Background: The healthcare field is experiencing rapid growth in the number of advanced practice providers (APPs) with projections that demonstrate that this trend will only continue. Even though the number of APPs is growing, the development of facility-specific APP management infrastructure often grows at a slower pace. Specific policies and procedures on APP utilization and clinical efficiency metrics are lacking. This can lead to deficiencies in the understanding of the education and practice boundaries of APPs.

Objective: Our study aimed to analyze the growth and utilization of physician assistants (PAs) in several hospitals located within Texas Medical Center (TMC) in Houston, Texas. We investigated potential factors influencing PA utilization and professional growth and information on the workflow structure, perceived barriers to the efficient utilization of PAs, and the integration of PAs into clinical teams and practice.

Methods: We used a mixed methods design to investigate the trends of PAs in hospitals within a large urban medical center. Eight clinical managers at eight different TMC institutions were invited to participate in an email survey and qualitative phone interview.

Results: The survey response rate was 62.5% (n=5). Analysis of interviews and survey responses identified five major themes regarding the utilization of the PA within the organizations: 1) the majority of locations employ PAs in team-based workflow structures with the main goal of creating increased access to care, 2) PAs provide an important degree of continuity and consistency for healthcare services, 3) most locations attempted to measure PA clinical efficiency, but struggled in regards to the best methods to do so, 4) hospitals have a favorable trend in retention rates of PAs and offer research opportunities and professional growth resources to their advanced practice providers, and 5) institutions encountered difficulty when it came to optimal billing practices for PAs.

Conclusions: The primary focus of a PA’s job responsibility has shifted from providing physician satisfaction to an increased focus on providing quality patient care and increased patient access. PAs help facilitate coordination of care and create a solid foundation for continuity of care. There is a need for an updated method to measure PA clinical efficiency and a need for standardized PA billing practices.