As hospitals’ interest in nurse practitioners (NPs) and physician assistants (PAs) grows, their leadership is eager to know how their medical staffing privileging policies for these professionals compare to peer hospitals. This study assesses the extent of variation of these policies in four clinical areas and examines whether the differences are associated with state scope of practice laws for NPs and PAs. We also examine the relationship of NP and PA privileging policies to each other. Our analysis finds no evidence that hospital privileging is associated with state scope of practice, and indeed within-state variation is more significant than cross-state variation. We also find a strong correlation between NP and PA privileging in all four clinical areas. These results suggest the need for additional research to understand the institutional-level variables and human dynamics at the level of medical staffing committees that may explain the dramatic variation in privileging policies and, ultimately, the effects of different privileging levels on costs and quality.
AuerbachD. I.ChenP. G.FriedbergM. W.ReidR.LauC.BuerhausP. I.MehrotraA. (2013). Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage. Health Affairs, 32, 1933-1941.
7.
BlockA. E.NortonD. M. (2008). Utilizing trauma nurse practitioners to decrease length of stay. Nursing Economics, 26, 368-373.
BrushJ. E.HandlerE. M.BigaC.BirtcherK. K.BoveA. A.CasaleP. N.WymanJ. F. (2015). 2015 ACC health policy statement on cardiovascular team-based care and the role of advanced practice providers. Journal of the American College of Cardiology, 65, 2118-2136.
FairmanJ. A.RoweJ. W.HassmillerS.ShalalaD. E. (2011). Broadening the scope of nursing practice. New England Journal of Medicine, 364, 193-196.
14.
FraserE. P.MorganP.JohnsonA. (2016). Specialty distribution of physician assistants and nurse practitioners in North Carolina. Journal of the American Academy of Physician Assistants, 29(4), 38-43.
15.
FriedsonE. (1970a). Profession of medicine: A study of the sociology of applied knowledge. Chicago, IL: University of Chicago Press.
16.
FriedsonE. (1970b). The problem of professional authority. In Professional Dominance: The Social Structure of Medical Care. New York, NY: Atherton Press.
HaanJ. M.DuttonR. P.WillisM.LeoneS.KramerM. E.ScaliaT. M. (2007). Discharge rounds in the 80-hour workweek: Importance of the trauma nurse practitioner. Journal of Trauma and Acute Care Surgery, 63, 339-343.
HravnakM.BaldisseriM. (1997). Credentialing and privileging: Insight into the process for acute-care nurse practitioners. AACN Clinical Issues, 8, 108-115.
22.
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
23.
KawarE.DiGiovineB. (2011). MICU care delivered by PAs versus residents: Do PAs measure up?Journal of the American Academy of Physician Assistants, 24(1), 36-41.
24.
LeylandA. H.GoldsteinH. (2001). Multilevel modelling of health statistics. Chichester, England: Wiley.
25.
MorganP.EverettC.HumeniukK.ValentinV. (2016). Physician assistant specialty choice: Distribution, salaries, and comparison with physicians. Journal of the American Academy of Physician Assistants, 29(7), 46-52.
OswanskiM. F.SharmaO. P.RajS. S. (2004). Comparative review of use of physician assistants in a level I trauma center. American Surgeon, 70, 272-279.
29.
PastoresS.O’ConnorM. F.KleinpellR. R.NapolitanoL.WardN.BaileyH.. . . CoopersmithC. M. (2011). The Accreditation Council for Graduate Medical Education resident duty hour new standards: History, changes, and impact on staffing of intensive care units. Critical Care Medicine, 39, 2540-2549.
30.
PearsonL. J. (2014). The 2014 Pearson report: A national overview of nurse practitioner legislation and health care issues. Burlington, MA: Jones & Bartlett Learning.
31.
PoghosyanL.NanniniA.SmaldoneA.ClarkeS.O’RourkeN. C.RosatoB. G.BerkowitzB. (2013). Revisiting scope of practice facilitators and barriers for primary care nurse practitioners: A qualitative investigation. Policy, Politics & Nursing Practice, 14, 6-15.
32.
PoghosyanL.NanniniA.StoneP. W.SmaldoneA. (2013). Nurse practitioner organizational climate in primary care settings: Implications for professional practice. Journal of Professional Nursing, 29, 338-349.
SchadewaldtV.McInnesE.HillerJ. E.GardnerA. (2013). Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care: An integrative review. BMC Family Practice, 14, 132.
35.
ShahN. N.KucharczukC. R.MitraN.HirshR.SvobodaJ.PorterD.. . . SchapiraM. M. (2015). Implementation of an advanced practice provider service on an allogeneic stem cell transplant unit: Impact on patient outcomes. Biology of Blood and Marrow Transplant, 21, 1692-1698.
36.
SinghS.FletcherK. E.SchapiraM. M.ContiM.TajimaS.BilboL. A.WhittleJ. (2011). A comparison of outcomes of general medical inpatient care provided by a hospitalist-physician assistant model vs a traditional resident-based model. Journal of Hospital Medicine, 6(3), 122-130.
37.
WalkerC. (2016). 2016 another banner year for the PA profession at the state level: 2017 looks to be just as groundbreaking. PA Professional, 8(11), 6-7.
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
