Half of office-based physicians use non-physician providers

About half of all office-based U.S. physicians-including urologists-belong to practices that employ non-physician providers, according to a government report. Primary care physicians are more likely to work with them than medical and surgical specialists.

According to the National Center for Health Statistics, in 2009, 49.1% of office-based physicians were in practices that used nurse practitioners (NPs), certified nurse midwives (CNMs), or physician assistants (PAs).

NPs, CNMs, or PAs were more likely to be in primary care and larger and/or multispecialty practices. They were less likely to work with older physicians or in smaller, single-specialty practices. Non-physician providers also tended to be in practices with higher revenues from Medicaid and a lower proportion of Medicare patients, according to the report, which was based on the 2009 National Ambulatory Medical Care Survey.

In addition, 45.9% of surgical specialists, which included urologists, reported use of a non-physician provider.

"Projections of the future physician work force predict declines in the supply of physicians and decreasing physician work hours for primary care," said the report’s authors, led by Melissa Park, MPH. "An expansion of care delivered by NPs, CNMs, and PAs is often cited as a solution to the predicted surge in demand for health care services and calls for an examination of current reliance on these providers."

The National Ambulatory Medical Care Survey samples physicians in 14 AMA specialties and a miscellaneous specialty category. Specialties are grouped into three major categories: primary care, surgical, and medical. Major specialties in the surgical category include general surgery, ophthalmology, orthopedic surgery, otolaryngology, and urology.