The contributions of physician assistants in primary care systems

Roderick S. Hooker PhD MBA PAChristine M. Everett PhD‐Candidate MPH PA‐CFirst published: 18 August 2011


Shortages of primary care doctors are occurring globally; one means of meeting this demand has been the use of physician assistants (PAs). Introduced in the United States in the late 1960s to address doctor shortages, the PA movement has grown to over 75 000 providers in 2011 and spread to Australia, Canada, Great Britain, the Netherlands, Germany, Ghana and South Africa. A purposeful literature review was undertaken to assess the contribution of PAs to primary care systems. Contemporary studies suggest that PAs can contribute to the successful attainment of primary care functions, particularly the provision of comprehensive care, accessibility and accountability. Employing PAs seems a reasonable strategy for providing primary care for diverse populations.

What is known about this topic

  • • Physician assistants (PAs) function under doctor supervision.
  • • The generalist training of PAs permits widespread use in most areas of medicine.
  • • PAs are educated in the physician model of medicine.

What this paper adds

  • • The contributions of PAs to primary care involve effectiveness, safety, patient satisfaction and outcomes of care comparable to a physician.
  • • The addition of PAs to primary care teams tends to improve care that is coordinated and comprehensive and helps to maintain the continuity of care.
  • • Role delineation of PAs in primary care appears to be underdeveloped.


We undertook a review about physician assistants (PAs) in primary care – a foundation for understanding how they contribute to the provision of primary care. The literature is large enough to offer some generalisations, but a secondary goal is to alert the reader to significant gaps in current knowledge. For historical reasons, it is written with an American backdrop but with an eye on the global expansion of PAs and an international readership. Nurse practitioners (NPs) are mentioned when the literature reviewed combines PAs/NPs into a single provider category. However, Laurant et al. (2009) have extensively reviewed the combined literature on PAs and NPs in a variety of roles, and this work will not be repeated here. Instead, this undertaking focuses on useful and contemporary studies to guide employers and policy‐makers as to whether PAs are suitable providers and how they may best be utilised in primary care.

Physician assistants are recognised as health professionals who practise medicine in collaboration with doctors through delegated clinical tasks and patient management (Cooper et al. 1998Lowes 2000Larsson & Zulkowski 2002Hooker 2004Parle et al. 2006). As of 2011, the United States has approximately 75 000 clinically active PAs and produces approximately 7000 graduates annually; there are almost 1000 PAs in other countries (with substantial growth predicted over the next decade) (Hooker 2010a). Their flexibility and generalist training permits them to function as providers under the supervision of a doctor in a variety of medical specialties and healthcare settings (American Academy of Physician Assistants [AAPA] 2009Hooker et al. 2010b). One‐third (34%) is employed in primary care settings (defined as family medicine, general medicine and general paediatrics). Because of the uniqueness of the American healthcare system, it is unclear whether the benefits experienced from the introduction of PAs as primary care providers will be experienced similarly in other healthcare systems (Hooker 2005). Nor has their use in primary care been consolidated in any systematic fashion that would be useful to potential employers. To address this gap, a review of PAs in primary care was undertaken. A description of PAs in primary care in the United States is provided and one question was posed: To what extent do PAs contribute to effective, safe and efficient team‐based primary care?

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