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Physician Staffing for the VA Volume I (1991) / Chapter Skim
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10 - NONPHYSICIAN PRACTITIONERS
Pages 363-372

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From page 363...
... Many of these analyses reported the successful use of PAs and NPs in ambulatory and long-term care. Second, the changing demographic structure of the VA patient population implies that an increasing proportion of patients will be over age 65, chronically ill, and will require care that may be appropriately delivered in ambulatory care or long-term care patient care areas (PCAs)
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From page 364...
... These analyses led to the definition of three groups of nonphysician providers: · Category I Administrative/Operational Support Personnel, which includes clerical support, medical records clerks, patient transporters, and others. · Category II Clinical Complementary Service Personnel, whichincludes nurses, podiatrists, optometrists, and such allied health professionals as occupational therapists, physical therapists, and speech therapists, among many other service personnel in the allied health technologies.
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From page 365...
... , psychologists, and social workers are data on FTEE by PCA available presently on a national basis. [For these three, the VA has designated distinct cost centers in its Cost Distribution Report (CDR)
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From page 366...
... INFERENCES FROM THE NPP SURVEYS The first two surveys, conducted in late summer of 1990, were of selected NPPs and their supervisors in a stratified random national sample of VAMCs. The NPPs examined were PAs, NPs, CNSs, and CRNAs; because the time allocation across PCAs, and thus patterns of patient care, for psychologists and social workers can be inferred from existing CDR data, these two provider types were not included in the surveys.
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From page 367...
... (The committee notes, however, that the VA has recently initiated pilot programs in which selected PAs are permitted to prescribe drugs according to specific protocols.) Several NPPs indicated that they operated with maximum flexibility and independence- which the committee interprets to mean, with very little physician .
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From page 368...
... However, the committee believes that the VA should actively investigate the appropriateness of such functions, and of expanded roles for NPPs in the patient care process, when there is significant supporting evidence.
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From page 369...
... Continuing Education for Physicians and NPPs From the analysis of the NPP panel survey data and commentary, the committee concludes that the utilization of these practitioners is more dependent on the attitudes and knowledge of individual physicians than on the training and the clinical skill level of the NPP. Before the VA can utilize NPPs in an efficient manner consistent with quality care, education programs for VA physicians must be established.
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From page 370...
... The committee applauds the efforts undertaken thus far to establish national guidelines for these two NPPs, especially the relatively detailed policies developed for PAs. The committee urges the VA to develop explicit national policies on the appropriate use of all NPPs through a careful evaluation of existing evidence on the efficiency and quality of their clinical practice.
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From page 371...
... is to promote a strong, coherent VA national policy on NPP use, while preserving the concept that individual VAMCs have both the autonomy to explore innovative uses of NPPs and the responsibility to ensure that the quality of care is protected through appropriate supervision. In the course of establishing these policies, the VA should seek to clarify whether the "federal enclave" doctrine exempts the individual VAMC from the clinical provisions of its state medical practice act, so that each may establish unambiguously its own NPP practice policies under guidance from VA Central Office.
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From page 372...
... 1990. Improved quality of care and reduction of housestaff workload using trauma nurse practitioners.
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Key Terms

  • npp panel
  • physician requirements
  • patient care
  • ambulatory care
  • category iii

  • empirically based
  • physician supervision
  • nurse practitioners
  • based models
  • appropriate utilization

  • panel report
  • social workers
  • service personnel
  • supplementary papers
  • nonphysician practitioners

  • care settings
  • physician staffing
  • practice acts
  • cost centers
  • judgment approaches

  • allied health
  • national sample
  • staff physicians
  • national guidelines
  • state practice

  • physician assistants
  • expert judgment
  • skill level
  • increase physician
  • affect physician


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