In today's society, there exists an ever-growing concern over the serious deficit in the primary physician services. With the high cost of health care consistently rising, increased demands are being made for better health care practices. The problems now facing the medical profession emphasize the lack of supply, distribution, organization, utilization, and financing of physician services.The problems of helath care are not mutually exclusive of one another; but rather, they are interrelated and dependent. The problems have manifest themselves in overburdened physicians, rapidly rising medical costs, lack of appropriate use of equipment and facilities, lack of any medical care and services in many rural areas, maldistribution of physicians in urban areas, and delays in seeking medical care by the population.During this time when medical schools are re-examining the objectives and potentialities of their programs, schools of allied health professions are developing and expanding their "non-physician" programs. One of these allied health professions receiving a great deal of attention is the physician assistant. The physician assistant, however, has not been readily accepted into established medical practice. Questions concerning minimum educational standards, licensing, legal responsibility, professional roles, and future professional goals have been raised.The present investigation was undertaken in order to determine the impressions of practicing, licensed physicians in the state of Indiana concerning the utilization, roles, and acceptance of the physician assistant concept. More specifically, this study was designed to determine what, if any, relationship between descriptive aspects of the physician and his practice and his impressions concerning the utilization of the physician assistant in medical practice. The descriptive aspects of the physician population included: medical specialty, age of physician, number of years in practice, type of practice, size of practice, the location of the practice, military experience, distance to urban areas, distance to nearest hospitals, and number of new patients seen each day.The population for this study consisted of a 10 per cent random sample of physicians practicing in Indiana during 1972. The questionnaire utilized was constructed and items selected on the basis of job descriptions, tasks, and functions presented or proposed, in some form, in clinical settings, physician assistant training programs, and to physician assistants throughout the country.The practice of quality medicine mandates that physicians be a conservative group and not take extreme positions. If confronted with a "rating-scale" type of answer, responses might tend to fall in the middle ranks. For this reason, a forced choice (yes or no) type of questionnaire was developed. Each item was designed to measure the impressions and opinions of the physician toward some aspect of the role concept for the physician assistant.A questionnaire was mailed to each of the sample members. Included with each questionnaire was: 1) an explanatory letter introducing the study, 2) an addressed, stamped envelope to be used in returning the survey form. At three week intervals, a follow-up survey form was sent to those sample members who had not returned the form. This was done for two follow-up periods to ensure maximum return.The data was handled in two ways. Initially, the data was handled in a descriptive manner; that is, a simple frequency count was done to see how physicians as a group answered each question or statement. Next, the physician population was categorized and each of the variables was measured. The statistical method used for this study was the chi square (x2) method.The mailing questionnaire was chosen as the method of data collection because it was inexpensive, successful with individuals of higher socioeconomic groups, larger sample size, and bias of the researcher minimum to results.The sample for this study consisted of a ten per cent random sample. The study was initiated in April, 1973, and terminated in September, 1973. A total of 451 questionnaires were mailed to the population sample. Of these, 225 were returned, accounting for a 51.3% questionnaire return.Of the physicians surveyed, 38.8% practiced general medicine. Genreal surgery accounted for 11.0% of the sample. The remainder was made up of various specialties. It was also observed that 32.0% of the physician sample were in the age range of 41-50 years and 28.4 were in the age range of 51-60 years. Only 2.7% of the physicians were under 30 years and 3.1% over 70 years.Of the physicians sampled, 34.4% had been practicing medicine for over 30 years and 53.9% of the physicians practiced alone. Only 1.4% of the physicians were retired.Of the physician sample, 49.8% saw from 26-50 patients each day and over 42% practiced in urban areas greater than 100,000 population. Only 8.1% of the physicians were practicing in areas of 5,000 or less population.With respect to military experience, 77.1% practiced medicine in the military.With a breakdown in regards to distance to nearest urbanarea (100,000 population), 45.4% were within 10 miles and 15.5% were located in areas greater than 50 miles from urban areas. Furthermore, 90.6% of the physicians were located within 10 miles of a hospital.It was observed that 72.1% of the physicians saw from 0-5 new patients each day; 6% saw more than 25 new patients each day.An analysis of the data revealed that physicians as a group agree with the philosophy of the physician assistant concept. The majority of physicians felt that the physician assistant should be trained through approved academic programs which were under the direction of recognized medical schools. In conjunction with this, the physicians felt that standardization in terms of quality and program content was desirable. It was interesting to note that only 79.7% of the physicians felt that standardization was necessary.Many felt they would rather train the physician assistant themselves for the specific needs of their own practice. Some physicians felt that the training programs could be offered through local hospital training schools and not only through medical schools.The next area of interest dealt with legal responsibility. Only 25% of the physicians responding felt that the physician assistant should be legally responsible for his performance.Almost 66 percent of the physicians said that the physician assistant should be permitted to write certain prescriptions. Also 41% said that the physician assistant should be able to write patient orders in the hospital.The majority of physicians felt that the physician assistant should be able to detect abnormal signs and symptoms and make preliminary diagnoses based on the results of such examinations and report these on patients' permanent records or charts. Nearly 52% of the physicians said that their patients would accept the physician assistant to take care of them when they were sick.Approximately 75% felt that the role of the physician assistant overlaps that of the registered nurse.Most of the sample did not feel that the widespread use of the physician assistant would reduce the present quality of health care. Related to this, almost 79% of the physician sample felt that present health care delivery services need to be restructured.The most quoted salary range for the physician assistant was in the 8 to 10 thousand dollar range.Most physicians stated that if they were to employ a physician assistant, they would devote more time to existing patients.Approximately 16% of the Indiana physicians, at present, employ a physician assistant and nearly 64% said they would consider employing a physician assistant in the future.On the basis of the data collected from this survey of physicians concerning the utilization of the physician assistant in Indiana, the following conclusions are made:(1) The majority of physicians feel that the physician assistant should be trained in approved programs.(2) Only 25% of the physicians feel that the physician assistant should be legally responsible for his performance.(3) The majority of physicians feel that the physician assistant should be permitted to write certain prescriptions.(4) The majority of physicians feel that the physician assistant would be accepted by their patients.(5) Nearly three-fourths of the physicians feel that the role of the physician assistant overlaps that of the registered nurse.(6) Nearly 70% of the physicians felt that health care delivery needs to be restructured in order to better meet patient needs.(7) Most physicians would utilize more time to existing patients if they were to employ a physician assistant.(8) The vast majority of physicians feel that the physician assistant is a valuable member of the health care team and will improve the quality of patient care.Ball State UniversityMuncie, IN 47306

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