Vol. 24 Annals of Health Law 310
B. PA Care – Acceptance, Content, and Quality
Quality of care is difficult and challenging to measure since it comes
with an array of changing concepts, criteria, and reliability.232 However,
quality of care can be assessed by a number of measures that can assure the
public that a PA is functioning in a safe and effective manner and that the
quality is comparable to that of physicians in the same setting.233 In fact,
PA utilization in medical practices has grown, partly as result of perceived
quality of care PAs deliver,234 which some health services experts describe
as indistinguishable from that of physician care.235
Public acceptance and familiarity with PAs is fairly well established in
American culture.236 In fact, one in four patients has received medical advice or treatment from a PA.237 With respect to income, education, insurance status, self-assessment of health status, or rural versus urban location,
recipients of care from PAs did not differ from recipients of care from physicians. 238 Notably, Medicare beneficiaries indicated that the levels of satisfaction of care provided by a physician, PA or NP was the same.239 Similarly, studies on patient satisfaction show that patients are satisfied with care
when their needs are met, regardless of the provider.240
The United States has seen a high level of patient acceptance of PA ser-
232. See generally Avedis Donabedian, Evaluating the Quality of Medical Care, 83
MILBANK Q. 691, 691-729 (2005) (measures of quality of care are often subjective, prone to
bias, and dependent on patient perceptions that may or may not reflect improvement in
233. Id. at 692-99.
234. Id.; see also Michael J. Dill et al., Survey Shows Consumers Open to a Greater
Role For Physician Assistants And Nurse Practitioners, 32 HEALTH AFF. 1135, 1139-40
(2013) (indicating that a survey conducted by the Association of American Medical Colleges
“suggests that most US adults seeking medical care are familiar with physician assistants and
nurse practitioners and have, indeed, relied on them at some point for their care.”).
235. Harold C. Sox, Jr., Quality of Patient Care by Nurse Practitioners and Physician’s
Assistants: A Ten Year Perspective, 91 ANN. OF INTERNAL MED. 459, 461 (1979).
236. See Dill et. al, supra note 234, at 1139 (demonstrating that surveys of the general
public typically show a good level of familiarity with the role of the PA).
237. Arch G. Mainous III et al., Physician Extenders: Who is Using Them?, 24 FAM.
MED. 201, 201 (1992). A 1992 report based on findings from a random sample of 687 adults
surveyed by telephone in the Kentucky Health Survey indicated that 1 in 4 people had received medical advice or treatment from a PA within two years of being surveyed. Id. More
than 90% of these subjects reported satisfaction with the care they received. Id.
239. Roderick S. Hooker et al. Patient Satisfaction with Physician Assistant, Nurse
Practitioner, and Physician Care: A National Survey of Medicare Beneficiaries, 12 J. SCI.
COMM. CLINICAL OUTCOMES MGMT 88, 91 (2005).
240. See Roderick S. Hooker, et al. Patient Satisfaction: Comparing Physician Assistants, Nurse Practitioners, and Physicians, 1 Permanente J. 38, 38 (1997); D.J. Cipher et al.,
Are Older Patients Satisfied With Physician Assistants and Nurse Practitioners?, 19 J. AM.
ACAD. PHYSICIAN ASSISTANTS, 36, 36-44 (2006).