Proper use of PAs pays off for Oregon practice
August 1, 1998 4 minutes read
Proper use of PAs pays off for Oregon practice
Each day Curt Hawkinson sees approximately 25 patients, ranging in age from newborns to the elderly. Hawkinson is a physician assistant (PA) and provides a comprehensive range of medical services for The Doctors' Clinic, a group practice in Salem, OR.
He was the first PA hired by the group practice of eight family practitioners, seven internists, and two general surgeons.
"A typical day for me is about 50% to 60% urgent care and same-day appointments, and the other 40% of the time seeing patients that I am the primary care provider for, or doing follow-ups for patients of the family physicians," Hawkinson says. In addition, he fills in for physicians on vacation.
"He helps our practice be both patient-friendly and cost-effective," says his supervising physician, David Edmonds, MD.
Physician assistants are licensed health care professionals who practice medicine with physician supervision. They perform a wide variety of medical and surgical services as delegated to them by their supervising physician. Although they are dependent practitioners, they do exercise a degree of autonomy in the diagnosis and treatment of illness. Over 31,000 physician assistants practice in the United States, covering virtually every specialty from primary care to surgical subspecialties.
Edmonds says his group practice had been toying with the idea of hiring a PA, but was not actively seeking to employ one when they hired Hawkinson. At the time, the practice was seeking a family physician to add to the staff, and one of the candidates was Hawkinson's wife. The practice hired them both.
When Hawkinson began working for the practice in 1996, Edmonds and the other physicians reviewed and signed off on 100% of Hawkinson's dictation. Today, only about 50% of Hawkinson's prepared charts go to the physicians for review.
"He's gained our trust. Curt talks to the physicians when he needs to," Edmonds says. "If I'm not here, he'll run a question by somebody else." An important element of a PA's education, explains Hawkinson, is knowing what you don't know.
One of the prime benefits to the practice of having a PA is that it "allows us to change our scheduling by taking more of the walk-ins," notes Edmonds. "Having Curt has allowed us to open our practice to more patients who don't have to wait to see a physician. This permits us to keep our physician schedules fuller, knowing urgent patients will be seen."
Before Hawkinson was hired, the physician on call would block out part of the day to see urgent care patients, and on occasion had unused appointments. Hawkinson's addition to the staff to handle urgent care patients gave the physicians a more predictable schedule.
Some patients specifically ask for PA
At first, 20% to 30% of the practice's patients had reservations about seeing a PA rather than a physician. "However, after being treated by him, less than 5% still have doubts," says Edmonds. Some patients even specifically ask to be treated by Hawkinson.
Edmonds says the addition of a PA also has made a good bottom-line impact. "Curt has been very good for the practice financially," he says.
Hawkinson's comparatively lower salary makes him an economical provider, and the practice says it has not had any significant problem getting reimbursed for the services he provides. "We've successfully argued to the insurance companies that Curt is doing the same thing a physician would be paid for," notes Edmonds.
A busy PA will see approximately 25 patients a day over a 47-week workyear. If the practice charges $51 per visit, this PA employee could generate $250,000 to $300,000 in charges per year.
According to a 1995 report by the Chicago-based American Medical Association (AMA), "The incentives for employing non-physician practitioners include increases in net income and physician productivity - (for) office visits and visits in all settings, both on a weekly and yearly basis."
For instance, the AMA study found that solo practitioners without a PA were able to handle an average 116.4 patient visits per week, compared to 127.2 visits for solo practices with one or more nonphysician providers on staff. The net annual income for non-PA solo practices was $186,900 vs. $220,000 for solo physicians with at least one PA on staff.
What advice would Edmonds give a practice thinking about hiring a PA? He says the important thing is to find a person who would be the right mix for your office.
Hawkinson said there was one physician in the group practice who was hesitant about adding a PA to the staff. "The doctor was concerned about how well a PA was educated and whether a PA had the skills to meet the needs of the practice." What it took was time and personal review of Hawkinson's work to convince the physician the practice made the right decision, Edmonds says.
Because the effectiveness of a physician assistant is directly related to the relationship with the supervising physician, the AMA adopted guidelines for Physician/Physician Assistant Practices. These guidelines are also endorsed by the American Academy of Physician Assistants in Alexandria, VA. Copies of the guidelines can be obtained by contacting the AAPA Public Affairs office at (703) 836-2272, ext. 3505.
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