The influence of government policies on the nurse practitioner and physician assistant workforce in the Netherlands, 2000–2022: a multimethod approach study
BMC Health Services Research volume 23, Article number: 580 (2023)
Many countries are looking for ways to increase nurse practitioner (NP) and physician assistant/associate (PA) deployment. Countries are seeking to tackle the pressing issues of increasing healthcare demand, healthcare costs, and medical doctor shortages. This article provides insights into the potential impact of various policy measures on NP/PA workforce development in the Netherlands.
We applied a multimethod approach study using three methods: 1) a review of government policies, 2) surveys on NP/PA workforce characteristics, and 3) surveys on intake in NP/PA training programs.
Until 2012, the annual intake into NP and PA training programs was comparable to the number of subsidized training places. In 2012, a 131% increase in intake coincided with extending the legal scope of practice of NPs and PAs and substantially increasing subsidized NP/PA training places. However, in 2013, the intake of NP and PA trainees decreased by 23% and 24%, respectively. The intake decreased in hospitals, (nursing) home care, and mental healthcare, coinciding with fiscal austerity in these sectors. We found that other policies, such as legal acknowledgment, reimbursement, and funding platforms and research, do not consistently coincide with NP/PA training and employment trends. The ratios of NPs and PAs to medical doctors increased substantially in all healthcare sectors from 3.5 and 1.0 per 100 full-time equivalents in medical doctors in 2012 to 11.0 and 3.9 in 2022, respectively. For NPs, the ratios vary between 2.5 per 100 full-time equivalents in medical doctors in primary care and 41.9 in mental healthcare. PA-medical doctor ratios range from 1.6 per 100 full-time equivalents in medical doctors in primary care to 5.8 in hospital care.
This study reveals that specific policies coincided with NP and PA workforce growth. Sudden and severe fiscal austerity coincided with declining NP/PA training intake. Furthermore, governmental training subsidies coincided and were likely associated with NP/PA workforce growth. Other policy measures did not consistently coincide with trends in intake in NP/PA training or employment. The role of extending the scope of practice remains to be determined. The skill mix is shifting toward an increasing share of medical care provided by NPs and PAs in all healthcare sectors.
The first nurse practitioners (NPs) and physician associates/assistants (PAs) entered the Dutch labor market in 2000 and 2004, respectively . The factors that contributed to the introduction of these professions included the increasing demand for care, regional medical doctor shortages, and the expected cost-effectiveness of NPs and PAs. This was combined with an accommodative policy that focused on the need for a university program for nurses [2, 3]. NP/PAs are perceived as professionals who can help alleviate healthcare challenges, because they can take over tasks from physicians.
The scopes of practice of NPs and PAs lie at the interface of the medical professions and result in task reallocation . In healthcare practice, some tasks of NPs and PAs may overlap [5, 6]. However, they have different profiles and educational preparation (Table 1) . In the Netherlands, universities of applied sciences are responsible for the content of educational programs, and such content is derived from the professional profiles. Training is at the master’s degree level. It includes a dual work-education model, with 1 day in school and 4 days of practical learning within the healthcare organization where the trainee works [1, 8].
Looking back on the reasons for the introduction of both professions in the Netherlands, NPs and PAs do indeed fill part of the increasing demand for care . Furthermore, several studies show that NP/PA deployment results in an equal or better quality of care, patient satisfaction, and comparable or reduced healthcare costs compared to medical doctor deployment [9,10,11,12,13,14,15,16,17,18,19,20]. In the USA, Veterans Affairs administrative data made clear that primary care patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients . For PAs, a systematic review showed that this efficiency was sometimes due to reduced labor costs and sometimes because they were more effective producers of care and activity . Furthermore, some studies state that a (local) shortage in medical doctors incentivizes NP/PA employment [15, 21, 22].
Since the start of NP and PA training, various and sometimes unique policy measures have been taken in the Netherlands to facilitate task reallocation and further NP/PA training and deployment. To understand the policy measures, an explanation of the Dutch healthcare system is provided in Table 2. Policies include extending the legal scope of practice, creating reimbursement opportunities, and providing a national subsidy scheme for NP/PA training. The subsidy includes a partial reimbursement for salary costs for the replacement of NP/PA students and is received by the students’ employer . Based on estimates of the future required NP/PA (training) capacity, the Ministry of Health, Welfare, and Sport decides the number of subsidized training places. Education for healthcare professionals is one of the public values the state regulates and preserves.
Evaluation data on the impact of these policies on the training and employment of NPs and PAs are currently limited to evaluations of the subsidy scheme for the training programs for NPs and PAs [23,24,25,26]. In these evaluations, the universities of applied sciences state that the number of NPs and PAs would never have increased so much without subsidy schemes [24,25,26]. However, it is still unknown to what extent these policy measures affect the NP/PA workforce.
This study aims to analyze the effects of policy measures on NP/PA workforce development in the Netherlands. The research questions that will be addressed are therefore as follows:
Which policy measures were taken by the government to facilitate NP/PA training and deployment?
How did NP/PA training and employment and the NP/PA-medical doctor capacity ratio develop over time and in each setting?
To what extent did policy measures affect NP/PA training and employment?
To answer the research questions, a multimethod approach consisting of a review and surveys was applied. To gain insight into which policy measures may have affected NP/PA training and employment, and the NP/PA-medical doctor capacity ratio, we analyzed whether the moment of implementation of policy measures corresponds with trends in the workforce size of the professions and the intake in NP/PA training courses.
We reviewed publications and reports to identify the relevant policy measures in the Netherlands between January 2000 and January 2022. Our focus was on changes in laws, regulations, and healthcare funding in healthcare sectors where NPs and PAs work and may affect these professions’ employment and training. The sources were government publications, publications of sectoral and professional organizations and research reports. We used two approaches to discover relevant information. First, we monitored documents and news items that have been published by professional associations of PAs, NPs, and medical doctors, the Consultation Platform NP/PA, the National Center of Knowledge for Task Reallocation in Primary Care, the National Healthcare Authority, the General Consultation Labor Market Policy in Healthcare and the Standing Parliamentary Committee on Health, Welfare, and Sport in the period from January 2014 to January 2022. Where relevant, references to earlier sources up to 2000 were included. We included sources regarding NPs or PAs containing the following terms: legislation, regulations, policy, subsidy schemes, financing of care, and reimbursement of care. Second, the overview was supplemented, and to complete it, policy measures and underlying publications were added by an NP/PA policy expert, professional associations, and the PA/NP committee within the Advisory Committee on Medical Manpower Planning (ACMMP), consisting of program coordinators of NP/PA training programs, NPs, PAs, and representatives of health insurers.
