Identifying ways to improve the health pathway of a child with a musculoskeletal problem: A comparison of practice of midlevel providers in the United States of America (USA) and the United Kingdom (UK)

In the USA midlevel providers (nurse practitioners (NP’s) and physician assistants (PA’s) are being increasingly used to counteract the deficit in trainee paediatric orthopaedic doctors. The NP’s/PA’s assist in maintaining an efficient and quality service, reviewing outpatient and inpatients, working either alongside a physician or independently. NP’s have been in training in the USA since the late 1960’s and more recently as a recognised profession are a mainstay of service delivery. Hence there is an accumulated wealth of expertise to be drawn on.A travel award enabled me to visit leading centres of paediatric orthopaedic excellence in North America to compare practice with midlevel providers. The focus was to identify areas of potential role development or expansion to improve or adapt service delivery for paediatric orthopaedic patients.Analysis of the findings identified areas of good practice, similarities and differences. Where possible, comparisons with the UK are made with recommendations for the future care of children with a musculoskeletal problem.Overall the experience gave me the opportunity to consider areas within my institution that may benefit from change but moreover it has confirmed to me the efficacy of my own role.