a routine health visit in the event that their primary care physician was not available. Of those who had been previously treated by a PA, 90% said they would be willing to see a PA again. Of those who have never been treated by a PA, 76% said they would be willing to see a PA. Even though there are only approximately 64,000 clinically practicing PAs in a country of more than 281 million people, a majority of respondents— 47% in the weighted sample—said they had been treated by a PA. To test whether the respondents were confusing PAs with other health care professionals, all were asked to describe the primary responsibilities of a PA and, for those previously treated by a PA, what condition they presented to the PA. The responses confirmed that the public has a general understanding of what a PA does. Nine percent of those previously seen by a PA said they were treated by a PA because the physician was not available. CONCLUSIONS: PAs are recognized by the public and are well accepted as competent medical providers. The next step in the research process will be a series of longer, more in-depth phone surveys with a nationwide audience to delve deeper into patient attitudes, perceptions, and behaviors.

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DISCUSSION

Early in the establishment of PA educational programs, surveys were undertaken to determine patient satisfaction, physician acceptance, and physician impressions as to whether PAs added productivity to the medical system.1,2 Many of these studies were undertaken by PA programs to measure the outcomes of their education efforts and thus were small, single program surveys. At that early point in the profession’s history, it was thought that if both physicians and patients accepted PAs, the profession would succeed and the educational programs should be continued. Thus, patient and physician acceptance could be considered surrogate markers for the measurement of the impact of PAs in the workforce—reasonable outcomes measurements for quantifying the impact of PA educational processes, but most likely a substitute measurement rather than a direct measurement of the impact.

The 1974 survey by Nelson and colleagues sampled patients from the final 2 weeks of patient encounter logs from graduating MEDEX students. While 31% of respondents had reservation about the competence of PAs before seeing one, following their PA encounter patients were overwhelming satisfied with their PA interaction (1%-3% dissatisfaction).

In 1986, Oliver and colleagues surveyed 308 patients following their visits with PAs in nine Midwestern family practice offices in small and mid-sized communities. The survey instrument measured patient comfort levels with a PA performing a long list of medical tasks ranging from the routine to the complex. The data confirmed that few (less than 1%) of patients were dissatisfied with PA services overall, and only 9.2% were uncomfortable with a PA delivering babies. One interesting finding of this survey was that patients scored female PAs significantly higher than males in favorability ratings, independent of the patient’s gender.

A 1997 survey by Hooker and colleagues was the first to compare patient experiences between physician and non-physician providers. In a large HMO, surveys measuring patient satisfaction with the provider were mailed following an outpatient visit. Satisfaction scores were reported varying from 89% to 96% in patients of PAs, NPs, CNMs, and physicians, and no statistically significant differences in scores were seen between providers by type, age, gender, or length of employment.

A 2007 telephone survey conducted for the AAPA showed that a large proportion of the public are familiar with the PA profession and hold positive attitudes toward it, and almost half of the sample population reported having been treated by a PA. The survey also confirms that the public recognizes the PA profession, considers PA providers competent, and those who have seen a PA would be willing to see one again. This survey is notable because of its nationwide scope, because it demonstrates that the public is aware of the PA profession, and because it shows the public accept PAs as competent members of the health care system.

Throughout the history of the profession, survey data have consistently demonstrated that once patients interact with PAs, they are satisfied with the interaction and the services delivered and that patient satisfaction with PAs is similar to satisfaction with physicians and NPs. The largest and most recent study provides evidence that the public is knowledgeable about PAs and considers them competent providers.

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REFERENCES

1. Patterson PK, Bergman AB, Wedgwood RJ. Parent reaction to the concept of pediatric assistants. Pediatrics. 1969;44:69-75.
2. Strunk HK. Patient attitudes toward physician’s assistants. Calif Med. 1973;118:73-77.
© 2007 American Academy of Physician Assistants.