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 in
a 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 and
physician 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
