Quality among a diversity of health care providers

Richard A Cooper
Med J Aust 2006; 185 (1): . || doi: 10.5694/j.1326-5377.2006.tb00437.x
Published online: 3 July 2006

Thirty years’ experience in the US with non-physician clinicians shows they can deliver quality care

Like Australia, the United States is experiencing physician shortages,1 and non-physician clinicians have become ever more important as providers of patient services. Most prominent among these are nurse practitioners (NPs) and physician assistants (PAs), as reviewed by Hooker in this issue of the Journal,2 but others also contribute to providing “physician services” in the US. They include alternative and complementary medicine providers (chiropractors, naturopaths and acupuncturists), mental health providers (psychologists, clinical social workers, counsellors and therapists) and members of several specialty disciplines (optometrists, podiatrists, nurse anaesthetists and nurse-midwives). Over the past 30 years, all have struggled to obtain licensure in the various states, to expand their practice prerogatives, and to achieve broader reimbursement from third-party payers. The progress that NPs and PAs have made is evident in Hooker’s review. The question is, do they contribute to quality? This editorial will comment on NPs, PAs and psychologists. A broader review, which forms the basis for this essay, assesses the full range of disciplines.3

  • Richard A Cooper

  • Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa, USA.



The content and ideas expressed in this editorial have been largely drawn from my previous article (co-authored with Stoflet), Diversity and consistency: the challenge of maintaining quality in a multidisciplinary workforce.3

Competing interests:

I have spoken about this subject at many professional meetings and have often been given an honorarium and usually had my expenses covered by the organisation that sponsored the meeting.


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