Surveys of training programs
At the end of 2018 and the end of 2021, the chairpersons of the national training committees were asked to send all training programs a survey regarding the annual intake and number of graduates from the 2-year MANP (Master Advanced Nursing Practice) and 2.5-year MPA (Master Physician Assistant) training programs at the universities for applied sciences. The training programs started in 1997 and 2001, respectively. Data were collected from the 2000–2001 cohort until the 2021–2022 cohort. We also collected data at the sector level from 2012 onward. No personal data were collected.
Surveys of alumni
Through surveys among alumni of all MANP and MPA courses at universities for applied sciences, we collected data on the labor market characteristics and executed tasks of NPs and PAs [5, 6, 27,28,29,30,31,32,33]. Training program graduates were invited to take part in the digital survey by e-mail in 2012, 2016, 2018, and 2021. Informed consent was obtained. No personal data were collected. The encrypted files, the decryption code and back-up data are stored securely.
We calculated the response based on the number of graduates at the time. Among NPs, there were 4,304 graduates from the MANP training programs at the end of 2021. Among PAs, there were 1,741 graduates. Alumni no longer working in the profession were also invited to complete the survey. We could not contact all alumni due to missing contact details. In 2022, there was contact information for 88% of MANP alumni and 96% of MPA alumni.
A weighting factor was constructed to extrapolate to the national level, based on the total number of persons per intake and the diploma year compared to the number of respondents from that year. In the 2018 (NP and PA) and 2021 (NP) data collection, we used an additional weighting factor to correct for alumni who were not working in the professions, as they were less likely to participate in the survey. This correction was based on the number of people registered in the Nurse Practitioner Register (NPs) and the Individual Health Care Professions register (NPs and PAs) and the share of inactive NPs and PAs in the registration of Statistics Netherlands. In 2021, no additional weighting factor was necessary for the PAs because: 1) the weighted number of respondents who worked as a PA did not exceed the number of registered PAs, and 2) the share of active PAs corresponded to the registration of Statistics Netherlands.
To gain insight into the influence of shortages in medical doctors who specialized after initial medical training on NP/PA training and employment, we also collected data on the capacity of medical doctors by medical field in terms of full-time equivalent (FTE) from 2013 onward. Medical doctors at a master’s degree level were excluded because their capacity was not a reason for implementing the NP/PA professions. To obtain these data we consulted reports from the ACMMP regarding the required training capacity of medical doctors .
In the overview of recent decades of Dutch healthcare policy, the government and health insurers have implemented various policy measures that may have affected NP/PA training and employment. The policy measures relate to subsidies for NP/PA training, the funding of platforms and research, extending the scope of practice, legal acknowledgment, reimbursement regulations, and healthcare funding (see timeline Table 3) and followed after recommendations of the Committee Implementation Training Continuum and Task Reallocation in 2003 .
Since 2004, the number of subsidized training places for NP and PA training has greatly increased. After 2013 the number of structurally subsidized places was fixed at 250 places for the MPA and 450 for the MANP. From 2013, general practices and out-of-hours primary care services could apply for additional funding . In 2021, it was decided to finance training for 20 additional PAs within primary care .
Funding platforms and research
Since 2004, the Dutch government has financed a knowledge center and consultation platforms on task reallocation. In addition, research on task reallocation was funded.
Extending the scope of practice
NPs and PAs have been granted legal authority for specific reserved medical procedures. Here, extending the scope of practice concerns routinely performed medical procedures of limited complexity, in which the risks are reasonable to oversee and for which national guidelines, standards, and protocols apply. From January 1, 2012, the scope of practice was extended for five years [38, 39]. From September 1, 2018, the extended autonomous scope of practice of NPs and PAs for specific reserved medical procedures became permanent. NPs and PAs can independently indicate, execute and delegate several reserved medical procedures depending on their experience and specialism and following laws and regulations, i.e., surgical procedures, endoscopies, catheterizations, injections, punctures, elective cardioversion, defibrillation, and prescribing drugs that are available only by prescription [40,41,42,43].
With the inclusion of NPs and PAs in the Individual Health Care Professions Register and Act in 2009 and September 2018, respectively, these professions obtained, among others, a protected professional title and governance by disciplinary law. Since January 1, 2014, and September 1, 2016, NP and PA graduates have received an MSc degree.
Since 2015, NPs and PAs have been allowed to open and close tasks in the reimbursement system in hospital care . As a result, they can carry out initial clinical visits independently in addition to follow-up visits. As of 2019, NPs and PAs may also register and invoice peer consultation and cotreatment activities in the reimbursement system under their name [45,46,47]. Starting in 2022, hospital care activities must be registered in the reimbursement system under the profession code of the healthcare professional providing care to promote task reallocation . In (nursing) home care and care for disabled individuals, starting in 2019, it became possible for NPs and PAs to provide and reimburse care for vulnerable groups in primary care, similar to elderly or disabled care physicians [49,50,51].
The Dutch government defines budgets for healthcare sectors where NPs and PAs operate. In the spring of 2012, agreements between the governing coalition and part of the opposition were made regarding an extensive program of fiscal austerity that would also affect curative care (among others, hospital care), long-term care (among others (nursing) home care), and mental healthcare . In the following years, the government made covenants with sectoral and professional organizations regarding, among others, healthcare budgets (Table 3) [53,54,55,56,57,58,59].
Further background information about the policy measures can be found in Additional file 1: Appendix 1.
The development of the Dutch NP/PA workforce
Intake in training programs 2001–2022
All NP and PA courses at the universities for applied sciences in the Netherlands (9 and 5, respectively) provided the information requested in the surveys. Figure 1 shows that the annual intake almost corresponded to the number of subsidized training places between the 2001–2002 and 2012–2013 cohorts, with a 131% increase in the 2012–2013 cohort . In 2013–2014, the annual intake in NP and PA training programs decreased sharply by 23% and 24%, respectively. Starting with the 2014–2015 cohort, the yearly intake increased again and almost matched once again the number of subsidized training places in 2018–2019.
The numbers of the annual intake by sector have been available since the 2012–2013 cohort . In hospital care, PA and NP training intake decreased by 27% and 29%, respectively, between 2012–2013 and 2013–2014 (Fig. 2). In (nursing) home care and mental healthcare, the number of new students entering the NP program fell in 2013–2014 by 33% and 20%, respectively. The intake decreased in a large majority of the training programs. For hospital care, 11 out of 14 NP/PA programs (79%) were involved. For NP training in (nursing) home care and mental healthcare, the intake dropped by 67% and 73% of the programs with newcomers in the 2012–2013 and 2013–2014 cohorts, respectively. In contrast, the number of primary care newcomers increased in both PA and NP training programs by 33%. Nevertheless, the numbers in this sector were relatively small, with 16 (PA) and 28 (NP) newcomers in 2013–2014. The influx into NP and PA training in (nursing) home care shows a rising trend from 2015–2016. Since the 2018–2019 cohort, the inflow into PA training in primary care has also increased sharply.
