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Mid-level practitioners
Publications
Listed by publication date. You can also view these publications alphabetically.
2007
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Washington State Nurse Anesthetist Workforce: A Case Study
Author(s): Louise Kaplan, Marie-Annette Brown, Holly Andrilla, L. Gary Hart
Research center:
WWAMI Rural Health Research Center
Topics:
Mid-level practitioners,
Workforce
Citation: American Association of Nurse Anesthestists 75:37-42
Date: 02 / 2007
The purposes of this study were to describe the Washington State Certified Registered Nurse Anesthetist (CRNA) workforce and analyze selected dimensions of their clinical practice. The authors developed a 31-item CRNA Practice Questionnaire that was mailed to CRNAs licensed in Washington with an address in Washington, Oregon and Idaho. Workforce data may assist CRNAs when negotiating with employers and institutions and in resolving interprofessional conflicts and can have implications for scope of practice, policy and legislative issues.
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Practice Patterns and Characteristics of Nurse Practitioners in Washington State
Author(s): CHA Andrilla, L. Gary Hart, L. Kaplan, MA Brown
Topics:
Mid-level practitioners,
Nurses
Report Number: Working Paper No. 109
Date: 2007
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Growth and Change in the Physician Assistant Workforce in the United States, 1967-2000
Author(s): Eric H Larson, L. Gary Hart
Research center:
WWAMI Rural Health Research Center
Topics:
Mid-level practitioners,
Workforce
Citation: Journal of Allied Health, Volume 36 Number 3, pp. 121-130
Date: 2007
The physician assistant (PA) profession grew rapidly in the 1970s and 1990s. As acceptance of PAs in the health care system increased, roles for PAs in specialty care took shape and the scope of PA practice became more clearly defined. This report describes key elements of change in the demography and distribution of the PA population between 1967 and 2000, as well as the spread of PA training programs. Individual-level data from the American Academy of Physician Assistants, supplemented with county-level aggregate data from the Area Resource File, were used to describe the emergence of the PA profession between 1967 and 2000. Data on 49,641 PAs who had completed training by 2000 were analyzed. More than half (52.4%) of PAs active in 2000 were women. PA participation in the rural workforce remains high, with more than 18% of PAs practicing in rural settings, compared with about 20% in 1980. Primary care participation appears to have stabilized at about 47% among active PAs for whom specialty is known. By 2000, 51.5% of practicing PAs had been trained in the states where they worked. The profession has grown rapidly; 56% of all PAs were trained between 1991 and 2000. In 2000, more than 42% of accredited PA programs offered a master's degree, compared to master's degree programs in 1986. Although many critical issues of scope of practice and patient and physician acceptance of PAs have been resolved, the PA profession remains young and continues to evolve. Whether the historical contribution of PAs to primary care for rural and underserved populations can be sustained in the face of increasing specialization and higher-level academic credentialing is not clear.
2006 -
Barriers to Autonomous Practice
Author(s): Louise Kaplan, Marie-Annette Brown, Holly Andrilla, L. Gary Hart
Research center:
WWAMI Rural Health Research Center
Topics:
Mid-level practitioners,
Nurses,
Pharmacy and prescription drugs,
Workforce
Citation: Nurse Practitioner, 31(1), 57-63
Date: 01 / 2006
Describes a study of the impact of a Washington State law changing nurse practitioners (NPs) prescribing authority. The study examined whether prescribing with indirect physician involvement eliminated barriers to practice, the extent to which the law created barriers to prescribing certain drugs, and compared NPs' experiences prescribing or providing controlled substances before and after implementation of the current law.
