Physician Assistants, Nurse Practitioners, and Community Health Centers under the Affordable Care Act

Critical medical anthropology has extensively critiqued biomedicine's hegemonic structure that places doctors in control of knowledge and power and casts patients as depersonalized recipients of treatment (not care). Yet in the United States, an increase in collaborative models of health care impacts not only the types of providers patients see for care but also how that care is delivered. Under the Patient Protection and Affordable Care Act (ACA), community health centers (CHCs) are at the center of the expansion of accessible and high-value primary health care. It is estimated that CHCs will add 15,000 new providers to their staffs by 2015, and most will be non-physician providers, such as physician assistants (PAs) and nurse practitioners (NPs). In this paper, I seek to understand the role of PAs and NPs in delivering health care to medically underserved populations. In doing so, I explore beyond the provider-patient relationship to include the relationships within collaborative care teams and relationships between the clinic and the community. Analysis of these multiple complex relationships among different types of providers, patients, and communities help us to understand how relationship dynamics and trust influence patient care and outcomes in this type of health care setting.