Is There a Place for PAs & NPs in Your Practice?

February 12, 2013

Physician assistants (PAs) and nurse practitioners (NPs) are increasingly commonplace in medical practices across the nation. Practices that employ these professionals, known as physician extenders for their ability to reduce pressure on physicians and extend quality patient care, have seen their revenues increase, along with patient satisfaction. As practices adapt to healthcare reform, they should ask themselves, “Is there a place for PAs and NPs in my practice”? Here, MOT helps you answer that question.
1. Are your physicians practicing at their highest and best use?
It’s rare to find a medical practice where the physicians don’t feel overwhelmed, tired and over-extended. The whole idea behind PAs and NPs is to help the physician care to patients.
The use of PAs and NPs frees up physicians time away from routine tasks so that they are able to focus on the needs of patients who require more complex care, says Christopher Hanifin, PA-C, with the department of physician assistants at Seton Hall University in South Orange, N.J. “Additional free time also contributes to an improved quality of life for the supervising physician,” he notes.
Experts point out that one of the biggest challenges that medical practices face today is ensuring that physicians spend their time on their highest and best use. Individual practices need to determine what that highest and best use is, of course, but once it’s been determined, any additional responsibilities should be taken on by support staff, whether it’s clinical or administrative.
To provide a better sense of highest and best use, consider a five-star restaurant: the chef creates the recipes, comes up with the menu and supervises the kitchen. He or she is not chopping opinions or whisking cream.

Extenders appreciate the opportunity to be integrally involved with patient care and can provide valuable assistance in care coordination, Hanifin says, adding that extenders can help physicians ensure that patients with complex needs have all of their medical issues addressed.
(Read MOT’s article “You Are Your Brother’s Keeper: Physician Liability for Allied Health Professionals”)

2. Are your patients waiting?
If your patients are waiting it might be time to consider employing a PA or NP. “Patients quickly get used to seeing a PA and appreciate decreased waits and increased access to care,” Hanifin contends. “Patients who call the office with a healthcare concern do not want to have to wait for an appointment.”
Keep in mind that waiting can occur throughout the appointment process. For example, how long did they have to wait for an appointment date? How long did they have to wait in the reception/waiting area and how long they sit in the exam room before the physician saw them?
There are three easy ways to determine if your patients are waiting. First, take a look at your daily, weekly and monthly schedule. Is it full? Is there any room for urgent appointments or new patients? If not, adding an extender might be worthwhile.
Now, think about your patients once they arrive in your medical office. Are they waiting in the reception area for more than 20 minutes? If so, ask yourself why? Is it simply a matter of scheduling or is there a lack of manpower?
Once your patients are in the exam room, track how long it takes them to see the physician. Each practice will have its own average wait time, and each practice must determine what is acceptable. If you’re patients are exceeding that wait time, you need to figure out why. If it’s not simply a matter of smart time management for the physician, you might want to think about hiring an extender.
While PAs and NPs have become more commonplace, patients still need to be educated about the role they play in a medical practice. “We definitely need to continue to educate patients and our colleagues,” says Angela Golden, president of The American Association of Nurse Practitioners (AANP), which represents the interests of 155,000 NPs around the country. Education is a primary mission for AANP.
(Read MOT’s article "Using PAs and NPs to Boost Productivity")

3. Does your state support the use of physician extenders?
When considering the use PAs and NPs, practices should make sure they understand the legislation in the state they practice. The impact extenders can have on a practice can be heavily influenced by state rules and regulations.
“In many cases, PAs are underutilized,” Hanifin notes. “Physicians are often surprised to discover the scope of services a PA can provide.” In fact, he notes, in many states PAs can perform almost any service that their supervising physician delegates to them.
For practices interested in expanding their ability to provide care through the use of extenders like NPs and PAs, an important part of the mix is ensuring a positive professional experience for these clinicians.
“One of the things that’s pretty important is to recognize the full extent of what they can provide to patients and to acknowledge their education and how much they bring to the patient’s team,” Golden says.
(Read MOT’s article “Do You Have the Right Staff?”)

Demand expands for extenders
More and more medical practices are looking to extenders to help them solve clinical challenges, and the demand for PAs and NPs is growing daily. Healthcare recruiting firms and job boards are experiencing an increase in assignments and job postings.
For example, Tricia Pattee, network product director with HEALTHeCAREERS in Centennial, Colo., says her firm has seen a definite increase in job postings. “For both NPs and PAs we’ve seen consistent growth every quarter for the past eight quarters, with the exception of fourth quarter 2011,” she notes.
Year-over-year increases are significant – 72 percent for NPs and 45 percent for PAs based on the number of jobs posted to these categories. Most of that growth is occurring in family medicine, internal medicine and emergency medicine, Pattee says.
Based on HEALTHeCAREERS’ data, the biggest areas of need for NPs are in Texas, New York, Florida, California and Pennsylvania. For PAs, it’s about the same, with the addition of North Carolina and Massachusetts.
“NPs are already in high demand, and I think that’s only going to increase fairly dramatically as more and more people become insured, Golden says. With anywhere from 32 to 50 million newly insured people entering the market, she can’t think of a specialty that will not be in high demand. 

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