Abstract

This contribution explores the changing positions of four major groups of health professionals in primary care in North America and Western Europe: general internists, family physicians, nurse practitioners and physician assistants. The mix of professionals varies greatly across countries in Europe and North America, illustrating that there is no single answer to the question: "What is the 'best' mix of health professionals?" The central questions of this study are: What explains the changing positions of the physicians, nurse practitioners and physician assistants in those regions; what is the future outlook of those groups? Nurses are the largest group of highest qualified health professionals. Over three million registered nurses work in the U.S. Some of those, in particular nurse practitioners (NPs) have, similar to physician assistants (PAs), gained independent status in seeing patients, prescribing medicine and referring to other professionals. But as their incomes continue to rise, the financial advantage of hiring NPs or PAs over physicians becomes less obvious, and they face competing claims of other health professionals in the field.

Authors and Affiliations