Impact of Physician Extenders and Midlevels in Plastic Surgery

Abstract

Background: With the rapidly changing health care marketplace, there is constant pressure on the health care industry to progress and to ensure high-quality and cost-effective service delivery. The aim of this article is to review the economic value and to evaluate the effectiveness and safety of the independent services provided by physician extenders in plastic surgery. Methods: The PubMed database was used to review the literature. The search was performed using key words “plastic surgery AND (“nurse practitioner” OR “physician assistant” OR “physician extenders”). Inclusion criteria were any study that evaluated economic value associated with the integration of the physician extenders as well as safety and effectiveness of the independently provided services by midlevels in plastic surgery. Results: The PubMed search yielded 182 articles. Following evaluation of the titles and abstracts, 27 articles were included in a qualitative review of content. Of these articles, 10 were ultimately included: four that analyzed economic value and six that evaluated effectiveness and safety of the independently provided services by physician extenders in plastic surgery. All four articles were associated with financial gain and six articles demonstrated safe and effective provision of the independently provided services by physician extenders. Conclusions: The integration of physician extenders has the potential to achieve more efficient workflow with well-coordinated and high-quality care for patients. The authors’ review suggests the integration of physician extenders in plastic surgery adds economic value to the practice and improves effectiveness and efficiency of the workflow safely.