Physician Assistants and Nurse Practitioners - Just What the Doctor Ordered?

If you're a physician, would you like to increase patient access to your practice, as well as improve your bottom line?  Would you like, someday, to take a real vacation?

Consider adding a Nurse Practitioner or Physician Assistant to your practice.  If you're not sure which one might work best for you, an article in Modern Medicine may help.

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In deciding whether you should opt for a PA or an NP, begin by finding out what your third-party payers' reimbursement policies are toward these nonphysician providers. Most insurers—including Medicare and Medicaid—pay for both, but some may be more inclined to pay for services provided by one profession than the other. You need to consider that when making your choice.

Next, check your state laws. NPs' and PAs' ability to prescribe varies from state to state. All NPs and PAs who prescribe controlled substances must register with the DEA, and some need a state controlled-substances license. Be on the lookout for changes in state law, however, because statutes regulating midlevels' scope of practice can change, enabling the nonphysician provider to do more for you and your patients. For example, they might be granted expanded prescribing authority, or the right to order physical therapy, pronounce people dead, sign death certificates, or provide services for homebound and hospice patients.

Supervision requirements vary, too, and you should determine whether your hospitals and nursing homes permit PAs and NPs to round on patients. Nurse practitioners are licensed to work independently in some states, whereas physician assistants, by definition, always work with a physician's supervision. This doesn't mean that you're expected to look over a PA's shoulder or check everything he or she does; few states even require you to be on site. But most insist that you be accessible via telecommunication whenever your PA is seeing patients, and many require you to review the PA's patient records. (You often will need to be on site if you're billing for the midlevel's services "incident-to" your own.

Read more in Modern Medicine:  PAs and NPs: How they boost practice earnings

Comments

In your opinion, which type of training (NP vs PA) best prepares a provider to provide quality medical care?

[Rita Schwab]

Both have extensive training and knowledge, and in many organizations their roles can be quite similar. The education foundation is a bit different since APNs begin by obtaining RN degrees and then continuing on with more advanced nursing education. Physician Assistant training focuses from the beginning on working closely with a physician as an "extender" if you will.

Although state laws and organization practices vary, both APNs and PAs are generally granted a wide latitude of independent judgement and can be enormously helpful in improving patient flow, satisfaction, and access to care.

As for which role is superior, that depends on the needs of the physician and practice. I have received good medical care from both.

If you are considering a career in one field or ther other, more information is available through the AAPA (American Academy of Physician Assistants) or the AANP(American Academy of Nurse Practitioners)

Rita