Rising numbers of patients seeing non-physician clinicians, study finds
ATLANTA -- In the decade between 1987 and 1997, the proportion of patients in the United States who visited non-physician clinicians rose from 30 percent to 36 percent, says a new study by an Emory University health policy professor and colleagues. This increase in treatment by health care providers such as nurses, chiropractors, podiatrists and optometrists reflected a growing number of patients receiving care from both physicians and non-physicians, rather than an increase in independent treatment by non-physicians, which declined during the study period.
Dr. Benjamin Druss, who holds the Rosalynn Carter Chair of Mental Health in Emory's Rollins School of Public Health, says these findings "show how the health workforce has evolved during a time of great change in the US health system. Patients are increasingly treated by multiple providers, who have a range of training and philosophical approaches to treatment." Dr. Druss and co-authors from Columbia University, the University of Pennsylvania, the University of Pittsburgh, and RAND are publishing their findings in the January 9, 2003 issue of the New England Journal of Medicine.
They cite data showing that in the 10-year study period, non-physicians were more likely to provide preventive services, less likely to provide acute care (diagnosis and treatment for specific illnesses), and more likely to work in the same location as a physician, suggesting that they may be working conjointly with physicians to care for patients.
The study draws on more than 40,000 individuals interviewed in national medical surveys conducted in 1987 and 1997. The decade under review was one in which there was an increase in the number of non-physician clinicians graduating from training programs, in state laws allowing non-physicians a greater scope of clinical practice, and in managed care plans that used these providers to control costs.
"For patients, the implications of these findings hinge on the degree to which physicians and non-physicians are working together effectively," says Dr. Druss. "Multidisciplinary teams can improve care, particularly for chronic conditions, but only if that care is carefully coordinated.
Without effective communication, provision of care by multiple providers can reduce continuity and quality of care. Given that patients are increasingly being treated by multiple providers, it is essential to better understand and improve the degree of integration between physician and non-physician clinicians in day-to-day practice."
The study was sponsored by the Robert Wood Johnson Foundation and the National Institute of Mental Health.