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As the nation shifts through proposed solutions to the shortage of primary care physicians, one option would be to fill the gap with so-called physician extenders, or mid-levels such as nurse practitioners (NPs) and physician assistants (PAs). That was the option promoted ina 2010 Institute of Medicine report, which also suggested expanding a nurses' scope of practice. Hospital medicine is a growing field with an increasing demand for additional healthcare providers, especially in the face of an aging, abundant population. Reductions in resident duty hours, coupled with a continued deficit of medical school graduates to appropriately meet the demand, require an additional workforce of health care providers to counter the shortage.A major dilemma of incorporating nonphysician providers such as nurse practitioners andphysician assistants into a hospital medicine practice is their varying academic backgrounds and inpatient care experiences. Medical institutions seeking to add NP’s and PA’s to their hospital