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Jane Cassels Record, Michael McCally, Stuart O. Schweitzer, Robert M. Blomquist, Benjamin D. Berger; New Health Professions After a Decade and a Half: Delegation, Productivity, and Costs in Primary Care. J Health Polit Policy Law 1 June 1980; 5 (3): 470–497. doi: https://doi.org/10.1215/03616878-5-3-470
Though knowledge about physician's assistants and nurse practitioners is far from conclusive, these new health practitioners (NHPs) appear to perform a large percentage of primary care services at a high level of quality and productivity. Moreover, the gap between the physician/NHP substitution ratio and the NHP/physician cost ratio seems wide enough to assure cost savings when NHPs are used well.