Integration of physician assistants into primary care: Acceptance and concerns among general practitioners

Background: Strategies to counteract the impending and in some places already existing shortage of general practitioners (GPs) are being discussed in Germany. One approach could be to establish interprofessional teams in GP practices by integrating physician assistants (PAs). Question: Can GPs imagine employing a PA in their practice and if so, under what conditions? Methods: In March/April 2023, about 5,000 GPs in North Rhine-Westphalia (NRW), who work in a region with a care level of < 100 %, and about 1,000 GPs from Saxony-Anhalt were asked to take part in an online-based survey. Simultaneously, semi-structured preliminary interviews (one online focus group with four participants, seven individual interviews) were conducted with GPs from NRW. Results: 290 GPs participated in the survey (response rate approx. 5 %). Of these, 46.3 % expressed interest in employing a PA in their practice. A majority of 60 % considered assignments such as conducting an open consultation for uncomplicated respiratory tract infections or vaccination consultations to be delegable. As many as 21.9 % would be willing to pay a PA more than 3,500 euro gross monthly salary (based on a full-time position) (8.7 % more than 4,000 euro), while 38.4 % stated that they could not currently afford the cost of employing a PA. The qualitative results underline these findings. One of the respondents' conditions for the employment of a PA was to abolish the quarterly budget limits for GPs. Discussion: Many GPs already express their interest and willingness to both employ PAs and to delegate medical tasks to them - in spite of unanswered questions and, possibly, by necessity. About a fifth of the participants can even imagine paying from their own budget the same gross salary that PAs employed by hospitals are paid. Reliable clarification of feasibility, safety and cost-effectiveness of the use of PAs as well as effects on the quality of treatment in primary care should be a priority for health policy actors. Take-home message: From the GP's point of view, the integration of PAs into GP-centred care in terms of an interprofessional team practice has got potential. At the same time, the question of financial feasibility is still unsettled.