Skill mix changes: substitution or service development?

Health Policy. 1998 Aug;45(2):119-32. doi: 10.1016/s0168-8510(98)00038-4.


An extensive review of published studies where doctors were replaced by other health professions demonstrates considerable scope for alterations in skill mix. However, the studies reported are often dated and have design deficiencies. In health services world-wide there is a policy focus which emphasises the substitution of nurses in particular for doctors. However, this substitution may not be real and increased roles for non-physician personnel may result in service development/enhancement rather than labour substitution. Further study of skill mix changes and whether non-physician personnel are being used as substitutes or complements for doctors is required urgently.

Publication types

  • Review

MeSH terms

  • Clinical Competence*
  • Cost-Benefit Analysis
  • Health Policy / economics
  • Health Policy / trends
  • Health Services Research
  • Health Workforce / economics
  • Health Workforce / standards
  • Health Workforce / trends*
  • Humans
  • Nurse Clinicians / standards
  • Nurse Clinicians / statistics & numerical data*
  • Nurse Clinicians / supply & distribution
  • Personnel Staffing and Scheduling / trends
  • Physician Assistants / standards
  • Physician Assistants / statistics & numerical data*
  • Physician Assistants / supply & distribution
  • Physicians / standards
  • Physicians / statistics & numerical data*
  • Physicians / supply & distribution
  • Quality of Health Care / trends
  • United Kingdom
  • United States