ArticleInternational journal of emergency medicine2012
Continued rise in the use of mid-level providers in US emergency departments, 1993-2009.
Article in International journal of emergency medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Workforce Attrition Among Emergency Medicine Non-Physician Practitioners.Annals of emergency medicine · 2025Article
- Not Like They Used To: The Decline of Procedural Competency in Medical Training.Annals of family medicine · 2025Article
- Prevalence and prescribing patterns of oral corticosteroids in the United States, Taiwan, and Denmark, 2009-2018.Clinical and translational science · 2023Article
- Challenges surrounding the emergency physician workforce and their impact on the Emergency Medicine Match.Clinical and experimental emergency medicine · 2023Article
- The contribution of physician associates or assistants to the emergency department: A systematic scoping review.Journal of the American College of Emergency Physicians open · 2023Article
- Article
- Factors associated with federally qualified health center financial performance.Health services research · 2022Article
- US emergency care patterns among nurse practitioners and physician assistants compared with physicians: a cross-sectional analysis.BMJ open · 2022Article
- Evaluation of the 2020 Pediatric Emergency Physician Workforce in the US.JAMA network open · 2021Article
- A Review of Interprofessional Variation in Education: Challenges and Considerations in the Growth of Advanced Practice Providers in Emergency Medicine.AEM education and training · 2021Article
- Integration of Advanced Practice Providers in Academic Emergency Departments: Best Practices and Considerations.AEM education and training · 2018Article
- Clinical information available during emergency department imaging order entry and radiologist interpretation.Emergency radiology · 2017Article
- Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants.Open forum infectious diseases · 2016Article
- A new kid on the block: the role of physician associates.Clinical medicine (London, England) · 2014Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEmergency department (ED) visits in the US have risen dramatically over the past 2 decades. In order to meet the growing demand, mid-level providers (MLPs) - both physician assistants (PAs) and nurse practitioners (NPs) - were introduced into emergency care. Our objective was to test the hypothesis that MLP usage in US EDs continues to rise.
findingsWe analyzed ED data from the National Hospital Ambulatory Medical Care Survey to identify trends in ED visits seen by MLPs. We also compared MLP-only visits (defined as visits where the patient was seen by a MLP without being seen by a physician) with those seen by physicians only. During 1993 to 2009, 8.4% (95%CI, 7.6-9.2%) of all US ED visits were seen by MLPs. These summary data include marked changes in MLP utilization: PA visits rose from 2.9% to 9.9%, while NP visits rose from 1.1% to 4.7% (both Ptrend < 0.001). Together, MLP visits accounted for almost 15% of 2009 ED visits and 40% of these were seen without involvement of a physician. Compared to physician only visits, those seen by MLPs only were less likely to arrive by ambulance (16% vs 6%) and be admitted (14% vs 3%).
conclusionsMid-level provider use is rising in US EDs. By 2009, approximately one in seven visits involved MLPs, with PAs managing twice as many visits as NPs. Although patients seen by MLPs only are generally of lower acuity, these nationally representative data confirm that MLP care extends beyond minor presentations.
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