Date of Graduation

Fall 8-13-2016

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Mark Pedemonte, MD

Second Advisor

Annjanette Sommers, MS, PA-C

Abstract

Background: There is a popular conception that PAs are able to spend more time with patients than physicians, and this is often quoted by PA school applicants as a reason for them choosing to pursue a career as a PA vs. becoming a physician. With the passage of the Affordable Care Act in 2010, there has been an increase of ten million more patients with access to insurance. This has led to an influx of new patients into the healthcare system; putting a strain on available resources. This review evaluates if the perception that PAs spend more time with patients than physicians who are in residency training is true, and whether PAs are efficient clinicians in the utilization of limited time.

Methods: An exhaustive search of available medical literature was conducted using MEDLINE-OVID, CINAHL, Web of Science, and EBMR Multifile. The keywords used for each search were: physician assistant, resident, emergency department, and productivity. Additional inclusion and exclusion criteria were used to focus the search. Relevant articles were assessed for quality using GRADE. Forty-Eight articles were reviewed for relevancy. Three retrospective studies met inclusion criteria and were included in this systematic review.

Results: The first study was conducted at a tertiary ED as an evaluation of PA productivity and found that PAs saw an equivalent number of patients per hour compared to ED residents in both the main ED and the fast track. The second study was conducted at a single high volume ED that sees 45 000 patients a year and evaluated PAs vs residents in the main ED; the study shows that the PAs saw more patients per hours than residents, whether they were in their first, second, or third year of residency training. The third study looked at PA vs resident productivity as well as patient satisfaction at a community hospital’s fast track. They found that PAs saw significantly more patients than residents, regardless of their year of training, and that there was no difference in patience satisfaction between the groups of clinicians.

Conclusion: In one of the studies PAs saw an equivalent number of patients per hour as the residents, and saw more patients per hour than residents in the other two: showing that in an acute setting PAs actually spend less time with patients than physicians in training. Further research needs to be done to see if this carries over into a primary care setting and if it remains true or at least equivalent to the productivity of physicians once they become attendings.

Keywords: Physician assistant, resident, emergency department, and productivity

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