Moreover, their background in both nursing and medicine may better lend itself to coordinating care between disciplines. After choosing a career as a nurse practitioner versus a physician assistant, a candidate must seek the necessary education. Welcome to Part 2 of our series on comparing Nurse Practitioners (NP) to Physician Assistants (PA) in Canada, with a specific focus of the roles in Ontario. For patient satisfaction, we developed a hierarchical linear model (HLM) that nested patients within facilities.  The lack of a nursing background for PAs and potentially less overall medical experience than NPs possibly may contribute to this finding. Table 2 reports location of practice in the hospital and workload. Nurse Practitioner vs Physician Assistant Scope of Practice. Of 118 VHA inpatient medicine services, 56 (47.5%) had APPs, of which 27 (48.2%) had NPs only, 15 (26.8%) had PAs only, and 14 (25.0%) had both NPs and PAs. 2014 Oct;9 (10):615-20 ... Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. “Full practice… Surveys were conducted by e‐mail with up to 4 reminders and a subsequent paper mailing. There were few differences between their roles and perceptions of care. Patient satisfaction is a complex amalgam of various factors including patient expectations, sociodemographics, emotional and physical state, quality of care, and physician communication. To become a nurse practitioner, candidates must: To become a physician assistant, a candidate must: There are differences when comparing the requirements of becoming a nurse practitioner versus a physician assistant. I have had great physician assistants and nurse practitioners who both have helped me so much. Background: Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care … [11, 12, 13] As the largest fully integrated healthcare system in the US, the VHA had 8.8 million veterans enrolled and 703,500 inpatient admissions in 2012. Nurse practitioners, on the other hand, do not have this requirement in most states, so they can operate completely independently in all respects. However, there is some guidance for the 270,000 nurse practitioners (NP) and 131,000 physician assistants (PA) in the United States. Both types of medical professionals can expect to operate with a high degree of autonomy, but Ryanne Coulson, a certified physician assistant, explains the legal distinctions and regulatory differences between the two roles. Nurse practitioners are primarily involved with working with patients and placing them at the center of their attention. Across 123 inpatient medicine services, we surveyed 264 nurse managers and received 198 responses (75.0%) from 114 inpatient medicine services. 1,2 Nurse practitioners (NPs) and physician assistants (PAs) were allowed to obtain waivers to prescribe buprenorphine beginning in 2016. [10, 22, 29, 30, 31, 32, 33, 34, 35] Third, we are unable to attribute causality to our findings and may not have accounted for all the differences between services. We conducted bivariate unadjusted and multivariable adjusted analyses. The presence of APPs was not associated with patient or nurse manager satisfaction. The Organizational Factors and Inpatient Medical Care Quality and Efficiency (OFIM) study provides a basis for this study with detail published elsewhere. NOTE: Abbreviations: N/A, not assigned specific patients; NPs, nurse practitioners; PAs, physician assistants. So, they ask me if I would like to see a physician assistant or a nurse practitioner and I told them that I can see either one. Nurse practitioners are primarily involved with working with patients and placing them at the center of their attention. One of the key differences to understand with these professionals is to consider the way they approach patient care. Given their very different background, regulation, and reimbursement, this has implications for inpatient medicine services that plan to hire NPs or PAs. [33, 36]We did, however, note a few significant differences in NP and PA scope. A nurse practitioner’s clinical practice can include: Assessment The COM is the senior attending physician in charge of departments of medicine that include most medical subspecialties within the VHA medical centers. Their impact on inpatient healthcare should be a subject of future research. Second, we did not measure other outcomes of care that may be affected by the use of APPs, such as clinical outcomes, process of care measures, or cost‐effectiveness, some of which have been shown in small studies to be impacted by APPs in inpatient medicine. Observational cross‐sectional cohort study. However, our study does not suggest a direct explanation for this finding, and we had no measure of prior clinical experience, and thus it should be an area for further research.There are a number of limitations to our study. They are formally trained to examine patients, diagnose injuries and illnesses and provide treatment. Anand Kartha MD, MS. Address for correspondence and reprint … There are a number of limitations to our study. A significant difference was observed based on bed size (F[3,109]=5.13, P<0.001); facilities with both NPs and PAs had, on average, a larger number of inpatient beds (mean=79.0, standard deviation [SD]=32.3) compared to those without NPs or PAs (mean=50.1, SD=29.4) or with PAs only (mean=44.2, SD=20.5) using Tukey post hoc analysis.The most common staffing model used staff (attending) physicians only working directly with APPs (N=29, 24.6%). The authors had full access to and take full responsibility for the integrity of the data and the accuracy of the data analysis. Most physician assistants practice medicine autonomously. © 2014 Society of Hospital Medicine. Overall, 81.9% of APPs worked in inpatient wards, 23.1% in step‐down units, 18.6% in intensive care units, 13.8% in skilled care units, and 4.9% in other locations. Finally, we found higher perception of both overall coordination of inpatient care and discharge coordination on services with NPs. This may reflect the deep commitment shown by the VHA to PA education dating back to the 1960s. NOTE: Abbreviations: NPs, nurse practitioners; PAs, physician assistants. Scope of Practice Determination. They can even open their own NP-run clinics. © 2014 Society of Hospital Medicine.  It also may reflect ongoing expansion of the role of APPs in the healthcare system since prior studies. NM survey responses were only used for the coordination of care regression model. Most NPs and PAs handled a caseload of 4 to 10 patients with a mean of 6.5, with no difference between the 2. Center for Healthcare Organization and Implementation Research (CHOIR) at the VA Boston Healthcare System, Boston, Massachusetts. View all blog posts under Family Nurse Practitioner | [9, 10, 22, 29, 30, 31, 32, 33, 34, 35] APPs practice in a variety of acute and subacute inpatient medicine settings including academic, community, rural, and urban settings without many discernable differences. Numbers may vary between items because all respondents may not have answered all items on survey questions. Their impact on inpatient healthcare should be a subject of future research. We conducted bivariate unadjusted and multivariable adjusted analyses.RESULTSOne hundred eighteen COMs (95.2%) and 198 nurse managers (75.0%) completed surveys. Like physicians, scope of practice for advanced level practitioners is varies by state. First, findings from the VHA may not be generalizable to other healthcare systems. The impact of nonphysician clinicians: do they improve the quality and cost‐effectiveness of health care services? In its simplest terms, this difference can be explained this way: This difference in focus affects the training and education necessary for nurse practitioners and physician assistants. Anand Kartha MD, MS . ACEP’s Medical Legal Committee has been asked to summarize the issues of working with, hiring and … Percentages do not add up to 100% because respondents may have more than 1 response to multiple response questions.Where do NPs and PAs provide care?N=38 (%)*N=28 (%)* Wards31 (81.6%)23 (82.1%)1.00Step‐down unit8 (21.1%)7 (25.0%)0.77Intensive care unit6 (15.8%)6 (21.4%)0.75Skilled care units5 (13.2%)4 (14.3%)1.00Other1 (2.6%)2 (7.1%)0.57What are NPs and PAs tours of duty?N=38 (%)*N=28 (%)* Weekdays37 (97.4%)25 (89.3%)0.30Weekends5 (13.2%)9 (32.1%)0.08Nights3 (7.9%)5 (17.9%)0.27Federal holidays3 (7.9%)9 (32.1%)0.02Other2 (5.3%)1 (3.6%)1.00What is the average clinical workload for NPs and PAs?N=37 (%)*N=26 (%)* Mean no. Percentages do not add up to 100% because respondents may have more than 1 response to multiple response questions. View all blog posts under Master of Science in Nursing. 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