PHYSICIAN PERCEPTIONS REGARDING THE ROLE OF THE PHYSICIAN ASSISTANT AND THEIR UTILIZATION IN INDIANA
Jessica M. Low, PA-S and Shawn R. Brady, PA-S, Graduate Students;
Jennifer A. Snyder, MPAS, PA-C, Associate Professor
Physician Assistant Program, Butler University, College of Pharmacy and Health Sciences, Indianapolis, Indiana
RESULTS CONTINUED
RESULTS CONTINUED
Perceptions of Physicians with Supervisory Experience
For fourteen of the fifteen survey question responses, there was a
statistically significant difference between the mean attitude rating toward
the roles of physician assistants among Indiana physicians who have or had
a supervisory role of physician assistants and those who do not or have not
had that same responsibility
Perceptions of Surveyed Physicians Working within Specific Specialties
A Student t test for independent samples was utilized to determine if there was a difference
between the mean attitudes of primary care physicians regarding the use of physician
assistants who practice in primary care compared to those physicians who do not practice in
primary care
Post hoc Power and Effect Size Analysis Used to Compare the Mean
Attitude Ratings of Physicians Who Supervise Physician Assistants
and Those Who Don’t
N
Group 1
Group 2
71
78
Mean
Group 1
Group 2
3.31
4.24
SD
Group 1
Group 2
1.166
.900
…primary care
71
78
3.83
4.78
1.121
.526
.999998
1.0849822
•Is there a difference between the mean attitude rating of Indiana physicians who supervise physician
assistants and those who do not toward the utilization of physician assistants?
…surgery
71
78
3.83
4.38
1.134
.768
.993435
.7331324
…prescribing medications
71
78
3.30
4.38
1.212
.777
.999996
1.0608973
•Is there a difference between the mean attitude rating of those Indiana physicians surveyed who graduated
from the IU SM and those who did not regarding the roles of physician assistants?
…basic office procedures
71
78
3.45
4.46
1.181
.817
.999976
.9946395
STUDY QUESTIONS
•Is there a difference between the mean attitude rating of Indiana physicians surveyed that practice in primary
care, surgery, and emergency medicine and those who do not practice in those specialties respectively
regarding the roles of physician assistants?
METHODS
• Descriptive non-experimental and inferential analysis; University IRB approved
• The Indiana Professional Licensing Agency (IPLA) database of active allopathic physicians was queried April
29th, 2009
• A disproportionate stratified, random sampling was performed at a 2:1 ratio, non-supervising (734):
supervising physicians (366), respectively
• Supervision of a physician assistant was defined by using the Medical Licensing Board standards of having a
formally approved application with the state’s licensing agency
• A survey first utilized by Burgess et al. (2003), was modified with demographic and fifteen Likert scale
questions ranging from 1 = strongly disagree to 5 = strongly agree and administered to a random sampling
• Instrument was piloted to increase reliability
• Survey data was analyzed by a t test of independent samples or a Mann Whitney U as statistically indicated
RESULTS
• One hundred and fifty-four surveys (14.8%) were returned from respondents for analysis
• 125 male and 26 female physicians; 3 respondents gender unknown
• Median age is 51 years with over 20 years of clinical practice experience (median 20.5 years)
• 62% graduated from IU SM; 38% did not
Family Practice
Obstetrics / Gynecology
Pediatrics
Internal Medicine
Emergency Medicine
Surgical Specialty / Subspecialty
Medical Subspecialty
Total
Group
35
2
2
4
3
21
22
89
I feel that…
…PAs are an asset to a physician’s practice
Power
2 tail
Effect Size
Cohen’s d
.999718
.8929199
71
78
3.39
4.73
1.115
.475
1.000
1.5636195
…the lack of payer acceptance impedes
their utilization
68
77
3.35
3.70
.806
1.101
.581325
.3627540
…employing PAs increases the risk of
malpractice in patient care
71
78
3.17
2.38
1.055
1.009
0.95263
.7653138
… employing PAs decreases malpractice in
patient care
71
78
2.56
3.24
.788
.809
.999306
… PAs provide an economic advantage to
physicians who hire them
71
78
3.48
4.22
.892
.732
.999794
.9069390
… PAs are too limited in their knowledge
base to provide adequate care
70
78
2.81
1.71
1.277
.705
.999996
1.0664659
… PAs can see the same amount of
patients in a given day as a physician
71
78
2.38
2.79
1.005
1.166
0.95086
.3766718
... hiring a PA would free up the
physician’s time for critical care or higher
level of care
… working with a PA would adversely
increase my time spent in administrative
duties
… PAs increase the accessibility of
healthcare to patients
71
78
3.34
4.31
1.027
.588
1.00
70
77
3.10
2.03
.903
.903
1.00
71
78
3.32
4.41
1.039
.711
1.00
Hospital
2
0
0
1
16
8
15
42
Urgent Care
1
0
0
0
0
0
0
1
ACKNOWLEDGMENTS
• Permission to utilize the original Likert survey was granted from Burgess, SE, RH Pruitt, P Maybee, AE Metz, and J
Leuner. Rural and urban physicians’ perceptions regarding the role and practice of the nurse practitioner, physician
