Why More Doctors Should Use NPs and PAs -- And Why They Don't From Medscape:
http://www.medscape.com/viewarticle/705120?src=emailthis Robert C. Scroggins, JD, CPA, CHBC Published: 07/09/2009
Introduction Today it's estimated that less than a third of medical practices use
physician extenders. Some physicians don't want to or don't see the
need. However, as our healthcare climate continues to evolve, there
are more reasons than ever why physicians should consider adding nurse
practitioners (NPs) and physician assistants (PAs). 1) Potential changes in healthcare present an opportunity for
physicians. If universal healthcare coverage becomes a reality, more than 40
million people will enter the mainstream healthcare system. There's
also talk of patients having a Medical Home, which would drive even
more healthcare delivery and management to the primary care physicians. To care for the new patients, we would potentially need an additional
10,000 physicians. However, according to the US Department of Health &
Human Services, the increase in the supply of primary care physicians
between 2005 and 2020 is anticipated to be only 18%, on the basis of
anticipated population growth and the aging of our population. However, PA and NP programs combined are delivering over 10,000
providers into the system annually. Realistically, the only practical
solution will be for physician extenders to help satisfy the demand. 2) Competition may require it. Physicians have seen an erosion of patients to minute clinics, other
retail clinics, and physician practices that have extended hours:
Saturdays, evenings, lunch hours, and early mornings. Although open
access and other forms of scheduling can increase your hours, there's
nothing like a physician extender to enable your practice to see more
patients sooner. 3) In a time of declining reimbursement, physician extenders can help
boost revenue. The typical PA brings in revenue of $231,000 with an average salary of
$84,000, according to The MGMA Physician Compensation and Production
Survey: 2008 Report Based on 2007 Data. After covering the cost of his
or her own salary, benefits, and incremental overhead a typical PA can
boost your bottom line by an estimated $30,000 or more. 4) Ancillary services can bring in more revenue, but often you'll need
additional qualified personnel in order to provide some of those
services and still see as many patients. In addition, extenders can
help generate more ancillary revenue because ancillary service volume
is driven by office visit encounters.
Objections Despite the foregoing advantages, many physicians are still reluctant
to add physician extenders. Physicians who I've spoken with have given
these objections. PAs and NPs don't fit with the culture of my practice. This is because you have not incorporated them into your practice, so
of course they are not a part of your current culture. Extender
services need to be thoughtfully added. If you hire on the basis of
intelligence, attitude, and personality, you can maintain your
practice culture without any problem whatsoever. I don't have the space to add another person. Space requirements definitely need to be addressed. Relatively
speaking, space is cheap. You should always err on the side of having
a little extra clinical space so that your production is not hampered.
Loss of production costs a lot more than extra square footage. It may
be time to look at relocation. If you are truly short on space, do not
try to add an extender with the assumption that you will make-do.
Enough space is a necessity. I'm reluctant to invest in the additional overhead; what if I hire
this person and then my volume declines or my income drops? Taking risks is part of being a business owner, and the flip side of
risk is reward. If you go about it correctly and hire the right
extender(s), it will be worth the investment. Talk to colleagues who
are using extenders successfully to find out how it went for them, and
consider bringing in a practice management consultant to help answer
questions about your specific practice infrastructure and how to plan
for the addition of 1 or more extenders -- and keep in mind that every
practice is different. I don't know how I'll divide the current workload; this will change my
whole workflow of the office, and it may become chaos. It may sound obvious, but your NP or PA should handle patient
encounters that do not require the training, knowledge, and experience
of a licensed physician. Remember that you will be there to step in
and/or field questions as needed. You will also want to fill the
extender's schedule before your own. This sounds backward and maybe a
little uncomfortable, but your schedule will fill up. Make sure that
you do not compete with your extender(s) for patients, but instead
ensure that they are as productive as possible. It is true that not every practice needs physician extenders. There
are situations in which these staff members are less valuable: if
you're a few years away from retirement and are winding down; if
you're content with the way your income has been going and have no
desire for changes; if you don't want the additional management and
supervisory responsibilities. Like anyone, you need to enjoy your work and not dread going to the
office, so if the addition of extenders would create more stress and
anxiety for you, it wouldn't make sense to add them. Other physicians who incorporate extenders and learn to delegate the
work that can be done by a nonphysician should experience higher
practice profitability and enjoyment. Put your energy toward figuring
out how to most effectively, efficiently, and profitably position your
practice to sell your product to 40 million new customers. If you have a question that you'd like this column to address, please
send your questions to
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