Physician extenders increase efficiency, improve patient care
Practices turning to midlevel providers to boost bottom lines
Do the physicians in your practice feel under constant stress to work harder and harder? Are your patients spending long hours in your waiting room because the appointment schedule is so far behind? Do patients often have to wait weeks for an appointment? Are you able to spend adequate time with each patient you see? Does your practice provide the kind of patient education you would like to provide? Are you seeing more and more patients but making less money?
If the answer to any of these questions is "yes," your practice could benefit from hiring physician assistants or nurse practitioners, experts say. Physician assistants and nurse practitioners allow physicians to improve their delivery system and make sure all patients can schedule an appointment within a reasonable amount of time.
As reimbursement declines, physicians have to see more and more patients to maintain a viable practice, says Darrell Schryver, DPA, principal with the Healthcare Consulting Group of the Medical Group Management Association (MGMA) in Englewood, CO. As a result, access to physicians has become a real problem, particularly in primary care settings for internal medicine, pediatrics, and family practice. As waiting times have increased, many practices are turning to midlevel providers to fill in the gaps.
"Scheduling and customer service are critical to today’s practices. That’s why physician assistants and nurse practitioners are so important," says William J. DeMarco, president of DeMarco & Associates, a consulting firm in Rockford, IL. "They allow physicians to see the more challenging and critically ill patients themselves while still maintaining control over the care of all patients."
An MGMA survey conducted for the annual report Performance and Practices of Successful Medical Groups finds that better-performing practices make extensive use of physician assistants and nurse practitioners, Schryver asserts. These extenders help boost a practice’s efficiency and still provide quality care, he says. For instance, if a potential new patient for a pediatric practice has to wait eight weeks for a well-baby check-up, the patient is likely to go somewhere else, even if your practice is highly recommended, Schryver points out.
As an alternative to losing patients, a group could hire two pediatric physician assistants to do the initial screening and get patients established. That way, your group wouldn’t lose the new patients. "We have found that practices that use physician assistants and nurse practitioners have generally become much more efficient. I am a strong supporter of the physician assistant role if it is well-structured and well-managed, with appropriate accountability and reviews," Schryver says. A midlevel provider is typically about half the cost of a primary care physician.
"Financially, hiring nurse practitioners was a great decision. It has allowed us to double the number of patients we can see," says Anne Meden-Cutler, administrator of Bristol Street Pediatrics in Elkhart, IN. The nurse practitioners at Bristol Street Pediatrics see patients with simple illnesses, handle many well-child visits, and allow the doctors to see the really sick children. "Doctors can stretch themselves only so far. Without nurse practitioners, we’d be in trouble during the flu season," Cutler says.
Nurse practitioners are popular with patients, too. Two of the questions on the practice’s yearly patient satisfaction survey ask whether patients are willing to see nurse practitioners and if they feel like nurse practitioners provide quality medical care. "In 10 years, we’ve never had anyone who says they prefer not to see them. They like them and they’re used to them," Cutler says.
At East Albany (GA) Medical Center, physician assistants allow the practice to guarantee that patients can be seen within 24 hours, says Ron Malcolm, PA-C. "It works out very smoothly. We are an extension of the physicians. They are able to triage more and take care of the patients who really need it," Malcolm says.
A physician assistant program typically is 111 weeks, compared to 155 weeks for medical school, according to the American Academy of Physician Assistants in Alexandria, VA. The program includes a combination of classroom and laboratory instruction, followed by clinical rotations in internal medicine, family medicine, surgery, obstetrics and gynecology, emergency medicine, and geriatric medicine. Nurse practitioners are registered nurses, usually with extensive experience, who go through additional master’s-level training.
Nurse practitioners initially were used in underserved rural and low income areas when the profession was first created in the 1960s, says Eric Scharf, CAE, executive director of the American College of Nurse Practitioners in Washington, DC. "We are seeing a broader acceptance of nurse practitioners in the mainstream medical community in a variety of settings," Scharf says.
The Bureau of Nursing at the U.S. Department of Health and Human Services estimates that there are about 80,000 nurse practitioners in this country, up from about 70,000 four years ago. According to the Bureau of Labor Statistics, there were about 34,200 certified physician assistants in clinical practice in 1999. The bureau estimates that the number of physician assistants in the U.S. will grow by 48% by 2008.
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