It should also be noted that the expanded PA group used a structured collaboration framework and incorporated a structured education program for its PAs. These components are integral to the expanded PA model, and our results may not be generalizable outside of a similar framework. The expanded PA group’s PAs were carefully selected at the time of hire, specifically educated, and supported through ongoing collaboration to provide efficient and appropriate care at the “top of their licenses”. Not all medical groups will be able to provide this level of support and education, and not all hospitalist PAs will want to and/or be able to reach this level of proficiency. However, successful implementation is entirely achievable for groups that invest the effort. The MDICS education process included 80 hours of didactic sessions spread over several months and is based on the Society of Hospital Medicine Core Competencies [13] as well as 6 months of supervised bedside education with escalating clinical responsibilities under the tutelage of an experienced physician or PA. Year-long academic PA fellowships have also been developed for purposes of similar training at several institutions [14].
Conclusion
Our results show that expanded use of well-educated PAs functioning within a formal collaboration arrangement with physicians provides similar clinical quality to a conventional PA staffing model with no excess patient care costs. The model also allows substantial salary savings to supporting institutions, which is important to hospital and policy stakeholders given the implications for hospitalist group staffing, increasing value, and allocation of precious time and financial resources.
Acknowledgements: The authors wish to thank Kevin Funk, MBA, of MDICS, Clarence Richardson, MBA, of GeBBs Software International, and Heather Channing, Kayla King, and Laura Knox of Anne Arundel Healthcare Enterprise, who provided invaluable help with the data aggregation used for this study.
Corresponding author: Timothy M. Capstack, MD, 7250 Parkway Dr, Suite 500, Hanover, MD 21076, tcapstack@mdics.com.
Financial disclosures: Dr. Capstack has ownership interest in Physicians Inpatient Care Specialists (MDICS). Ms. Segujja received compensation from MDICS for statistical analysis.