Primecare Medical Group hired its first nurse practitioner 20 years ago, at a time when it needed some help but didn’t have quite the patient base for another full-time physician.
Today, four of the practice’s six providers are NPs. Jim King, one of Primecare’s physicians, and the president-elect of the American Academy of Family Physicians (AAFP), says part of the reason is the difficulty of recruiting doctors to rural locations like Selma, Tenn., where the practice is based.
“An NP or PA [physician assistant] can be very helpful when the physician has a full schedule and [patients] have acute-care needs,” agrees Tom Weida, a family physician with Hershey Medical Center’s University Physician Group in Pennsylvania. His 12-provider office has one of each.
Thanks to these so-called nonphysician providers — a term that also applies to nurse-midwives — patients “can get high-quality care and [get faster] access,” says Weida.
While physicians must supervise the work of nonphysician providers, the relationship between them is often more collaborative than authoritative, and although varying state regulations dictate some of the care parameters, you have significant latitude in what you deem an appropriate supervisory level.
The usage of nonphysician providers is growing sharply — one-third over the past five years for family practices and more than 20 percent for nearly all single-specialty groups — according to Medical Group Management Association data. By and large, the results have been positive for both patients and practices.
Might a nonphysician provider satisfy your needs over a full-fledged physician, who will cost more and probably be more difficult to recruit and retain? Are there distinct financial benefits? And, most importantly, will your patients accept a nonphysician as a “real” provider?
Yes, yes, and yes. If you do it right.
So, what do they do?
PA and NP duties overlap to a large extent. “Folks will use them for acute care, chronic care, physicals, well visits,” says Weida. Other possible tasks within the scope of PA and NP responsibilities include ordering and interpreting lab tests, performing hospital rounds, prescribing drugs (except in Indiana; other states mandate certain restrictions), and even taking call. Some PAs also perform minor surgeries or serve as first assist to a surgeon, while many NPs take the lead on patient education. “Our NP is in charge of our patient education committee,” says Weida. “She helps manage the patient education materials on our bulletin boards.”
The exact functions assigned to your NP are largely up to you. “There are many ways an NP or PA can be utilized,” Weida says. “In our clinic, we let them see patients. In other clinics, they see patients, but the doctor follows up with each patient.” Regardless, count on a nonphysician provider to help shift the nature of your workload, allowing you to focus on more complex patient concerns. “We accept them into the team and have them do a full range of services, which is consistent with the [concept of the] personal medical home, which we advocate,” Weida says.
With so much similarity, which is right for your practice? That depends on your exact circumstances. If you perform many minor surgeries, such as mole removal, perhaps you should go with a PA. If you champion preventive healthcare, maybe an NP makes more sense. Or your decision may be purely geographical. “No PAs here,” says King of his rural location.
Will patients accept them?
Most of your patients will welcome a nonphysician provider on your staff, particularly after reaping the main benefit: “They can usually get an appointment sooner,” notes King. “Most of the patients receive the NP quite well, as long as they know she is working with a physician. They’re comfortable knowing the NP can go talk to the doctor for anything.”
In fact, about 10 percent of patients in King’s practice prefer to see the NP exclusively. Then again, about an equal number insist on a doctor under all circumstances. “I do have some patients who refuse to see an NP and want to work with the doctor,” says King “Each person decides on his own comfort level.” For the rest, the decision is a question of problem magnitude: “If they have chest pain, they’ll want to see the doctor. For a cold, they’re comfortable with the nurse practitioner.”
