Roles and re­spon­si­bil­i­ties are ex­pand­ing for nurse prac­ti­tion­ers and physi­cian as­sis­tants—but not with­out some re­sis­tance

Modern Healthcare - - Front Page -

Re­ports re­mind providers to tem­per zeal for IT adop­tion with concern for data se­cu­rity

The nation’s health­care sys­tem is said to be fac­ing a physi­cian short­age just as 30 mil­lion unin­sured in­di­vid­u­als are about to en­ter the pa­tient pool and threaten to overload an al­ready stressed sys­tem. The an­swer, say some, is bet­ter and wider use of nurse prac­ti­tion­ers and physi­cian as­sis­tants, some­times called “physi­cian ex­ten­ders” or “mid-lev­els,” who can han­dle rou­tine pro­ce­dures and of­fice vis­its, which would al­low doc­tors more time to see new pa­tients or those with more com­plex con­di­tions.

That’s the the­ory at least, and the phrase in vogue now is to have mid-lev­els “prac­tice to the top of their li­cense.”

In prac­tice, how­ever, the pic­ture is murky, as li­cens­ing re­quire­ments and scope of prac­tice lim­its can vary widely, and “top of their li­cense” can have a dif­fer­ent def­i­ni­tion from state to state and of­fice to of­fice. While the un­der­ly­ing de­sire is to main­tain flex­i­bil­ity, no one ap­pears ea­ger to draw any bright lines.

In such a cli­mate, turf wars are in­evitable. The most pub­lic of these is the fight be­tween pri­ma­rycare doc­tors and the re­tail clinic in­dus­try, whose fa­cil­i­ties are usu­ally staffed by NPs and which re­cently added the man­age­ment of chronic con­di­tions onto their list of ser­vices—much to the cha­grin of the Amer­i­can Academy of Fam­ily Physi­cians. But smaller bat­tles are also likely to break out in some prac­tices where physi­cian com­pen­sa­tion is based on pro­duc­tiv­ity and that pro­duc­tiv­ity gets di­min­ished by a physi­cian as­sis­tant mostly earn­ing a straight salary.

When the Amer­i­can Med­i­cal As­so­ci­a­tion’s House of Del­e­gates meets next month, one of the items be­fore it will be a res­o­lu­tion in­tro­duced by the Med­i­cal So­ci­ety of the State of New York, which notes how the fed­eral gov­ern­ment and

Pri­mary care, in­clud­ing pe­di­atrics and fam­ily care, ac­counts for large por­tions of the ser­vices pro­vided by both physi­cian as­sis­tants and nurse prac­ti­tion­ers.

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