NP, PA, and medical doctor capacity
In 2012, 2016, and at the end of 2018 and 2021, 45%, 40%, 38%, and 46% of MPA alumni, respectively, completed the survey, and 36%, 38%, 34%, and 36% of the alumni of the 2-year MANP training programs, respectively, completed the survey. The number of practicing NPs and PAs has sharply increased since these professions were introduced in the Netherlands (Table 4) [5, 6, 27,28,29,30,31,32,33]. In 2012, 1442 NPs and 347 PAs were employed. Ten years later, 4,568 NPs and 1,590 PAs worked in the Netherlands. The intake in the training programs determines the size of both groups. There is no structural influx from abroad .
The capacity of NPs and PAs supersedes the growth of medical doctors in FTEs. While the number of FTEs in medical doctors increased from 2013 to 2022 by an annual growth rate of 2% , since 2012, the number of FTEs in NPs and PAs has increased annually by 14% and 16%, respectively. The capacity of NPs and PAs rose more steeply in all sectors than the capacity of medical doctors (Table 4). There were major differences between sectors in the capacity growth and the capacity ratio of NPs and PAs compared to medical doctors. For example, in 2012, 4.4 FTEs of NPs worked in hospital care relative to every 100 FTEs of medical doctors in this sector. In 2022 this ratio increased to 9.0/100. The capacity of NPs in hospital care increased by an annual growth rate of 9%. In (nursing) home care, the NP-medical doctor ratio increased from 7.7/100 FTE in 2012 to 41.3/100 FTE in 2022. For PAs, the number of FTEs grew fastest in (nursing) home care, at 22% per year, with the most significant increase (44% per year) after 2019. The PA-medical doctor ratio increased from 0.8/100 FTE in 2012 to 5.3/100 FTE in 2022. Approximately 85% of the NPs and 96% of the PAs in this sector work in nursing homes.
Synthesis: Policy measures in relation to NP/PA workforce development
The moment of implementation of policy measures was compared with trends in the annual intake in training programs and the size of the professions. The results show that until 2012, the training program intake numbers were almost equal to the number of subsidized places. In 2012, a sharp increase in intake in the training programs coincided with the introduction of four policy measures: a temporary legal authorization for NP/PAs for specific medical procedures (extending the scope of practice), the inclusion of PAs in the Individual Health Care Professions Act (legal acknowledgment of the professional level), the start of an online knowledge platform, and a substantial increase in the number of subsidized places. The training intake in primary care increased in 2013 after an additional subsidy for training NPs, and PAs was awarded. The sharp decrease in the intake of NP/PA trainees in 2013 in hospitals, (nursing) home care, and mental healthcare coincided with covenants regarding fiscal austerity in these sectors.
From 2018–2019 we see a solid general increase in intake, especially in PA training programs in primary care. This finding coincides with the definitive inclusion of PAs in the Individual Health Care Professions Act, the definitive full authority of NP/PAs for specific medical procedures (extending the scope of practice), and primary care budget growth. From 2019, we also see a substantial increase in the number of FTEs of NP/PAs working in (nursing) home care and a shift in the NP-medical doctor and PA-medical doctor capacity ratios in (nursing) home care. This finding coincides with a new NP/PA reimbursement opportunity for extramural care to vulnerable groups in this sector. Other healthcare reimbursement policies do not coincide with NP/PA training or employment trends.
This paper provides an overview of the policy measures taken in the Netherlands to encourage task reallocation and to facilitate the training and deployment of NPs and PAs. We conducted a multimethod analysis of which policy measures coincide with trends in the workforce development of NPs and PAs. This paper reveals that some policy measures significantly coincide with and likely affected NP/PA workforce trends, while others do not consistently coincide with trends in the training and employment of NPs and PAs.
The impact of training subsidies and fiscal austerity on the intake in training programs
Based on our research, we conclude that subsidies for NP and PA training strongly coincide with the intake in training programs and, thus, the development of the NP/PA workforce in the Netherlands. Nevertheless, the sharp decrease in the intake of NP/PA trainees in 2013, despite an increase in the number of subsidized training places, makes it clear that other factors in addition to the number of subsidized places may be important. For example, healthcare providers may have chosen to train fewer employees in 2013 due to ‘sudden’ fiscal austerity measures in 2012. A second alternative explanation for the decline is the increase in subsidized training places and intake in 2012. The number of subsidized places in previous years was possibly lower than the number of potential entrants in the programs, which led to an increasing reservoir of interested parties. After they started their training in 2012, the reservoir dried up. A third explanation, also suggested by Peters & Van der Horst (2016), is the lack of clarity within hospitals regarding the consequences of the planned introduction of a new reimbursement system in 2015 in hospitals, where hospitals now negotiate with insurance companies on the reimbursement of their self-employed physicians and collect these funds. This introduction led to an initial reluctance to train NPs and PAs since one of the uncertainties was who would employ these NPs and PAs .
However, although relevant, the second and third explanations do not clarify why the inflow declined the most in healthcare sectors, where fiscal austerity was also the most severe and not in primary care, which experienced higher budgetary growth. The influence of fiscal austerity on the number of newcomers in the programs remains the most likely explanation for the decrease in 2013. This position is further supported by the fact that the intake in hospital care, (nursing) home care, and mental healthcare sectors also decreased in most training programs, inducing a more general trend. A (temporary) decrease in the training of healthcare professionals has not yet been documented as a possible consequence of economic austerity. However, such an observation would certainly fit with the consideration of Visser et al. (2017) that high-yield interventions often require substantial investments, which proves to be an obstacle when providers are confronted with a decrease in financing . Furthermore, the annual intake in NP and PA training programs within primary care increased sharply from the 2018–2019 cohort. This finding coincides with the agreements made in the 2018 covenant on continued budget growth in primary care . Finally, over time the structural expansions in training subsidies seem to trump a one-off large fiscal contraction, although more of such contractions could lay ahead.
