Commentaries on Health Services Research

A cornerstone of patient-centered medical homes (PCMHs) is team-based care; however, little information exists on the composition of providers delivering direct primary care in PCMHs. This study examined the number and distribution of primary care physicians, NPs, and PAs in New York state practices (n=7,431). Designated PCMHs had more NPs and PAs per primary care physician relative to non-PCMHs. The ratios of NPs to primary care physicians were almost twice as high in PCMHs compared with non-PCMHs (0.20 and 0.11), and ratios were similarly different for PAs to primary care physicians (0.16 and 0.09, respectively). The multivariate analyses also support that higher NP and PA staffing was associated with PCMH designation—that is, for every 25 primary care physicians, PCMHs had one additional NP and/or PA. The growth of PCMHs may require more NPs and PAs to meet the anticipated growth in demand for healthcare. Policy- and practice-level changes are necessary to use them in the most effective ways