311 Physician Assistant Scope of Practice 2015
vices since the integration of PAs into clinical practice.241 In fact, studies
have shown that a large proportion of patients who have not previously
been seen by a PA report a willingness to accept healthcare services delivered by PAs.242 This figure subsequently rose to ninety-five percent among
patients surveyed after having received care from a PA.243
Outcome of care also measures quality of healthcare.244 In a study of Air
Force primary care clinics, the RAND Corporation assessed the experience
of a decrease in physicians available for ambulatory care services.245 In response, Air Force primary care clinics employed increased numbers of PAs
and NPs to care for service members and their families.246 To determine
whether the providers compromised care, the study assessed the quality of
the providers’ care on the basis of responses to predetermined diagnostic,
therapeutic and disposition criteria.247 PAs performed as well as or better
than physicians in identifying desirable therapeutic actions in five out of six
of the evaluated therapeutic criteria.248
PA productivity similarly factors into quality of care, as documented in
an analysis of the state of Utah.249 Although PAs make up only 6.3% of
Utah’s combined clinician workforce (physician, PA, NP), they account for
approximately 7.2% of the patient care in the state.250 Nearly three-quarters
of Utah’s PAs work at least thirty-six hours per week, spending a greater
percentage of total hours working in patient care than physicians.251
Data on primary care physician office encounters in the late 1990s shows
that approximately one-quarter of office-based primary care physicians used
PAs and/or NPs. 252 The study analyzed characteristics of patients and found
241. D.J. Cipher, supra note 240 at 36-44.
242. Roderick S. Hooker, et al. Patient Satisfaction: Comparing Physician Assistants,
Nurse Practitioners, and Physicians, 1 Permanente J. 38, 38 (1997); Dorothy Budzi, Veterans’ Perceptions of Care by Nurse Practitioners, Physician Assistants, and Physicians: A
Comparison from Satisfaction Surveys, 22 J. Am. Acad. Nurse Practitioners 170, 170-76
243. ASS’N OF ACADEMIC HEALTH CTRS,. THE ROLES OFPHYSICIAN ASSISTANTS AND
NURSE PRACTITIONERS IN PRIMARY CARE 51-57 ( D. Kay Clawson & Marian Osterweis eds.,
244. Donabedian, supra note 232, at 692-93.
245. See generally GEORGE A. GOLDBERG & DAVID G. JOLLY, QUALITY OF CARE
PROVIDED BY PHYSICIAN’S EXTENDERS IN AIR FORCE PRIMARY MEDICINE CLINICS (Rand
246. Id. at 1.
247. Id. at 34.
248. Id. (discussing the therapeutic criteria evaluated, which included desirable and undesirable actions on the part of the healthcare provider).
249. See D.M. Pedersen et al., The Productivity of PAs, APRNs, and Physicians in
Utah, 21 J. AM. ACAD. PHYSICIAN ASSISTANTS, 1 42, 42–47 (2008).
252. Roderick S. Hooker & Linda F. McCaig, Use of Physician Assistants and Nurse