High NP and PA employment in sectors with medical doctor shortages
Our results support earlier research in which medical doctor shortages are mentioned as one of the reasons for healthcare organizations to employ an NP or PA [15, 21, 22]. We showed considerable intersectoral differences in the ratio of FTEs in NPs versus FTEs in medical doctors. This ratio is relatively high in sectors with a high unfulfilled demand for medical doctors, such as care for disabled individuals, mental healthcare, and (nursing) home care . Given the significant differences between sectors, it is plausible that exogenous factors, such as sectoral labor market shortages in medical doctors, accelerated the employment of NPs and PAs. From 2019, we see a substantial increase in NP/PA employment in nursing home care and entrants into PA training program in primary care. In 2019, an increasing shortage of elderly care physicians was signaled, as was a shortage of general practitioners in primary care for the first time since 2013. It is plausible that the increasing shortage of elderly care physicians accelerated the substantial increase in NP/PA employment in nursing home care. Another explanation is the introduction of new NP/PA reimbursement opportunities in 2019. However, other reimbursement regulations do not coincide with workforce or intake trends.
Medical doctor shortages in relation to extending the scope of practice
In 2012, extending the scope of practice coincided with a sharp increase in the intake in training programs. Thus, extending the legal scope of practice might stimulate NP/PA workforce growth and professional roles, provided that certain situational conditions are met. For example, a collaborative relationship between a PA and a clinician is vital, as it builds trust followed by the number of reassigned tasks through negotiated performance autonomy [62, 63]. As De Bont et al. (2016) argued, role development is a situated endeavor in regard to extending the scope of practice. The development of such extended roles depends on, among other things, the willingness of local physicians to delegate tasks . This willingness is probably closely related to regional and sectoral conditions, such as medical doctor capacity. Full practice authority is associated with a higher number of NPs in both rural areas and primary care, where there is a shortage of physicians [65, 66]. In combination with an extended scope of practice, medical doctor shortages may act as an accelerator for task reallocation and NP/PA workforce development. However, the results do not indicate an association because the 2012 intake increase also coincided with the inclusion of PAs in the Individual Health Care Professions Act, the start of an online knowledge platform, and an increase in the number of subsidized places. Because the 2012 intake increase in the training programs affects NPs and PAs, the inclusion of PAs in the Individual Health Care Professions Act is unlikely to be associated with the increase. It is also unlikely that the start of an online knowledge platform immediately impacts training program intake. In summary, the number of subsidized training places strongly coincides with the intake in training programs, leaving the role of the extended scope of practice unclear.
Strengths and limitations
This is the first multimethod study to provide insight into the potential effects of various NP/PA policy measures on the workforce development of NPs and PAs in the Netherlands. In addition, the link between medical doctor capacity and the availability of rich data at the sector level provides further insight into the potential role of medical doctor capacity in NP/PA workforce development. A limitation of this study is that we must consider the possibility that the number of practicing (FTE in) NPs and PAs in the 2012 and 2016 studies has been overestimated. In these years, no bias was corrected for a somewhat higher nonresponse among nonpracticing graduates. The recent growth in the number of FTEs in PAs and NPs may be steeper than previously indicated. Another point of interest is that although this study shows that financial policy measures coincide with trends in the intake in training programs, there is no proof of causality. Although trends in education and employment do not coincide with other profession-specific policy measures, such as the funding of knowledge and consultation platforms and evaluation, these measures could still contribute to a gradual growth of the NP/PA workforce. A strong point of this research is that it adopts a multimethod approach on the national level in which, using multiple sources, a link has been made between government policy and NP/PA workforce development. Our study raises opportunities for future qualitative research to explain the potential causality of coinciding trends.
Governments, health insurers, and other stakeholders need insight into the healthcare workforce and influencing factors. Such insight enables them to effectively create policies regarding the increasing demand for care, increasing healthcare costs, workforce shortages, and the deployment of new professions as possible solutions to such challenges. It is recommended that further qualitative research be conducted to better understand the differences between healthcare sectors in the scale of NP/PA employment and training and the potential causality of the coinciding trends described in this paper.
This is the first longitudinal study on NPs and PAs to show that specific policies coincide with NP and PA workforce growth. We find that it is plausible that sudden and severe fiscal austerity has inhibited workforce growth. The internationally unique governmental subsidies for extensive master’s level training coincide and are likely associated with an increase in NP and PA training. Overall, we witnessed substantial NP/PA workforce growth over the years. In 2022, 4,568 NPs and 1,590 PAs were employed in the Netherlands, of whom the majority worked in hospital care, followed by mental healthcare (NPs), (nursing) home care, and primary care. The role of extending the scope of practice remains unclear. Other policy measures such as the legal acknowledgment of professional and educational levels, reimbursement, and funding knowledge platforms and research, do not consistently coincide with the trends in the intake in NP/PA training or employment. The differences in the scale of NP/PA employment between sectors can probably be largely explained by situational conditions.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Advisory Committee on Medical Manpower Planning (Stichting Capaciteitsorgaan in Dutch)
Master Advanced Nursing Practice
Master Physician Assistant
Physician assistant/physician associate
Capaciteitsorgaan. Capaciteitsplan 2024–2027. Deelrapport 9. Physician Assistant en Verpleegkundig Specialist Algemene Gezondheidszorg. [Capacity plan 2024–2027. Subreport 9. Physician Assistant and Nurse Practitioner General Healthcare.]. Utrecht: Stichting Capaciteitsorgaan [Advisory Committee on Medical Manpower Planning]; 2022. Available from: https://capaciteitsorgaan.nl/app/uploads/2023/01/Capaciteitsplan-2024-2027-Deelrapport-9-PA-VS-AGZ-DEF-12-jan-23.pdf.
Nederlandse Vereniging van Nurse Practitioners. Nurse Practitioner Beroepsdeelprofiel. [Nurse Practitioner professional section profile.]. 2004.
Roodbol P. The maturation of the Nurse Practitioner in the Netherlands. 10th ICN NP/APN Conference; 25/26–08–2018; Rotterdam 2018.. Available from: http://www.npapn2018.com/presentations. [16–10–2019].
Maier CB, Batenburg R, Birch S, Zander B, Elliott R, Busse R. Health workforce planning: which countries include nurse practitioners and physician assistants and to what effect? Health Policy. 2018(10):1085–92. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30241796. [15–09–2022].
Korf W, Vadanescu A, Visee H, Rossing H. Alumnionderzoek Physician Assistant [Alumni Research Physician Assistant]. Amsterdam: Regioplan; 2022. Available from: http://capaciteitsorgaan.nl/app/uploads/2022/08/20049-Eindrapport-Alumnionderzoek-PA-Regioplan-1juli22.pdf. [15–09–2022].
Korf W, Vadanescu A, Visee H, Rossing H. Alumnionderzoek verpleegkundig specialisten. [Alumni research Nurse Practitioners]. Amsterdam: Regioplan; 2022. Available from: http://capaciteitsorgaan.nl/app/uploads/2022/08/20049-Eindrapport-Alumnionderzoek-VS-Regioplan-5juli.pdf. [15–09–2022].
