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PAs and NPs in HMOs.

Recognition of NPP contributions to the delivery of care in HMOs has come slowly. Staffing continues to be a function of physician attitude instead of management rationale. Only a few enlightened HMOs seek management and staffing input from NPPs. Investigation of the role of NPPs in HMOs has seriously lagged behind that of physicians, nurses, pharmacists, and other health professionals. The status, reward systems, and job satisfaction of nonphysician clinicians, as well as efforts and problems in recruiting them, have been inadequately reported. Only a handful of HMOs have contributed to our understanding of NPP productivity and task delegation. If HMOs plan to continue using NPPs, much more information on optimizing their deployment must be shared. Member satisfaction surveys must be reported, prescribing practices must be compared, liability issues explored, and outcomes research pursued. We know little about the outcome of nonacute illness managed by NPPs. Do NPPs negate their cost-effectiveness by using more or different resources? Do differences between PAs and NPs exist with regard to each of these issues? Because so many study variables can be held constant by a large HMO which provides care in a given area under uniform market forces, HMOs can best explore how to maximize NPP effectiveness.