assistant, and certified nurse midwife. Journal Rural Health. 2003; 19 (5): 321-328
• Jennifer A. Snyder, Associate Professor and Jennifer S. Zorn, Assistant Professor at Butler University received a Butler
University College of Pharmacy and Health Sciences Lilly Endowment Grant to financially support this study
Question
Histogram Curve
.8515231
1.1591759
1.1849391
1.2243938
Type
Negatively skewed
Non-parametric Mann Whitney U
…primary care
Negatively skewed
Non-parametric Mann Whitney U
…surgery
Negatively skewed
Non-parametric Mann Whitney U
…prescribing medications
Negatively skewed
Non-parametric Mann Whitney U
…basic office procedures
Negatively skewed
Non-parametric Mann Whitney U
I feel that…
…employing PAs increases the risk of malpractice in patient
care
… employing PAs decreases malpractice in patient care
… PAs provide an economic advantage to physicians who
hire them
Negatively skewed
Parametric
T test
Parametric
T test
Normal
distribution
Normal
distribution
Parametric
T test
Parametric
T test
Negatively skewed
… PAs can see the same amount of patients in a given day
as a physician
Positively skewed
... hiring a PA would free up the physician’s time for critical
care or higher level of care
Normal
distribution
… PAs increase the accessibility of healthcare to patients
Non-parametric Mann Whitney U
Normal
distribution
Normal
distribution
… PAs are too limited in their knowledge base to provide
adequate care
… working with a PA would adversely increase my time
spent in administrative duties
Student T Test
PAs have the skills to provide health care services in…
…primary care
Question
I feel that…
…the lack of payer acceptance impedes their
utilization
…employing PAs increases the risk of
malpractice in patient care
… employing PAs decreases malpractice in
patient care
… PAs provide an economic advantage to
physicians who hire them
... hiring a PA would free up the physician’s
time for critical care or higher level of care
Negatively skewed
Negatively Skewed
Levene’s Test for Equality
of Variances
F
Sig
6.745
.010
-2.190
.030*
95% Confidence
Interval
Upper Lower
-.663
-.034
.063
.802
4.636
.000*
1.119
.450
.002
.968
-5.190
.000*
-.939
-.422
5.669
.019
-5.496
.000*
-1.005
-.473
38.700
.000
-6.980
.000*
-1.245
-.694
t
Sig
(2-Tailed)
Mann
Whitney U
Asymp. Sig
(2-tailed)
1494
1318.5
1742
1336
1399
.000*
.000*
.000*
.000*
.000*
830
1355.5
2277
1107
1140
.000*
.000*
.051
.000*
.000*
F
Sig
Parametric
T test
Non-parametric Mann Whitney U
Non-parametric Mann Whitney U
Sig
t
Sig
5.802
.017
-1.767
.080
95% Confidence
Interval
Upper
Lower
-.648
.038
There was no difference between the mean attitude ratings of those physicians surveyed
who practice in primary care and those who practice in all other specialties (4.14 versus
4.45, non-primary care: primary care, respectively) regarding the role of physician assistants
who practice in family practice, internal medicine, pediatrics, or obstetrics / gynecology.
There was a statistically significant difference between the mean attitude rating of those
physicians surveyed who practice in both emergency medicine and surgical specialties and
those physicians who do not regarding the skills of physician assistants in those specialties,
respectively (3.72 versus 4.42, non-emergency medicine: emergency medicine and 4.11
versus 4.60, non-surgical: surgical, respectively)
Question
Mann Whitney U
Asymp. Sig
(2-tailed)
764.5
1316.5
.004*
.009*
PAs have the skills to provide health care services in…
…emergency situations
…surgery
My practice…
Which describes your attitude regarding prescriptive privileges
40
30
30
20
20
10
10
0
0
Do not know the PAs do not have PAs should not PAs should have PAs have the PAs should have
Indiana law
prescriptive
have
more restricted appropriate level
greater
regarding
privileges
prescriptive
prescribing
of prescribing
prescribing
prescriptive
privileges
privileges than
privileges
privileges than
privileges
they currently do
they currently do
No plans to hire Is considering Already has a Already has a Plans to hire a Did not respond
a PA within the hiring a PA PA and does notPA and plans to PA within the
next 3 years within the next 3 plan to hire
hire another
next 3 years
years
another within within the next 3
the next 3 years
years
T test for Equality of Means
t
Sig
PAs have the skills to provide health care
services in…
95% Confidence
Interval
Upper
Lower
…emergency situations
1.549
.215
-.750
.454
-.513
.231
…primary care
4.311
.040
-.991
.324
-.463
.154
…surgery
2.226
.138
-1.018
.310
-.506
.162
…prescribing medications
2.561
.112
-1.664
.098
-.686
.059
…basic office procedures
.138
.711
-1.012
.313
-.557
.180
…PAs are an asset to a physician’s practice
.393
.532
-.146
.884
-.378
.326
…the lack of payer acceptance impedes their
utilization
3.963
.048
-.504
.615
-.387
.230
…employing PAs increases the risk of
malpractice in patient care
.163
.687
-.205
.838
-.400
.325
… employing PAs decreases malpractice in
patient care
