Midlevel practitioners playing bigger role in hospitals

As teaching hospitals seek to carve out more time for educating residents, physician assistants and nurse practitioners are taking on more patient care responsibility.

By Jay Greene, AMNews staff. Jan. 15, 2001.

At Harborview Medical Center in Seattle, a bold new experiment will take place this month: Physician assistants and nurse practitioners will become primary case managers for patients in the teaching hospital's new short-stay unit.

Nationwide, several thousand physician assistants and nurse practitioners work in hospital departments. But now, under doctor supervision, some midlevel practitioners are managing patient care.

"Research is beginning to show that nurse practitioners and physician assistants can increase patient satisfaction and reduce errors and costs because you have a consistent person caring for patients," said Christine Abrass, MD, professor of medicine at the University of Washington School of Medicine in Seattle.

But some doctors at Harborview are skeptical. "There has been resistance to change from faculty," Dr. Abrass said. "There is a general lack of experience with working with midlevel practitioners. Most doctors are not as familiar with their skills and abilities. When they understand their roles and how they will have more time for research and teaching, they become more comfortable."

Through education, physicians are beginning to accept the idea that midlevel practitioners will manage patients in the short-stay unit designed to treat illnesses of low to moderate intensity, said Dr. Abrass. There is a strongly held belief in academic medical centers that not assigning a resident or intern to a patient is a fundamental breach of the traditional medical training philosophy, she said. "This is a big change, but we believe the unit will serve as a role model for other training programs." [...]