Internists are pressured to see more patients while still providing top-quality care, so it may be time to expand practice capacity. Adding another physician is certainly one option, but adding a physician assistant (PA) or nurse practitioner (NP) as a collaborative member of the practice team may be an economical and patient-friendly solution. Given how difficult it can be in some areas and situations to recruit an internist, it may also be more practical to hire a nonphysician provider.
A PA or NP can increase accessibility, productivity and revenue while contributing to excellent quality and patient satisfaction. With NP/PA salaries roughly half that of a physician, there is a strong business case for hiring either.
NPs/PAs are trained to provide a wide range of clinical care, which includes conducting interviews and performing physical evaluations, diagnosing conditions (including ordering laboratory tests and interpreting results), developing and implementing therapeutic plans, and providing preventive health services and counseling. While they may not be able to handle the same intensity and complexity as a physician, these health care professionals can handle many types of office visits, do certain procedures, support hospital and nursing home rounds, take after-hours call, and contribute to care coordination/population management initiatives for the entire practice.
The practice may have a preference of PA or NP, or the choice may be determined by the availability of qualified applicants. Because the training and typical scope of practice for NPs and PAs differ, it is important to examine what the practice needs the new provider to do. Does the practice need someone who can provide education and preventive services? Does it need help providing procedures, making rounds or taking call? Are there any limitations based on state regulations?
While both types of providers have similar clinical skills, there are some differences in supervision, billing, and prescriptive authority that will need to be considered when deciding which to hire. A good understanding of roles and responsibilities, as well as scope of practice, are critical to ensuring that the practice team and patients benefit as much as possible from adding a PA or NP. How those roles are communicated to the staff and to the patients will go a long way to making the new provider successful.
For more details about the training, supervision and scope of practice of NPs and PAs, as well as billing for their services, see the newly revised Center for Practice Improvement and Innovation's “Hiring a Nurse Practitioner or Physician Assistant. “ ACP has a policy paper that goes into greater depth regarding NPs' training, relationship with physicians and scope of practice. A similar policy paper on PAs will be published soon.