Physician assistant medical practice in the health care workforce: A retrospective study of medical malpractice and safety comparing physician assistants to physicians and advanced practice nurses

As the physician assistant (PA) profession has matured, it has become a significant factor in the nation's health care delivery system. Quality of care stakeholders are increasingly concerned about the medical care being delivered by non-physician providers. Stakeholders include local and national government, health care delivery organizations, health care provider education programs, the health insurance industry, and the general public. Each is affected by the liability of physician assistant medical practice. While PAs are being trained and hired at a rate that assumes adequate competence, quality and safety, current research is absent of a comprehensive analysis of PA malpractice over time.;This study examined 17 years of data related to unsafe medical practice (i.e., practice that harms patients or the public). The study analyzed and compared a variety of markers (e.g., civil lawsuits and Medicare program exclusions filed with the National Practitioner Data Bank) of safety between physicians, PAs, and advanced practice nurses (APNs). Results of the study suggested that: (a) the overall incidence and ratio of malpractice claims per provider was no greater for PAs and APNs than for physicians over a 17 year period; (b) the average and median malpractice payments of PAs were less than that of physicians while that of APNs were greater; (c) the trend in median payment increases was less for PAs than physicians and APNs, and higher for APNs than physicians; (d) PAs did not negate their cost effectiveness through the costs of malpractice; (e) the rate of malpractice incidence increased for PAs and APNs over the study period but remained steady for physicians; and (f) the reasons for disciplinary actions against PAs were similar to that of physicians and APNs. Other study findings included gender differences in both malpractice payment incidence and malpractice payment amount and disparities between states regarding the frequency of disciplinary actions as compared to malpractice incidence.