An Evaluation of the Impact of Physician Assistants on the Productivity and Quality of Care in an Out-Patient Clinical Setting

Abstract

Background: Increasing numbers of physician assistants (PAs) are being integrated into the Canadian healthcare system to improve efficiency and access to care. There is limited data in Manitoba and across Canada evaluating the productivity and quality of PAs in an out-patient setting. Objective: To evaluate PA productivity and quality in an outpatient urgent care style setting at “the Minor Illness and Injury Clinic” (“TMIIC”) in Winnipeg, Manitoba. Methods: A survey was used to collect quantitative and qualitative data from physicians comparing practice with and without a PA. Quantitative data including patient per hour and walk-in patient volume were collected over a two-year period and analyzed using the Wilcoxon signed-rank test. Qualitative data included Likert-scale assessments of PA productivity and quality, likelihood of accepting procedural patients and open responses that were analyzed using reflexive thematic analysis. Results: Working with a PA was associated with physicians managing 51% more patients compared to working alone (p = 0.016). Physicians were approximately twice as likely to accept a walk-in patient when working with a PA than if working alone (p = 0.016). Physician perception of PA productivity and quality was overall positive, with some variability in the formation of differential diagnoses and chronic disease management. Most physicians supported increasing the number of PAs in the healthcare system, citing improved clinical efficiency and access to care while identifying challenges in PA training and retention as the main barrier. Conclusion: This study demonstrates that the addition of PAs to an out-patient urgent-style clinic resulted in a significant increase in the number of patients seen. Physicians in this study perceived positive impacts on both productivity and quality of patient care when PAs were involved. PAs improve access to care for patients attending TMIIC and there would likely be similar outcomes in other out-patient settings. This supports the expansion of PA practice in Manitoba.