Increased Roles for Advanced Practitioners

Combined recruiting searches for NPs and PAs increased by an astounding 320 percent between 2012 and 2014, according to the "2014 Review of Physician and Advanced Practitioner Recruiting Incentives" report, by physician recruiting firm Merritt Hawkins. The report also notes the growing use of team-based care. These trends are not really surprising given the number of developments that are changing the face of healthcare through provisions in the Affordable Care Act.

What that means for small independent practices is an increasing uptick in the use of NPs and PAs. Our 2015 Staff Salary Survey indicates that 63 percent of all respondents utilize at least one NP or PA at their practices.

Really, this is no surprise. Advanced practitioners can bring a number of strengths to the table. According to the American Association of Nurse Practitioners (AANP), "NPs are more than just healthcare providers," they bring a focus on patient education and counseling, care coordination, and wellness promotion that is uniquely different from a physician's approach.

Depending on individual state laws, NPs are able to provide a range of primary- and specialty-care (autonomously or collaboratively) that includes:

• Ordering and interpreting diagnostic tests, such as X-rays and lab work;

• Diagnosing and treating acute and chronic illnesses;

• Prescribing medications; and

• Educating patients on disease management and prevention.

Susan Apold, an adult NP who practices in New Rochelle, N.Y., says she started out at her practice devoting a lot of time to patient education and care management; something that nurses excel at. But over time, those duties expanded to writing prescriptions and managing chronic illnesses, as the physician she works with became more confident of her skills. "There was a learning curve for Dr. Giampietro [the physician I work with], to know what I was capable of doing. And that's fair - he was in practice for 15 years before I came along. So there's an education piece that has to happen," she says.

Liz Yankello, practice manager for Sewickley Valley Pediatric & Adolescent Medicine, says that working with her NPs is a joy; they have a different approach to patient care, and are able to spend more time speaking with patients. "…They just bring that nursing perspective to the visit that really just adds something extra," she says.