Dawn Morton-Rias, president and CEO of the National Commission on Certification of Physician Assistants, emphasizes, "Patients have choices; they return to a practice because of relationships. Patients demand not just well-trained professionals, but people they can relate to. That's not to say office staff aren't personable, but patients can Google providers in 10 seconds, and they expect a different level of interaction."

She describes a practice in Maine that expanded from two physicians to eight practitioners, allowing them to remain open seven days a week. "In that practice, the PAs maintain their own panel; they are the patients' provider of choice."

Pushback from other staff is expected, she says, so she recommends the "try before you buy" scenario to bring advanced practitioners on board:

• Bring a student in for a four-week rotation. They'll benefit, too, from close supervision while testing out their skills.

• Offer licensed advanced practitioners small part-time positions, for a few hours a week. This can include double-booking on those days so productivity remains high. Keep an eye out for positive results.

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Adding advanced practitioners to your practice can grow your patient base and still allow for good patient relationships.