Ever since I read the Chen-Chevalier paper on physician labor supply, I’ve been thinking about how we use physicians and physician assistants in the practice of medicine, and in particular in the practice of hospital medicine. To refresh your memory, Chen and Chevalier, whom we’ve discussed in this space before, observed the following:
Our estimates suggest that the median man in our sample with 10 years experience earns apremium of over $25 per hour as a physician rather than as a PA with 10 years experience. The corresponding median female in our sample earns a premium of only $16 per houras a doctor rather than a PA. However, a larger part of the diﬀerence in male vs. female returns to entering medical school stems from diﬀerences in hours worked. The median male physician in our sample with 10 years of experience works 11 hours more per week than the median female physician in our sample with 10 years of experience. Simply put, the majority of women physicians do not appear to work enough hours earning the physician PA wage premium to amortize the higher up-front investments in becoming a physician. [Emphasis added]
That is why there has been increasing interest in relying more heavily on the combination of PAs and hospitalists to replace medical residents. In 2009, the American Journal of Medical Quality published a paper that concluded as follows:
Our study shows that the combination of PAs and hospitalists can meet the clinical inpatient needs of a diverse inner-city population that relies on a public hospital for acute care. Most outcomes remained equivalent between the 2 periods, including adverse events, readmission rate, patient satisfaction, and quality issues related to mortality and readmissions. All-cause mortality was actually lower during the PA-hospitalist period, although this difference may have been owing to the on-site direct attending supervision. Although our model may not suit every institution, we maintain that it is practical and generalizable. Long-term viability of the new model must be evaluated by including a cost analysis of the replacement model.