Physician extenders called solution to resident work-hour restrictions

Large numbers of physician extenders (PEs)-physician assistants and nurse practitioners-have been hired by general surgery residency programs during the last 5 years to bolster the resident education experience, and these professionals continue to be in demand, according to a recent study.

Most of the PEs have been hired in response to work-hour restrictions imposed by the Accreditation Council for Graduate Medical Education (ACGME) in 2003.

"Our study demonstrates that PEs are a practical solution for addressing surgical resident work-hour restrictions," said first author Christopher Pezzi, MD, of Abington Memorial Hospital, Abington, PA. "By relieving surgical residents of administrative tasks and routine procedures, residency programs can maximize the educational experience for these surgeons in training."

A questionnaire mailed to program directors of all ACGME-accredited general surgery residency programs found that almost 80% of these programs had at least one PE. Collectively, the programs that responded to the questionnaire employed a total of 840 PEs, which averages to 5.3 PEs per program. Before ACGME work-hour limitations, the average number of PEs per general surgery program was 2.0. Sixty-one percent of PEs were hired in response to ACGME restrictions.

Data showed that PEs were used mostly for procedural and administrative duties. PE duties included taking patient histories and performing physical examinations, interacting with consultants, first-assisting, and caring for patients in the emergency room. PEs were also responsible for paperwork, scheduling tests, assisting with billing and coding, and other procedural duties.

Nearly 50% of the programs planned to hire PEs within the next 3 years if funding is available, which would translate into job openings for an additional 431 PEs.

Findings of the study were reported in the Journal of the American College of Surgeons (2009; 208:587-91).