Laurant M, Van Vught A. Profielen Physician Assistant en Verpleegkundig Specialist in de praktijk. Convergeren of divergeren? [Profiles Physician Assistant and Nurse Practitioner in practice. Converge or diverge?]. Radboudumc en Hogeschool van Arnhem en Nijmegen; 2018. Available from: https://zorgmasters.nl/extdocs//20181112-Profielen-Physician-Assistant-en-Verpleegkundig-Specialist-in-de-praktijk.pdf. [07–01–2020].
Van den Driesschen Q, De Roo F. Physician assistants in the Netherlands. JAAPA. 2014;27(9):10–1. Available from: https://journals.lww.com/jaapa/Fulltext/2014/09000/Physician_assistants_in_the_Netherlands.1.aspx.
Van den Brink G, Hooker RS, Van Vught AJ, Vermeulen H, Laurant MGH. The cost-effectiveness of physician assistants/associates: A systematic review of international evidence. PLoS One. 2021(11):e0259183. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34723999. [15–09–2022].
Liu CF, Hebert PL, Douglas JH, Neely EL, Sulc CA, Reddy A, et al. Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care. Health Services Research. 2020;55(2):178–89 https://www.ncbi.nlm.nih.gov/pubmed/31943190.
Halter M, Wheeler C, Pelone F, Gage H, de Lusignan S, Parle J, et al. Contribution of physician assistants/associates to secondary care: a systematic review. BMJ Open. 2018;8(6):e019573 https://www.ncbi.nlm.nih.gov/pubmed/29921680.
Kilpatrick K, Reid K, Carter N, Donald F, Bryant-Lukosius D, Martin-Misener R, et al. A Systematic Review of the Cost-Effectiveness of Clinical Nurse Specialists and Nurse Practitioners in Inpatient Roles. Nurs Leadersh (Tor, Ont). 2015;28(3):56–76 https://www.ncbi.nlm.nih.gov/pubmed/26828838.
Martin-Misener, Harbman P, Donald F, Reid K, Kilpatrick K, Carter N, et al. Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review. BMJ Open. 2015;5(6):e007167 https://www.ncbi.nlm.nih.gov/pubmed/26056121.
Timmermans MJC, van den Brink GT, van Vught A, Adang E, van Berlo CLH, Boxtel KV, et al. The involvement of physician assistants in inpatient care in hospitals in the Netherlands: a cost-effectiveness analysis. BMJ Open. 2017;7(7):e016405. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28698344.
Lovink MH, van Vught A, Persoon A, Koopmans R, Laurant MGH, Schoonhoven L. Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study. Nurs Health Sci. 2019;21(3):282–90 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850111/pdf/NHS-21-282.pdf.
Timmermans MJC, van Vught A, Peters YAS, Meermans G, Peute JGM, Postma CT, et al. A multicenter matched-controlled study. PLoS One. 2017;12(8):e0178212. https://www.ncbi.nlm.nih.gov/pubmed/28793317.
Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJAH. Nurses as substitutes for doctors in primary care. Cochrane Database of Systematic Reviews. 2018. Available from: https://pubmed.ncbi.nlm.nih.gov/30011347/.
Ruggeri M, Drago C, Moramarco V, Coretti S, Köppen J, Islam MK, et al. New professional roles and patient satisfaction: Evidence from a European survey along three clinical pathways. Health Policy. 2018;():–;122(10):1078–84. https://abdn.pure.elsevier.com/en/publications/new-professional-roles-and-patient-satisfaction-evidence-from-a-e.
Tsiachristas A, Wallenburg I, Bond CM, Elliot RF, Busse R, van Exel J, et al. Costs and effects of new professional roles: Evidence from a literature review. Health Policy. 2015;119(9):1176–87. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25899880.
Kleven P, Leferink N, Van den Brink G, Kouwen A. De financiële effecten van taakherschikking. Een hermeting gericht op de effecten van de inzet van physician assistants en verpleegkundig specialisten in financieel-economisch perspectief. [The financial effects of task reallocation. A re-measurement aimed at the effects of the deployment of physician assistants and nurse practitioners from a financial-economic perspective.] Nijmegen: Hogeschool van Arnhem Radboudumc; 2019. Available from: https://zorgmasters.nl/extdocs/Eindrapport-De-financiele-effecten-van-taakherschikking-3-januari-2019.pdf. [13–01–2020].
Halter M, Wheeler C, Drennan VM, de Lusignan S, Grant R, Gabe J, et al. Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment. Clin Med. 2017;17(2):126–31. Available from: https://pubmed.ncbi.nlm.nih.gov/28365621/.
Gruca TS, Nelson GC, Thiesen L, Asprey DP, Young SG. The workforce trends of physician assistants in Iowa (1995–2015). PLoS One. 2018;13(10):e0204813. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30296294.
Ecorys S. Taakherschikking: een toepassing via de opleiding van Verpleegkundig Specialisten en Physician Assistants. Eindrapportage beleidsdoorlichting Artikel 4.2 thema 3B. [Task reallocation: an application through the training of Nurse Practitioners and Physician Assistants. Final report policy review Article 4.2 theme 3B.]. 2016. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjQuoC968vwAhUh5OAKHTn5BLgQFjAAegQIAhAD&url=https%3A%2F%2Fwww.tweedekamer.nl%2Fdownloads%2Fdocument%3Fid%3D7fd973ae-1fd2-47d1-b8d8-2bfca54edab7%26title%3DTaakherschikking%253A%2520een%2520toepassing%2520via%2520de%2520opleiding%2520van%2520Verpleegkundig%2520Specialisten%2520en%2520Physician%2520Assistants.%2520Eindrapportage%2520beleidsdoorlichting%2520Artikel%25204.2%2520thema%25203B.pdf&usg=AOvVaw361kwEyEifw0A07uCahzJq. [15–5–2021].
Peters F. Evaluatie van de ‘Subsidieregeling opleiding tot advanced nurse practitioner en opleiding tot physician assistant' [Evaluation of the 'Subsidy scheme for advanced nurse practitioner and physician assistant training']. Nijmegen: Kenniscentrum Beroepsonderwijs en Arbeidsmarkt Nijmegen; 2014. Available from: http://docplayer.nl/4492680-Evaluatie-van-de-subsidieregeling-opleiding-tot-advanced-nurse-practitioner-en-opleiding-tot-physician-assistant.html. [08–01–2020].
Peters F. Tweede evaluatie van de ‘Subsidieregeling opleiding tot advanced nurse practitioner en opleiding tot physician assistant' [Second evaluation of the 'Subsidy scheme for advanced nurse practitioner and physician assistant training']. Nijmegen: Kenniscentrum Beroepsonderwijs en Arbeidsmarkt; 2016. Available from: https://zorgmasters.nl/extdocs/2744-Peters-KBA.pdf. [07–01–2020].
