Studies Needed on Collaborative Relationship Between Physicians and NPs, PAs

May 17, 2023


Contact: Ellen Mullally

Physicians, nurse practitioners (NPs), and physician assistants (PAs) increasingly work in teams to ensure effective medical care delivery in nursing homes (NHs). Yet, according to a new study in the May issue of JAMDA, there is a serious dearth of studies that address the collaborative relationship between these practitioners or the impact of physician relationships on NPs and PAs providing care in this setting.

In Physician Practice Characteristics Influencing Nurse Practitioner and Physician Assistant Care in Nursing Homes: A Scoping Review, the authors found no studies that incorporated any physician variables into their outcome analyses. Papers deemed eligible for review included peer-reviewed studies written in English and quantitative in nature that examined the impact of NPs and/or PAs on care in nursing homes. The studies included randomized controlled trials, quasi-experimental and retrospective cohort studies, systematic reviews, scoping reviews, and serial cross-sectional analyses.

The authors said, “Our review is the first to examine the extent to which physician practice variables have been accounted for in studies of NP and PA practice in nursing homes. We were unable to find any study that incorporated physician variables into their outcome analyses.” They added, “The existence of such a ‘conceptual gap’ likely reflects an underappreciation for the relationship between physician practice and NH quality despite emerging evidence lending credence to such.”

The findings of this study, the authors suggested, relate directly to the design of future studies. They said, “As we strive to better understand the unique contributions from each medical provider discipline and how their roles complement each other, studies must, at the very least, consider the mediating effect of physician practice characteristics.” They further noted that while prospective studies may be the ideal, information from retrospective studies or even case reviews may be helpful, especially given the current lack of data in this area.

This study was conducted by researchers at Florida State University, Tallahassee, FL; and University of Florida, Gainesville, FL.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editors for an interview, please email





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.


About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.