.463
.497
-.296
.768
-.033
.244
… PAs provide an economic advantage to
physicians who hire them
4.352
.039
.008
.994
-.272
.274
… PAs are too limited in their knowledge base
to provide adequate care
.808
.370
-1.046
.297
-.578
.178
... hiring a PA would free up the physician’s time
for critical care or higher level of care
.254
.615
-.368
.713
-.371
.254
… working with a PA would adversely increase
my time spent in administrative duties
.320
.572
.129
.897
-.323
.368
… PAs increase the accessibility of healthcare to
patients
.065
.800
-.373
.710
-.404
.275
I feel that…
Non-parametric Mann Whitney U
Non-parametric Mann Whitney U
T test for Equality of Means
F
40
For all fifteen questions, there was no difference between the mean attitude
ratings of those physicians surveyed regarding the roles of physician
assistants in Indiana from those physicians who graduated from the IU SM
and those who did not
Perceptions of Surveyed Physicians who Graduated from Indiana
University School of Medicine (IU SM)
Levene’s Test for Equality
of Variances
Levene’s Test for Equality of Variances
T test for Equality of Means
PAs have the skills to provide health care services in…
…emergency situations
…primary care
…surgery
…prescribing medications
…basic office procedures
I feel that…
…PAs are an asset to a physician’s practice
… PAs are too limited in their knowledge base to provide adequate care
… PAs can see the same amount of patients in a given day as a physician
… working with a PA would adversely increase my time spent in administrative duties
… PAs increase the accessibility of healthcare to patients
Question
…emergency situations
…the lack of payer acceptance impedes their utilization
Question
Test Statistic
PAs have the skills to provide health care services in…
…PAs are an asset to a physician’s practice
Recall however, that power was not obtained for the question, “I feel the lack
of payer acceptance impedes their utilization.”
Question
Histogram, Mandated Analysis, and Test Statistic Used to Compare the Mean Attitude
Ratings of Physicians Who Supervise Physician Assistants and Those Who Don’t
RESPONDENT CHARACTERISTICS
Solo
9
2
1
1
0
1
5
19
Question
PAs have the skills to provide health care
services in…
…emergency situations
Percent
•Of the nearly 600 PAs in Indiana, one-fourth are working in primary care (family practice, internal medicine,
pediatrics, and obstetrics / gynecology); three-fourths of all PAs are working in specialty care.1
•In July 2007, Indiana was the last state to grant prescribing privileges to PAs.2,3
•Indiana’s physician workforce is evenly divided between physicians who are graduates of the Indiana
University School of Medicine (IU SM) (51.9%), the only medical school in the state, and elsewhere (48.1%).4
•In July 2009, there were 713 allopathic and forty-six osteopathic physicians supervising physician assistants
and 15,297 non-supervising physicians.1,6
•This is the first randomized study to determine the perception of physicians in Indiana regarding the roles of
physician assistants.
RESULTS CONTINUED
Percent
BACKGROUND
CONCLUSION
• The results of this study showed in all, a more favorable outlook existed for the utilization
of PAs by those who have formally supervised physician assistants
• Widespread education directed to non-supervising physicians regarding the role and
utilization of PAs in Indiana may be helpful in optimizing their attitudes
• Since twenty-six percent of those surveyed admittedly did not know the law regarding
PA prescriptive privileges or did not know PAs had prescriptive privileges, this is a
critical starting point in that education process.
• There was not a mean difference in attitude ratings between surveyed physicians
graduating from IU SM and elsewhere.
• Surveyed physicians supervising physician assistants in emergency medicine and surgical
specialties had a statistically more positive regard for PA utilization in those specialties than
physicians who did not work in those specialties
• Of those physicians surveyed, overall forty-two percent are considering hiring (10%) or are
planning to hire a PA (32%) in the next three years
REFERENCES
1. Indiana Professional Licensing Agency, Physician Assistant List Acquired April 29, 2009
2. Indiana Code Accessed August 25, 2009
3. Indiana Governor Signs Legislation Allowing Physician Assistants to Prescribe Medicines Accessed
August 25, 2009
4. Indiana University School of Medicine Physician Workforce Task Force. Task Force Findings and
Recommendations: Indiana Physician Profile, Analysis and Projection - Final Report, 2006.
Indianapolis, IN: Indiana University School of Medicine; November 2006.
5. Burgess, SE, RH Pruitt, P Maybee, AE Metz, and J Leuner. Rural and urban physicians’ perceptions
regarding the role and practice of the nurse practitioner, physician assistant, and certified nurse
midwife. Journal Rural Health. 2003; 19 (5): 321-328
6. Indiana Professional Licensing Agency, Physician List Acquired April 29, 2009