Peters F. Derde evaluatie van de ‘Subsidieregeling opleiding tot advanced nurse practitioner en opleiding tot physician assistant’ [Third evaluation of the 'Subsidy scheme for advanced nurse practitioner and physician assistant training']. Nijmegen: KBA Nijmegen; 2021. Available from: https://www.staten-generaal.nl/9370000/1/j4nvgs5kjg27kof_j9vvkfvj6b325az/vltvqk0wozzq. [15–09–2022].
Aalbers W, Van de Leemkolk B, Van der Velde F. Alumni van de masteropleiding Physician Assistant. [Alumni of the Master's program Physician Assistant.]. Utrecht: Prismant; 2019. Available from: https://capaciteitsorgaan.nl/app/uploads/2020/03/2020_03_02-4.1-Rapportage-Alumni-PA-2019.pdf. [10–07–2022].
Van de Leemkolk B, Van der Velde F. Alumni van de masteropleidingen tot verpleegkundig specialist. [Alumni of the Master's degree program Nurse Practitioner.]. Utrecht: Prismant; 2019. Available from: https://capaciteitsorgaan.nl/app/uploads/2019/11/5.0-Rapportage-VS-2019.pdf. [10–07–2022].
Wierenga M, Van der Velde F. Alumni van de masteropleiding Physician Assistant. [Alumni of the Master's program Physician Assistant.]. Utrecht: Kiwa Carity; 2016. Available from: https://capaciteitsorgaan.nl/app/uploads/2016/06/201606-Alumni-masteropleiding-PA-2016-DEF.pdf. [10–07–2022].
Noordzij E, Van der Velde F. Alumni van de Masteropleidingen tot verpleegkundig specialist. [Alumni of the Master's degree programs in nurse practitioner.]. Utrecht: Kiwa Carity; 2016. Available from: https://capaciteitsorgaan.nl/app/uploads/2016/06/201606-Alumni-masteropleidingen-VS-2016-DEF.pdf. [10–07–2022].
Van der Velde F, Van der Windt W. Alumni van de masteropleiding Physician Assistant. [Alumni of the Master's program Physician Assistant.]. Utrecht: Kiwa Prismant; 2013. Available from: https://capaciteitsorgaan.nl/app/uploads/2016/02/2013_Rapport-Alumni-Physician-Assistant-eindversie.pdf. [10–07–2022].
Van der Velde F, Van der Windt W. Alumni van de masteropleiding Advanced Nursing Practice. [Alumni of the Master's program Advanced Nursing Practice.]. Utrecht: Kiwa Prismant; 2013. Available from: https://capaciteitsorgaan.nl/app/uploads/2016/02/2013_Rapport-Alumni-Advanced-Nursing-Practice-eindversie.pdf. [10–07–2022].
Vis E, Flinterman L, Van Schaaijk A, Batenburg R. Het arbeidsaanbod van de beroepen geestelijke gezondheid in 2022. Een onderzoek ten behoeve van de capaciteitsraming 2022. [The labor supply of the mental health professions in 2022. A study for the capacity estimate 2022.]. Utrecht: NIVEL; 2022.
Capaciteitsplannen geneeskundig specialisten 2024–2027. [Capacity plans for medical specialists 2024–2027.]. Utrecht: Stichting Capaciteitsorgaan; 2022. Available from: https://capaciteitsorgaan.nl/publicaties.
LeGrand-van den Boogaard MJM, Erkelens DW, Kootstra G, Ros P, Schnabel P, Schulkes-van de Pol JA, et al. De zorg van morgen. Flexibiliteit & Samenhang. Deel 1 hoofdlijnen. Advies van de Commissie Implementatie Opleidingscontinuüm en Taakherschikking. [Tomorrow's care. Flexibility & Cohesion. Part 1 main features. Advice from the Commission Implementation Training Continuum and Task Reallocation.]. Den Haag; 2003. Available from: https://docplayer.nl/58286445-De-zorg-van-morgen-flexibiliteit-samenhang.html. [23–7–2022].
Stichting KOH. Stimuleringssubsidie 2022. [Incentive subsidy 2022.] 2022 Available from: https://stichtingkoh.nl/taakherschikking/stimuleringssubsidie-2022. [10–07–2022].
Riedstra S. Wind in de Zeilen. Voortgangsrapportage 15–05–2021 [Wind in the sails. Progress report 15–05–2021]. 2021. Available from: https://www.vlissingen.nl/inwoner/wind-in-de-zeilen/voortgangsrapportages/voortgangsrapportages-uitvoeringsregisseur.html. [03–06–2022].
Tijdelijk besluit zelfstandige bevoegdheid verpleegkundig specialisten. [Temporary Decree on independent authorization for nurse practitioners.]. (2011). Available from: https://wetten.overheid.nl/BWBR0030980/2012-01-01. [10–07–2022].
Tijdelijk besluit zelfstandige bevoegdheid physician assistant. [Temporary Decree on independent authorization for physician assistants.], (2011). Available from: https://wetten.overheid.nl/BWBR0030978/2017-01-01. [10–07–2022].
De Bruijn-Geraets DP, Van Eijk-Hustings YJL, Castro-Van Soerland N, Vrijhoef HJM. voorBIGhouden 2. Eindrapportage Evaluatieonderzoek Art. 36a Wet BIG met betrekking tot de inzet van de Verpleegkundig Specialist en de Physician Assistant: Electieve cardioversie, defibrillatie, endoscopie. [voorBIGhouden 2. Final report Evaluation study Art. 36a BIG Act with regard to the deployment of the Nursing Practitioner and the Physician Assistant: Elective cardioversion, defibrillation, endoscopy.]. Maastricht UMC+, Patiënt & Zorg, KEMTA; 2016. Available from: http://venvnvs.nl/wp-content/uploads/sites/164/2016/12/2016-12-14-Rapport-voorBIGhouden-2.pdf. [07–01–2020].
De Bruijn-Geraets DP, van Eijk-Hustings YJL, Bessems-Beks MCM, Essers BAB, Dirksen CD, Vrijhoef HJM. National mixed methods evaluation of the effects of removing legal barriers to full practice authority of Dutch nurse practitioners and physician assistants. BMJ Open. 2018;8(6):e019962. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29934382.
