Costs, Productivity, and the Utilization of Physician's Extenders in Air Force Primary Medicine Clinics

This report addresses the question of whether the extensive use of physician extenders — nonphysicians trained to perform some of the medical and administrative tasks traditionally performed by physicians — in Air Force hospitals is cost-effective. Specifically, it examines the productivity of extenders in outpatient care and the costs of procuring and using extenders. The authors focused on one type of extender, physician assistants (PAs), who are typically Air Force corpsmen with one year of classroom and one year of clinical training. The general conclusions were the following: In typical Air Force primary adult medicine clinics, PAs can substitute for physicians one-to-one for 80-90 percent of the patients whose problems lie within the PA's expertise. Relying on PAs to perform most of the primary medicine workload is currently cost-effective, and will remain so until the earnings of civilian physicians decrease markedly relative to the earnings of PAs.