Worldwide as well as in the Netherlands, the population is aging and complexity of care increases. More qualified professionals are needed, nonetheless relatively few medical students are interested in elderly care. A possible solution is the substitution of medical care from physicians to nurse practitioners (NPs), physicians assistants (PAs) and registered nurses. This thesis shows that, although great variation was seen in organization, physician substitution is possible with maintenance of quality of healthcare and provides opportunities for physicians to fulfill a role as clinical expert for older people with more complex needs. Furthermore it shows that NPs, PAs and nurses all have their own unique added value as they contribute to quality of healthcare, provide person centered care and strengthen the care team. Physician substitution should not be an aim in itself, but it should benefit an optimal skill mix matching the healthcare needs of older people and improving health care services.