Possible Fringe Benefits Associated with Increasing the Supply of Physician Extenders in Primary Care: The Impact of Physician Extenders on Race and Gender Concordance

Background: A number of studies have examined the role of race and gender concordance in health care settings, but few have examined the role that provider type may play in this phenomenon.

Methods: Data generated by a survey instrument based on CAHPS 4.0 examine the impact of provider type (physician vs. physician extender) on the propensity for race and gender concordance. The study includes a sample of the white and black adult subpopulations enrolled in North Carolina Medicaid’s managed care network system. The survey was a computer assisted telephone interview survey conducted during the summer of 2012. The dependent variables, race concordance and gender concordance, are operationalized by responses to survey questions related to the race and sex of respondents and their primary care providers. The independent variable of interest is provider type and distinguishes physicians (general practitioners and specialty care providers) from physician extenders (nurse practitioners and physician assistants). Several other demographic variables serve as predictor and control variables. Two separate logistic regression models, one for each dependent variable, are utilized for the analysis.

Findings: Bivariate analysis of the data reveals that race concordance (p < 0.05) and gender concordance (p < 0.001) are more prevalent among the physician extender providers. These results warrant comprehensive multivariate regression analyses, which will determine whether recent trends to employ more physician extenders in primary care settings have the added benefit of promoting race concordance and gender concordance. Concordance could subsequently improve the patient-provider relationship in terms of enhanced trust, satisfaction, and communication.