Survey Shows Six in 10 Family Physicians Routinely Work With Nurse Practitioners, Physician Assistants, Certified Nurse Midwives

WASHINGTON — Family physicians are on the forefront of providing team-based care in collaboration with nurse practitioners, physician assistants, and certified nurse midwives, according to a policy brief by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

The policy brief, written by Lars Peterson, MD, PhD, and his colleagues in the May-June 2013 Journal of the American Board of Family Medicine, found nearly 60 percent of family physicians responded “yes” to the question, “Do you routinely work with nurse practitioners, physician assistants, or certified nurse midwives?” The question was part of an ABFM survey required of family physicians who opened their online portfolio on the ABFM website.

“These findings are important because we know our health care system will increasingly rely on teams of health professionals in the patient-centered medical home,” said Andrew Bazemore, MD, director of the Graham Center. “Demand for primary care is growing as our population grows and ages and as more people gain insurance coverage. Earlier research has shown that teams of professionals that include physicians, nurse practitioners and physician assistants can do much to meet demand for care, improve access to care, ensure patients get the full range of medical and nursing care, and have a positive impact on controlling health care costs.”

Peterson agreed. “Our findings show that family physicians and nurse practitioners, physician assistants and midwives are routinely working together to ensure that patients have access to primary care services,” he said. “Such teams are even more important in rural areas which already suffer from a shortage of providers.”

An earlier Graham Center analysis of the primary care workforce found that areas with a ratio of one nurse practitioner or physician assistant for every family physician had the lowest costs, the fewest avoidable hospitalizations and, therefore, the fewest hospital discharges.

“This may suggest that teams of NPs and/or PAs with family physicians achieve better outcomes than either alone, but within a specific range of combination,” Graham Center researchers wrote. Other research indicates a ratio of four nurse practitioners for every primary care physician provided the highest quality and lowest cost health care.

“Clearly teams of health professionals are integral to improving care, expanding access and affecting costs,” said Bazemore. “This survey shows that family physicians are embracing collaborations with nurse practitioners, physician assistants and other health professions colleagues.”


About the American Academy of Family Physicians
Founded in 1947, the AAFP represents 110,600 physicians and medical students nationwide. It is the only medical society devoted solely to primary care.

Approximately one in four of all office visits are made to family physicians. That is 240 million office visits each year — nearly 87 million more than the next largest medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.

To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit For information about health care, health conditions, and wellness, please visit the AAFP’s award-winning consumer website,

June 03, 2013


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.