374. Wet van 4 oktober 2017, houdende wijziging van de Wet op de beroepen in de individuele gezondheidszorg in verband met het opnemen van de physician assistant in de lijst van registerberoepen, het toekennen van zelfstandige bevoegdheid voor bepaalde voorbehouden handelingen aan physician assistants en verpleegkundig specialisten en het opnemen van de mogelijkheid tot het instellen van een tijdelijk register voor experimenteerberoepen [374. Law of 4 October 2017, amending the Law on professions in individual health care in connection with the inclusion of the physician assistant in the list of registered professions, the granting of independent authority for certain reserved actions to physician assistants and nurse practitioners and the inclusion of the possibility to set up a temporary register for experimental professions.]. (2017). Available from: https://zoek.officielebekendmakingen.nl/stb-2017-374.pdf. [10–07–2022].
Rijksoverheid. Welke voorbehouden handelingen mag een zorgverlener uitvoeren? [What reserved procedures may a healthcare provider perform?] Available from: https://www.rijksoverheid.nl/onderwerpen/voorbehouden-handelingen/vraag-en-antwoord/voorbehouden-medische-handelingen. [18–08–2022].
Regeling medisch specialistische zorg - NR/CU-260. [Regulations for specialist medical care - NR/CU-260.]. (2014). Available from: https://puc.overheid.nl/nza/doc/PUC_1839_22/. [10–07–2022].
Regeling medisch-specialistische zorg - NR/REG-1907a. Versie 3. [Regulations on specialist medical care - NR/REG-1907a. Version 3.]. (2018). Available from: https://puc.overheid.nl/nza/doc/PUC_211874_22/. [10–07–2022].
Nederlandse Zorgautoriteit. Monitor Taakherschikking. Physician assistants & Verpleegkundig specialisten in de medisch-specialistische zorg. [Monitor Task Reallocation. Physician assistants & Nurse practitioners in specialist medical care.]. 2019. Available from: https://puc.overheid.nl/nza/doc/PUC_268977_22/1/. [10–07–2022].
Voorneveld-Nieuwenhuis J. NZa regelt ook DBC voor ICC en medebehandeling door VS en PA in het ziekenhuis. [The Dutch Healthcare Authority also arranges DBC for ICC and co-treatment by NP and PA in the hospital..]. Dè Verpleegkundig Specialist. 2018. Available rom: https://zorgmasters.nl/extdocs/DVS201804_10_NZa-regelt-ook-DBC-voor-ICC-en-medebehandeling-door-VS-en-PA-in-het-ziekenhuis_bvlgd.pdf. [10–07–2022].
Taakherschikking. Update augustus 2021. Nuancering op artikel 23, lid 3 NR/REG-2207a; registratie AGB-code uitvoerend zorgverlener (RZ22a). [Task reallocation. Update August 2021. Qualification of Article 23, paragraph 3 NR/REG-2207a; registration AGB code executive care provider (RZ22a).]. (2021). Available from: https://www.nza.nl/zorgsectoren/medisch-specialistische-zorg/registreren-en-declareren-van-zorg/taakherschikking. [07–07–2022].
Beleidsregel prestatiebeschrijvingen en tarieven modulaire zorg 2022 - BR/REG-22124c. [Policy rule for performance descriptions and rates for modular care 2022 - BR/REG-22124c.], (2022). Available from: https://puc.overheid.nl/nza/doc/PUC_712174_22/1/. [07–07–2022].
Beleidsregel Prestatiebeschrijvingen en tarieven modulaire zorg - BR/REG-19120b. [Policy rule Performance descriptions and rates for modular care - BR/REG-19120b.]. (2019). Available from: https://puc.overheid.nl/nza/doc/PUC_253088_22/2/. [21–7–2022].
BIJLAGE 1 bij Beleidsregel prestatiebeschrijvingen en tarieven modulaire zorg 2022—BR/REG-22124d. [Policy rule Performance descriptions and rates for modular care—BR/REG-19120b.]. Available from: https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fpuc.overheid.nl%2FPUC%2FHandlers%2FDownloadBijlage.ashx%3Fpucid%3DPUC_723788_22_1%26bestand%3DBijlage_1_bij_BR-REG-22124d_Prestatiebeschrijvingen.pdf%26bestandsnaam%3DBijlage%2B1%2Bbij%2BBR-REG-22124d%2BPrestatiebeschrijvingen.pdf&data=05%7C01%7Cellen.dankers-demari%40radboudumc.nl%7C404dc779874146c9ae4908dab72e45d0%7Cb208fe69471e48c48d87025e9b9a157f%7C1%7C0%7C638023706774325249%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=TnKjKaWEbJU6qSsBfks7v32ZMB4pwiSjW64VlBKG7dg%3D&reserved=0. [30-10-2022].
ChristenUnie; CDA, D66; GroenLinks; VVD. Lenteakkoord: verantwoordelijkheid nemen in crisistijd. [Spring agreement: taking responsibility in times of crisis.]. 2012. Available from: https://docplayer.nl/2353034-Lenteakkoord-verantwoordelijkheid-nemen-in-crisistijd.html. [14-07-2022].
Algemene Rekenkamer. Zorgakkoorden. Uitgavenbeheersing in de zorg deel 4. [Care agreements. Expenditure control in healthcare part 4.]. 2016. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiusqGklvj4AhWJzqQKHfVAD1kQFnoECBcQAQ&url=https%3A%2F%2Fwww.rekenkamer.nl%2Fbinaries%2Frekenkamer%2Fdocumenten%2Frapporten%2F2016%2F12%2F06%2Fzorgakkoorden%2FRapport%2BZorgakkoorden%2BWR.pdf&usg=AOvVaw3CHV-AOHwBsJZgJF2q_5nY. [14-07-2022].
Ministerie van Volksgezondheid Welzijn en Sport, NVZ, NFU, Patiëntenfederatie Nederland, ZKN, FMS, et al. Addendum 2018 onderhandelaarsakkoord medisch-specialistische zorg 2014 t/m 2017. [Addendum 2018 negotiation agreement specialist medical care 2014 to 2017.]. 2017. Available from: https://www.eerstekamer.nl/overig/20170608/addendum_2018/document. [14-07-2022].
Ministerie van Volksgezondheid Welzijn en Sport, LHV, InEen, Patiëntenfederatie Nederland, ZN. Addendum bestuurlijk akkoord huisartsenzorg en multidisciplinaire zorg 2018. [Addendum administrative agreement general practitioner care and multidisciplinary care 2018.]. 2017. Available from: https://zoek.officielebekendmakingen.nl/blg-809178.pdf.
