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Primary Care Physician Perceptions of the Nurse Practitioner in the 1990s
Mary L. Aquilino, PhD, RN, CS, FNP;
Peter C. Damiano, DDS, MPH;
Jean C. Willard, MPH;
Elizabeth T. Momany, PhD;
Barcey T. Levy, PhD, MD
Arch Fam Med. 1999;8:224-227.
Objective To evaluate factors associated with primary care physician attitudes toward nurse practitioners (NPs) providing primary care.
Design A mailed survey of primary care physicians in Iowa.
Setting and Participants Half (N=616) of the noninstitutional-based, full-time, primary care physicians in Iowa in spring 1994. Although 360 (58.4%) responded, only physicians with complete data on all items in the model were used in these analyses (n=259 [42.0%]).
Main Outcome Measures There were 2 principal dependent measures: physician attitudes toward NPs providing primary care (an 11-item instrument) and physician experience with NPs in this role. Bivariate relationships between physician demographic and practice characteristics were evaluated by  2 tests, as were both dependent variables. Ordinary least-squares regression was used to determine factors related to physician attitudes toward NPs.
Results In bivariate analyses, physicians were significantly more likely to have had experience with an NP providing primary care if they were in pediatrics or obstetrics-gynecology (78.3% and 70.0%, respectively; P<.001), had been in practice for fewer than 20 years (P=.045), or were in practices with 5 or more physicians. The ordinary least-squares regression indicated that physicians with previous experience working with NPs providing primary care (P=.01), physicians practicing in urban areas with populations greater than 20,000 but far from a metropolitan area (P=.03), and general practice physicians (P=.04) had significantly more favorable attitudes toward NPs than did other primary care physicians.
Conclusions The association between previous experience with a primary care NP and a more positive attitude toward NPs has important implications for the training of primary care physicians, particularly in community-based, multidisciplinary settings.
From the College of Nursing (Dr Aquilino), the Health Policy Research Program (Dr Damiano), Public Policy Center (Ms Willard and Dr Momany), and the Department of Family Medicine (Dr Levy), The University of Iowa, Iowa City.
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