The Association of American Medical Colleges' Center for Workforce Studies reported the United States is in the midst of a perfect storm: an aging physician workforce, millions of baby boomers becoming Medicare-eligible, and millions more younger people becoming insured through the Affordable Care Act. The predicted aftermath is a shortfall of 45,000 primary-care physicians by 2020. The broadcasting of this and related statistics is partly responsible for an increasing buy-in by all stakeholders — including government, healthcare delivery organizations, provider education programs, the payer industry, and the general public — on the utilization of advanced practitioners.
NPs, PAs, and advanced practice registered nurses (APRNs) are hot items in the medical hiring world because of the increasing necessity of their skilled presence in private practice. Many already recognize that bringing these high-quality and cost-effective care providers on board can be a superior alternative to adding a physician.
But not everyone is well-versed in either the field's economic realities or the capacity of advanced practitioners to positively transform a growing practice. How does a private practitioner blend these professionals into a cohesive staff team and rest assured that patients will welcome them as bona fide medical professionals?
Keep communication open
The key, says Jean Hansen, CEO of Kansas City Internal Medicine, a multi-clinic practice, is "communication — upfront and often." Hansen recommends detailing the benefits of an advanced practitioner through a meeting or other communication to staff as soon as the decision is made about a new addition to the patient care team.
Transparency in hiring, whenever possible for a practice, can promote trust in administrative decisions and enrich staff loyalty. An astute practice manager works proactively to avoid any questions like, "What is the new hire bringing to the clinic that we don't already provide?" or to answer the question as soon as it arises. Do not presume existing staff are knowledgeable about advanced practitioner training and abilities, especially if this is the practice's first time to hire one.
Aside from the readily apparent benefit of having a less costly, additional decision maker on board, some staff might be assured to hear advanced practitioners bring legal benefits, as well. Dawn Morton-Rias, president and CEO of the National Commission on Certification of Physician Assistants, explains, "Practices experience greater liability without credentialed, licensed providers on board. In recent years, the legal tolerance level for non-credentialed providers has become very low."
It's also important to remember the needs of the newly hired advanced practitioner in the transition. Observable parts of the onboarding process will communicate messages to everyone involved. With each step, keep in mind the goal of a high-functioning team. Choices that appear unsystematic can appear arbitrary or haphazard. Hansen explains that advanced practitioners are integrated in similar fashion as physicians. "They are a provider who is credentialed with the payers, as well as oriented to our electronic health record, physician protocols, and business practices," she says.
NP Sharon Lockridge's role at a suburban occupational medicine clinic in Texas is strictly clinical, which frees up the physician to accomplish more administrative duties. The team approach also enables a two-pronged staff management process, which includes observation and review of clinical skills plus acculturation and social functioning of individuals. She credits the working environment's family-like atmosphere in part to the communication habits of the physician-administrator.
"He's very customer-oriented and clearly communicates that's our priority," Lockridge says, "and we maintain a policy of 'praise in public, correct in private' for everyone." She describes how a medical assistant (MA) initially felt threatened by the addition of the NP position, "But once the physician explained the difference in our roles, including my greater liability, the MA relaxed into the team again."