De minister voor Medische Zorg en Sport, NVZ, NFU, Patiëntenfederatie Nederland, ZKN, FMS, et al. Bestuurlijk akkoord medisch-specialistische zorg 2019 t/m 2022. [Addendum administrative agreement general practitioner care and multidisciplinary care 2018.]. 2018. Available from: https://www.tweedekamer.nl/downloads/document?id=2c527fd9-1dce-4b18-9a8a-d09bc3e3986d&title=Bestuurlijk%20akkoord%20medisch-specialistische%20zorg%202019%20t%2Fm%202022.pdf. [14-07-2022]
De minister voor Medische Zorg en Sport, LHV, InEen, Patiëntenfederatie Nederland, ZN. Bestuurlijk akkoord huisartsenzorg 2019 t/m 2022. [Administrative agreement for general practitioner care 2019 to 2022.]. 2018. Available from: https://www.tweedekamer.nl/downloads/document?id=0e57151d-cc64-4e6c-bd57-44e92002246c&title=Bestuurlijk%20akkoord%20huisartsenzorg%202019-2022.pdf. [14-07-2022].
De staatssecretaris van Volksgezondheid Welzijn en Sport, GGZ NL, MIND, NVvP, LVVP, NIP, et al. Bestuurlijk akkoord geestelijke gezondheidszorg (GGZ) 2019 t/m 2022. [Administrative agreement on mental health care (GGZ) 2019 to 2022.]. 2018. Available from: https://www.tweedekamer.nl/downloads/document?id=443badd8-52f6-4abd-9d13-9b4fd3a78078&title=Bestuurlijk%20akkoord%20geestelijke%20gezondheidszorg%20%28GGZ%29%202019-2022.pdf. [14-07-2022].
Minister van VWS, ActiZ, BTN, Patiëntenfederatie Nederland, VNG, V&VN, et al. Hoofdlijnenakkoord wijkverpleging 2019 t/m 2022. [Outline agreement for district nursing 2019 to 2022.]. 2018. Available from: https://www.tweedekamer.nl/downloads/document?id=642d504d-3197-4813-ad33-08c25fd8fa19&title=Hoofdlijnenakkoord%20wijkverpleging%202019-2022%20.pdf. [14-07-2022].
Peters F, Van der Horst J. Belemmeringen bij het opleiden van verpleegkundig specialisten en physician assistants. [Obstacles in training nurse practitioners and physician assistants.]. Nijmegen: Kenniscentrum Beroepsonderwijs Arbeidsmarkt; 2016. Available from: https://www.rijksoverheid.nl/binaries/rijksoverheid/documenten/rapporten/2016/11/01/tweede-evaluatie-van-de-subsidieregeling-opleiding-tot-advanced-nurse-practitioner-en-opleiding-tot-physician-assistant/tweede-evaluatie-van-de-subsidieregeling-opleiding-tot-advanced-nurse-practitioner-en-opleiding-tot-physician-assistant.pdf. [11-02-2020].
Visser J, Van 't Veer L, Hoendervanger J, Gaspar K, Stadhouders N, Koolman X, et al. Eerste verkenning effecten hoofdlijnenakkoorden. [First exploration of the effects of outline agreements.]. SiRM, Celsus Academie, Talma Institute; 2017 maart, 2017. Available from: https://www.sirm.nl/docs/Publicaties/eerste-verkenning-effecten-hoofdlijnenakkoorden.pdf. [21-7-2022].
Graham S, Dalke K, Jones I. Exploring Physician Assistant (PA) Autonomy and the Relationship between PAs and Supervising Physician(s) in Canada. Capstone Project: a requirement of the University of Manitoba Master of Physician Assistant Studies Program; 2017. Available from: https://mspace.lib.umanitoba.ca/bitstream/handle/1993/32373/graham_sheena.pdf?sequence=1.
Freeborn DK, Hooker RS. Satisfaction of physician assistants and other nonphysician providers in a managed care setting. Public Health Rep. 1995;110(6):714-9.
De Bont A, Van Exel J, Coretti S, Güldem Ökem Z, Janssen M, Lofthus Hope K, et al. Reconfiguring health workforce: a case based comparative study explaining the increasingly diverse professional roles in Europe. BMC Health Services Research. 2016. Available from: https://www.abdn.ac.uk/munros/documents/de_Bont_et_al_.pdf.
Kyum Yang B, Johantgen ME, Alison M, Trinkoff AM, Idzik SR, Wince J, et al. State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review. Medical Care Research and Review. 2020. [21-07-2022].
Xue Y, Kannan V, Greener E, Smith JA, Brasch J, Johnson BA, et al. Full Scope-of-Practice Regulation Is Associated With Higher Supply of Nurse Practitioners in Rural and Primary Care Health Professional Shortage Counties. Journal of Nursing Regulation. 2018;8(4):5-13. Available from: https://www.sciencedirect.com/science/article/pii/S215582561730176X.
Centrale Commissie Mensgebonden Onderzoek. Uw onderzoek: WMO-plichtig of niet? [Your research: subject to WMO or not?]. Available from: https://www.ccmo.nl/onderzoekers/wet-en-regelgeving-voor-medisch-wetenschappelijk-onderzoek/uw-onderzoek-wmo-plichtig-of-niet. [10-11-2022].
Radboudumc. Welk niet-WMO-onderzoek moet worden getoetst? [Which non-WMO research should be tested?]. n.d. Available from: https://www.radboudumc.nl/over-het-radboudumc/kwaliteit-en-veiligheid/kwaliteit-en-veiligheid/toetsen-van-medisch-wetenschappelijk-onderzoek/bij-welke-commissies-kunt-u-terecht/cmo-radboudumc/niet-wmo-onderzoek/welk-niet-wmo-onderzoek-moet-worden-getoetst. [10-11-2022].
We thank everyone who has provided information and contributed ideas about the development of the workforce of PAs and NPs in the Netherlands. Especially, Mr. T. Hoogeveen and the members of the ACMMP PA/NP committee for sharing their expertise. Furthermore, we thank F. van der Velde, MSc. and G. van der Brink, MSc. for their contribution to the surveys.
The data were collected within the research program of the ACMMP. No external funding was received.
Ethics approval and consent to participate
All experiments were performed in accordance with relevant guidelines and regulations. Informed consent was obtained from all subjects/participants. The need for Ethical approval was waived by the ‘Ethics Committee on Human Subject Research Radboudumc (non-Act on medical-scientific research with humans)’ (CMO Radboudumc (niet-WMO)). The study was not eligible for assessment, because there were no indications that: (1) participants would experience the research as too burdensome given their condition or the nature of the research, and (2) the research would generate hitherto unknown data about the (future) health status of a participant or blood relatives [67, 68].
Consent for publication
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Dankers-de Mari, E.J.C.M., van Vught, A.J.A.H., Visee, H.C. et al. The influence of government policies on the nurse practitioner and physician assistant workforce in the Netherlands, 2000–2022: a multimethod approach study. BMC Health Serv Res 23, 580 (2023). https://doi.org/10.1186/s12913-023-09568-4
- Nurse practitioners
- Physician assistants
- Physician associates