The physician assistant in general practice in the Netherlands

Abstract

Purpose: In 2003, the first US-trained physician assistant (PA) was employed in the Netherlands because of difficulties in recruiting general practitioners (GP). Our study describes the use of this PA. Methods: We studied clinical activities of GP care for number and type of contacts, diagnoses, drug prescriptions, and new referrals, in a general practice in the Netherlands, before and after the introduction of the PA. Data were obtained from electronic medical records. Results: The total number of contacts per 1,000 patients increased by 17.0%. Measured per full time equivalent (FTE) of a GP, the number of GP contacts decreased slightly (2.3%). Type of contacts, diagnoses, drug prescriptions, and new referrals to primary care of the GPs changed significantly, although changes were small. The number of PA contacts per 1 FTE PA was about 60% of that of the GPs, with clinical activities overlapping substantially. Nevertheless, there were significant differences in type of contacts, diagnoses and drug prescriptions. The PA saw more women, children, and patients aged 25-44 years; performed more practice consultations, made more women's health-related diagnoses, and prescribed more drugs for dermatological and respiratory problems. Conclusions: Our study suggests that this PA improved access to GP care. The PA did not lead to a major decrease in the GPs' workload or major redefinition of the GP role. Overall, the range of the PA's clinical activities was comparable to that of the GPs. However, the PA seems to have treated more acute cases. Aside from these results, our study provides avenues for more research on PAs in Europe.