Combined effects of advanced practice providers and physicians on health outcomes: an exploratory study in North Carolina

Background/Aims: Deployment of non-physician healthcare professionals, such as advanced practice providers (APPs) in the US, could offer a partial solution to the physician shortages faced by healthcare systems worldwide. This study examined how the combined effects of APPs and primary care physicians are related to health outcomes in the state of North Carolina, US. In particular, the authors considered whether the role of APPs as either complements or substitutes for physicians was more likely to be related to overall health. Methods: A cross-sectional design was used, performing linear regression with county-level data of measures related to APPs, primary care physicians and health outcomes across 97 counties in North Carolina. Results A higher deployment of APPs was found to be beneficial for health outcomes, but only when there was also a large number of primary care physicians in relation to the population of a county. Conclusions The results of this study suggest that the positive effect of a higher deployment of APPs on health outcomes is dependent on the number of primary care physicians, which supports the idea of APPs as complements to, rather than substitutes for, physicians. Implications for practice Increased deployment of non-physician healthcare professionals has been viewed as a possible approach to mitigating staff shortages in the UK as well as the US. However, simply substituting an APP for a physician may not yield the best health outcomes. Managers should consider the working relationship between physicians and APPs, and how they allocate healthcare tasks.