20052003 -
Contribution of Nurse Practitioners and Physician Assistants to Generalist Care in Underserved Areas of Washington State
Author(s): Eric H Larson, Lorella Palazzo, Bobbi Berkowitz, Michael J Pirani, L Gary Hart
Research center:
WWAMI Rural Health Research Center
Topics:
Mid-level practitioners,
Nurses,
Workforce
Citation: Health Services Research, 38(4), 1033-1050
Date: 08 / 2003
Uses productivity data from the non-physician clinician (NPC) and physician populations in Washington State to assess the contribution to generalist care made by NPCs, giving special attention to the role of NPCs in rural and underserved areas and the role of women NPCs in the female provider population. Overall, generalist NPCs make up 23.4 percent of the generalist provider population and perform about 21 percent of the generalist outpatient visits in Washington State. NPC contribution is higher in rural areas of the state and a bit lower in urban areas. In rural areas, female physicians provided only 49.3 percent of the visits by female providers; female NPCs provided the remaining 50.3 percent. In urban areas, female physicians provided about 63.5 percent; female NPCs provided 46.5 percent. NPCs made similar contributions to total care in rural HPSAs compared to rural non-shortage areas, though physician assistants appear to contribute somewhat more care in HPSAs with severe shortages of providers. The results suggest that accurate and meaningful estimates of available generalist care must take into account the contribution of NPCs.
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Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington
Author(s): Kevin Grumbach, L. Gary Hart, Elizabeth Mertz, Janet Coffman, and Lorella Palazzo
Research center:
WWAMI Rural Health Research Center
Topics:
Mid-level practitioners,
Physicians
Citation: Annals of Family Medicine, 1(2), 97-104
Date: 07 / 2003
Compares the geographic distribution and patient populations of physician and nonphysician primary care clinicians. Includes the proportion of clinicians within each discipline practicing in rural areas, Health Professional Shortage Areas (HPSAs), and areas with vulnerable populations.
2001 -
National Estimates of Physician Assistant Productivity
Author(s): Eric H Larson, L. Gary Hart, Ruth Ballweg
Research center:
WWAMI Rural Health Research Center
Topics:
Mid-level practitioners,
Workforce
Citation: Journal of Allied Health, Volume 30, Number 3, pp. 146-152(7)
Date: 2001
Analysis of productivity data from a nationally representative sample of physician assistants (PAs) showed that PAs performed 61.4 outpatient visits per week compared with 74.2 visits performed by physicians, for an overall physician full-time equivalent (FTE) estimate of 0.83. However, productivity of PAs varies strongly across practice specialty and location, with generalist PAs performing more visits than their specialist counterparts. Rural PA productivity is higher than urban productivity because of the concentration of generalist PAs in rural settings. A generalist PA physician FTE estimate of 0.75 appears to be more accurate than the 0.5 currently under consideration in proposed modifications to Health Personnel Shortage Area designation regulations.
1998 -
Availability of Anesthesia Personnel in Rural Washington and Montana
Author(s): Peter J Dunbar, Jonathan D Mayer, Meredith Fordyce, Denise M Lishner, Amy Hagopian, Ken Spanton, L. Gary Hart
Research center:
WWAMI Rural Health Research Center
Topics:
Mid-level practitioners,
Workforce
Citation: The Journal of the American Society of Anesthesiologists 88(3):800-808
Date: 03 / 1998
Anesthesia has historically been an undersupplied specialty. Health personnel issues used to be dominated by the findings of the 1980 Graduate Medical Education National Advisory Committee study, which suggested that anesthesia would be a balanced specialty for the rest of the century. Recent studies, however, have demonstrated that there is an oversupply of all specialists, including anesthesiology. These studies take a "top down" view of health personnel through analysis of national statistics and exploration of subsets of the data by hospital size and rurality. This approach assumes that the databases of the American Hospital Association and the American Medical Association are accurate and do not take into account the presence of certified registered nurse anesthetists (CRNAs), who are the predominant providers of anesthesia care in the smallest and most remote hospitals in the United States. We compared the 1994 master file of the American Medical Association with our local knowledge of the practitioners in the rural areas of Washington state and found numerous small errors. These errors of one or two practitioners made no difference to the analysis of practitioner groups with more than approximately five people, but in the most rural communities the erroneous presence or absence of a single practitioner made a significant difference.
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