Do Patients Prefer Seeing a Physician over a Physician Assistant? A Systematic Review

PURPOSE: Mid-level providers, notably Physician Assistants (PAs), are utilized in the U.S. health care system to relieve demands. This systematic review addresses the question, “Do patients prefer seeing a physician over a PA?” MATERIALS AND METHODS: This systematic review included 11 primary research articles assessing patient preference or satisfaction for physicians vs. PAs/mid-level providers. Article selection criteria included (1) primary research articles that (2) had patient-reported data (3) for patient preference or patient satisfaction for (4) PAs/mid-level providers vs. physicians/other. Data was extracted using a review form that assessed the research level, quality, and results. Evidence base rating was determined on the results across articles. Articles were divided into those that address physicians vs. mid-level providers and those that address physicians vs. PAs RESULTS: Across the 6 articles that assessed physicians vs. mid-level providers, the results did not indicate patient preference for physicians. Of the 5 articles that addressed satisfaction of care, 4 reported no differences and 1 reported greater satisfaction with PA/NPs over physicians. Of the 3 articles that addressed access to care, 1 reported no difference, 1 reported greater access to physicians, and 1 reported greater access for PA/NPs. Of the 5 articles that assessed physicians vs. PAs, the results did not indicate patient preference for physicians. Two articles reported no differences in engagement with provider or satisfaction with care. A third article found all satisfaction measures higher after implementation of a PA-directed system. Of the two articles that used scenarios, one found patients preferred residents, whereas the other found patients preferred a PA. CONCLUSIONS: The evidence base indicates patients had no preference or stronger satisfaction with physicians. However, there were a limited number of studies addressing preference/satisfaction for PAs vs. physicians and half the articles grouped PAs and NPs together. Future research should include prospective cohort studies measuring patent preferences and satisfaction within various settings while controlling for extraneous influences (i.e., patient demographics, health, and type of care).