Nurse practitioner and physician assistant satellite health centers. The pending demise of an organizational form?

A national cohort of 44 rural satellite health centers originally staffed by nurse practitioners (NPs) and physician assistants (PAs) was studied in 1975 and resurveyed in 1979 and in 1984 to examine the viability of this type of health-care delivery organization during a period of significant growth in the nation's physician supply. Twelve of these practices had ceased to function, although eight have been replaced by physician practices. Of the remaining 32, 14 have physicians on their staffs and 18 remain staffed only by NPs and PAs. Those centers staffed by physicians experience greater patient utilization, charge more for office visits, have larger budgets, and generate more of their budgets from fees for services and therefore appear to be more organizationally stable than centers staffed only by NPs and PAs. Although broader studies are needed for substantiation, these findings suggest that the period when NP/PA-staffed satellite health centers were important organizations for delivering care to previously underserved rural communities may be ending.