Non-Physician Providers

Non-Physician Providers

DOI: 10.4018/978-1-4666-6355-8.ch003


In this chapter, the role played by non-physician providers such as Nurse Practitioners (NPs) and Physician Assistants (PAs) is discussed in depth. These providers have delivered services in a variety of healthcare settings for a long time, but there is a recent urgency about the importance of the role that they can play in the healthcare system. The authors expound on research related to cost, quality, and satisfaction of patients receiving care from non-physician providers, and address barriers such as restrictive scope of practice and unjust payment policies. The use of other providers such as pharmacists and grand-aides is also addressed.
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The NP workforce presents a potential answer to [these] pressures, but it has been largely overlooked by policy makers, the public, and other healthcare stakeholders. Fully integrating the contributions and skills of all primary care practitioners and, specifically, the contributions of nurse practitioners is a vital policy step toward achieving high-value healthcare. —Naylor and Kurtzman, 2010, p. 898


1. Education And Growth Of Non-Physician Providers


Advanced Practice Registered Nurses (APRNs) are registered nurses (RNs) with a master’s, post-master’s or doctoral degrees that have passed national certification examinations (Brassard and Smolenski, 2011). They are certified by professional or specialty nursing organizations, and are licensed to provide services that are consistent with their areas of expertise and state-specific laws that govern nursing scope of practice (Naylor and Kurtzman, 2011). For example, they teach and counsel patients to understand their health conditions and ways to improve their health, coordinate care and advocate for patients, and refer patients to physicians (Brassard and Smolenski, 2011). There are four types of APRNs: Clinical Nurse Specialists (CNSs); Certified Registered Nurse Anesthetists (CRNAs); Certified Nurse Midwives (CNMs) and NPs. CNSs “provide advanced nursing care in hospitals and other clinical sites; provide acute and chronic care management; develop quality improvement programs; [and] serve as mentors, educators, researchers and consultants” (Brassard and Smolenski, 2011, p. 2). CRNAs administer anesthesia before and after surgical, therapeutic, diagnostic, and obstetrical procedures and provide pain management in settings such as operating rooms, outpatient surgical centers, and dental offices (Brassard and Smolenski, 2011). CNMs provide women-specific primary care services such as gynecological exams, contraceptives, prenatal care, management of low-risk labor and delivery, and neonatal care. They typically practice in hospitals, birthing centers, and community clinics (Brassard and Smolenski, 2011). NPs “take health histories and provide complete physical exams; diagnose and treat acute and chronic illnesses; prescribe and manage medications; order and interpret lab tests and X-rays;[and] provide health teaching and supportive counseling” (Brassard and Smolenski, 2011, p. 2).

Physician Assistants (PAs), on the other hand, are providers who practice medicine under physician supervision. They perform physical exams, diagnose and treat illnesses, order and read tests, provide preventative services, assist in surgery, and prescribe medications (United States Government Accountability Office, 2008).

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