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 BACKGROUND 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. STUDY QUESTIONS 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? 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? 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 RESPONDENT CHARACTERISTICS 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 RESULTS CONTINUED 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 Recall however, that power was not obtained for the question, “I feel the lack of payer acceptance impedes their utilization.” Perceptions of Surveyed Physicians who Graduated from Indiana University School of Medicine (IU SM) RESULTS CONTINUED Perceptions of Physicians with Supervisory Experience RESULTS CONTINUED 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 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) 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 QuestionHistogram CurveTypeTest Statistic PAs have the skills to provide health care services in… …emergency situationsNegatively skewedNon-parametricMann Whitney U …primary careNegatively skewedNon-parametricMann Whitney U …surgeryNegatively skewedNon-parametricMann Whitney U …prescribing medicationsNegatively skewedNon-parametricMann Whitney U …basic office proceduresNegatively skewedNon-parametricMann Whitney U I feel that… …PAs are an asset to a physician’s practiceNegatively skewedNon-parametricMann Whitney U …the lack of payer acceptance impedes their utilization Normal distribution ParametricT test …employing PAs increases the risk of malpractice in patient care Normal distribution ParametricT test … employing PAs decreases malpractice in patient care Normal distribution ParametricT test … PAs provide an economic advantage to physicians who hire them Normal distribution ParametricT test … PAs are too limited in their knowledge base to provide adequate care Negatively skewedNon-parametricMann Whitney U … PAs can see the same amount of patients in a given day as a physician Positively skewedNon-parametricMann Whitney U... hiring a PA would free up the physician’s time for critical care or higher level of care Normal distribution ParametricT test … working with a PA would adversely increase my time spent in administrative duties Negatively skewedNon-parametricMann Whitney U … PAs increase the accessibility of healthcare to patientsNegatively SkewedNon-parametricMann Whitney U Histogram, Mandated Analysis, and Test Statistic Used to Compare the Mean Attitude Ratings of Physicians Who Supervise Physician Assistants and Those Who Don’t Student T Test Levene’s Test for Equality of Variances T test for Equality of Means QuestionFSigt (2-Tailed) 95% Confidence Interval I feel that…UpperLower …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 * Question Mann Whitney U Asymp. Sig (2-tailed) 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 * 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 Levene’s Test for Equality of Variances T test for Equality of Means QuestionFSigt 95% Confidence Interval PAs have the skills to provide health care services in… UpperLower …emergency situations …primary care …surgery …prescribing medications …basic office procedures I feel that… …PAs are an asset to a physician’s practice …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 … PAs are too limited in their knowledge base to provide adequate care 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 Levene’s Test for Equality of VariancesT test for Equality of Means QuestionFSigt 95% Confidence Interval PAs have the skills to provide health care services in…UpperLower …primary care QuestionMann Whitney U Asymp. Sig (2-tailed) PAs have the skills to provide health care services in… …emergency situations * …surgery * 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): 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 PAs should have greater prescribing privileges than they currently do PAs have the appropriate level of prescribing privileges PAs should have more restricted prescribing privileges than they currently do PAs should not have prescriptive privileges PAs do not have prescriptive privileges Do not know the Indiana law regarding prescriptive privileges Percent Which describes your attitude regarding prescriptive privileges Did not respondPlans to hire a PA within the next 3 years Already has a PA and plans to hire another within the next 3 years Already has a PA and does not plan to hire another within the next 3 years Is considering hiring a PA within the next 3 years No plans to hire a PA within the next 3 years Percent My practice… Question PAs have the skills to provide health care services in… N Group 1 Group 2 Mean Group 1 Group 2 SD Group 1 Group 2 Power 2 tail Effect Size Cohen’s d …emergency situations …primary care …surgery …prescribing medications …basic office procedures I feel that… …PAs are an asset to a physician’s practice …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 … 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 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 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