The attitudes of rural Minnesota family physicians toward nurse practitioners and physician assistants

Increased use of nurse practitioners and physician assistants has been promoted as a possible solution to the shortage of primary care providers in rural locations. If the use of nonphysician providers is to be optimized in these areas, awareness and acceptance of their capabilities by rural family physicians is essential. This study surveyed the attitudes of rural Minnesota family physicians toward the use of physician assistants and nurse practitioners. Forty-six percent of the 600 rural family physicians surveyed responded to the questionnaire. Approximately 90 percent of responding physicians indicated a high degree of confidence in the abilities of nonphysician providers in the areas of preventive and routine care; some concern was expressed about the proficiency of nonphysician providers taking call, covering the emergency room, and doing hospital rounds-activities that involve a broader base of clinical knowledge and diagnostic skills. Other concerns were an increased workload for physicians due to their assumed supervisory roles, an increase in complexity of cases seen by physicians, increased physician liability, job competition between nonphysician providers and physicians, and the lack of educational opportunities and supervisory guidelines for physicians regarding collaborative relationships. Appropriate roles for family physicians, nurse practitioners and physician assistants are not well-defined in the minds of respondents, and it appears future acceptance and practice patterns will depend on how these roles are established and accepted.