Chapter Two (' Practitioner Roles')

Non-Physician Practitioners in Primary Care
by
Timothy Bilash MD, MS
June 17, 1994
www.DrTimDelivers.com

based on
"The Roles of Physicians Assistants and Nurse Practitioners in Primary Care"
D. Kay Clawson and Marian Osterweis, Eds, 1993

1. "Few can specify how primary practice differs from the practice of specialists": who is the few referred to, and could it be because only generalists were asked? (p12)
   
   
2. Studies showing better patient satisfaction and compliance of patients with 50% more patient time spent by nurses over physicians do not include important characteristics, including referral rates. (p14) They are not blinded studies. (p17)
   
   
3. "99 percent of all health problems of an area's population is considered primary care"? (p14)
   
   
4. The statement that the functions of primary care are not present in secondary or tertiary care implies that secondary and tertiary services are thought of as merely technical in nature (like ordering radiology exams, the patient is sent for them and returns after completion). The definitions of longitudinal, comprehensive, and coordination functions imply administrative, hospital model akin to information processing and medical records. Who is it that is capable of doing the coordinating? (p16)
   
   
5. "Acceptance of, and satisfaction with, care provided by non-physician professionals is mixed." (p17)
   
   
6. "It has not been demonstrated that some aspects of primary care might be better achieved by NPP (Non-Physician Practitioners) than by physicians ." (p17)
   
   
7. Is it possible that the willingness of people to go to a practitioner directly may be more related to the convenience to walk at will and reimbursement guarantees, than of practitioner characteristics or availability? (p17)
   
   
8. 'The evidence seems to suggest that an NPP role is supplementary and complementary; whether they are a substitute for physicians in the primary care role is not clear' (p18)
   
   
9. "Little is known about the extent to which these managed care organizations achieve the elements of primary care, and the extent to which the NPP's they employ contribute to achieving those elements." (p19)
   
   
10. The role of residents at the HMO facilities with NPP is not stated. (p18)