Peter Salovey President | Yale University
Peter Salovey President | Yale University
Physicians, nurse practitioners, and physician associates (PAs) each play distinct roles in improving patient care quality, according to a study conducted by Yale and Fair Haven Community Health Care. The research focused on federally qualified health centers across the United States and assessed how these clinicians contribute to care quality. The findings challenge the assumption that having more physicians is always preferable, suggesting instead that strategic staffing could help address specific community health challenges.
The study was published on October 22 in JAMA Open Network. Benjamin Oldfield, senior author of the study and assistant clinical professor at Yale School of Medicine, stated: “We were initially interested in whether there was a magic clinician ratio between doctors, nurse practitioners, and physician associates that might be associated with the highest quality of care.”
Health centers like those involved in the study serve 31.5 million Americans, many from impoverished or minoritized backgrounds. Oldfield emphasized their importance: “Health centers are extremely important models of care for minoritized populations.”
The research team evaluated 791 U.S. health centers using five staffing model categories: balanced proportions of clinicians; more nurse practitioners than physicians; more physicians than nurse practitioners; equal proportions of both; and large health centers with significantly larger workforces.
Oldfield noted the results showed "higher performances on diagnostic-related measures like cancer screening and HIV testing were associated with staffing models with more physicians." Conversely, better performance on health promotion metrics such as obesity assessment was linked to models favoring nurse practitioners and PAs.
These insights can guide health centers facing budget constraints in determining optimal staffing strategies for addressing community-specific issues. For example, tackling pediatric obesity may benefit from prioritizing nurse practitioner staffing.
Furthermore, the study supports equitable national initiatives encouraging various clinician roles within health centers through incentives like student loan forgiveness. Oldfield concluded: “Our findings suggest that all of these roles make critical and unique contributions to quality.”
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