In California, as in other states, consumers are having difficulty getting access to physicians in some specialties, including gastroenterology, orthopedics, and dermatology. The challenges may be particularly acute for patients of community clinics and public hospitals. Many specialty medical practices have incorporated physician assistants (PAs) and nurse practitioners (NPs) into their outpatient settings to improve access to care, reduce wait times, and improve quality of care. A study by the Center for the Health Professions at the University of California, San Francisco, examined these emerging models to evaluate their success and identify strategies that could be replicated. The study focused on outpatient care in three specialties with particularly high demand rates: orthopedics, gastroenterology (GI), and dermatology. The research found that utilization of physician assistants and nurse practitioners varied across these specialties. For example: (1) Orthopedics. Orthopedic practices commonly rely on physician assistants to do many orthopedic assessments and procedures. The prevalence and long track record of this model throughout the United States suggests it will become even more widely adopted; (2) Gastroenterology. A growing number of GI practices employ NPs and PAs to do high-level procedures. The business model is strong, suggesting that this approach will become more widespread; (3) Dermatology. Some practices employ PAs as clinical providers for routine cases, allowing supervising physicians to focus on complex cases and surgeries.
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