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
By
Jeffrey G. Nicholson
A dissertation submitted in partial fulfillment of
the requirements for the degree of
Doctor of Philosophy
(Educational Leadership and Policy Analysis)
at the
UNIVERSITY OF WISCONSIN-MADISON
2008
ACKNOWLEDGEMENTS
There are many individuals who have been significant influences in both my life and
career as a physician assistant and educator. I would like to thank Dr. Gene Jones for giving me a
start in PA education and for first believing in my teaching and research potential when I was his
student. I would like to thank Dr. Rod Hooker for sharing his incredible research acumen with
me and for his kind words of encouragement at critical junctures in the completion of this
dissertation. I am honored to work with and learn from someone who is recognized as the
foremost researcher in the PA profession. The following individuals have also been inspirations
to me in PA education and deserve my public appreciation for their examples of professional
leadership, education, research, and dedication to the advancement of the PA profession: Nish
Orcutt, Jim Cawley, Tony Miller, Rick Dehn and Dennis Blessing. Thank you for your
mentorship and examples over the years. I am honored and grateful to be considered your
colleague.
Dr. Jerlando Jackson, thank you for allowing me to combine my educational leadership
and medical careers in the choice of this dissertation topic and for your considerable work in
guiding me through the dissertation writing process. Dr. Craig Gjerde, thank you for
participating on my committee and for your encouragement and mentorship during my tenure at
the University of Wisconsin – Madison PA Program. I also thank the American Academy of
Physician Assistants and the Physician Assistant Education Association for supporting this
dissertation with grant funding. And finally, I thank Dean Susan Skochelak and the University of
Wisconsin School of Medicine and Public Health for supporting the completion of this doctoral
degree.
ABSTRACT
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.
