Primary care physician perceptions of the nurse practitioner in the 1990s

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 tan Ii-item instrument) and physician experience with NPs in this role. Bivariate relationships between physician demographic and practice characteristics were evaluated by chi(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 cart NP and a more positive attitude toward NPs has important implications for the training of primary care physicians, particularly in community-based, multidisciplinary settings.