Expand Your Multidisciplinary Practice with Physician Extenders
Chiropractors who are interested in cost-effectively expanding their multidisciplinary practice face a difficult choice when it comes to deciding who to hire. While bringing on an additional medical physician or expanding current physician practice hours may seem like the logical choice, non-physician practitioners, also called physician extenders (PEs), can provide a better alternative.
Two Categories of Physician Extenders
Multidisciplinary Practice Team Meeting
There are two categories of PEs: physician assistants (PAs) and nurse practitioners (NPs). While they cannot practice independently of physicians, PAs and NPs can perform almost all of the tasks done by physicians while providing a comparable level of patient care. This can include conducting physical examinations, ordering diagnostic tests and diagnosing and managing conditions such as diabetes and high blood pressure.
The American Association of Medical Colleges (AAMC) estimates that the U.S. will face a physician shortage of over 90,000 physicians by 2020. This figure is expected to reach over 130,000 by 2025. This trend is likely to continue as the number of insured patients increases under the Affordable Care Act. This looming physician shortage will see an increase in the utilization of PEs in all health care practices. Accompanying the physician shortage related increase in demand, the amount of education required to practice has led to the increase in the number of physician extenders. PEs can enter the health care system after only two to three years of professional training, compared to approximately eight years for medical physicians.
A Unique Approach to Patient Care
The primary difference between NPs and PAs is a direct result of the professional education each receives. This also impacts the potential roles that each can play in the multidisciplinary practice. PAs receive training that is similar to that of medical doctors with an approach toward health care that focuses on the study of disease. The nursing-centered model of education for NPs has a more comprehensive approach which focuses on health promotion. This focus on the promotion of health makes the NP an excellent complement to chiropractic and helps the two professions work in a more coordinated manner in the multidisciplinary setting.
NPs can bring a more holistic approach to patient care than PAs, by looking at the patient as a whole, including both their physical and social needs. Their holistic philosophy of care means that NPs make an excellent fit in the chiropractic multidisciplinary practice. This can have a significant impact on patients’ experience. As the healthcare system continues the shift toward a patient-centric model of care, patient satisfaction ratings have become increasingly more important. This will not only affect patient retention and the ability to attract new patients to the practice, it can have a bottom line impact on reimbursement.
While NPs may be the ideal fit for a holistic multidisciplinary practice model, PAs may be a better choice for practices that focus on specialty areas. Pain management, ambulatory surgical procedures, and other subspecialties work well for PAs due to their focused training. Just like when adding any new member to your practice team, it is important to clarify the model in which you will practice and to hire appropriately.
NPs and PAs Offer Cost Savings
One of the greatest benefits of adding a PE to your multidisciplinary team is the considerable financial savings realized in comparison with adding a medical physician or extending physician practice hours. The base salary for a medical physician is more than twice that of mid-level practitioners. In addition, the cost of malpractice insurance for PAs and NPs is significantly lower than that for medical physicians, due to their lower rates of malpractice claims and lower costs per claim. When lawsuits do arise involving PEs, they often involve the failure of the PE to contact their supervising physician. For this reason, it is important to follow the correct steps when integrating a PE into your multidisciplinary practice.
Integrating a PE into Your Practice
PEs should be used to enhance patients’ experience with your practice and the care they receive. PAs or NPs are not a substitute for a medical physician. They are an extension of the physician’s professional expertise. You can avoid potential problems and misunderstandings by letting patients know in advance that they will be seeing a PE who works in conjunction with a physician. Assure patients that the medical doctor is nearby and ready to respond should the need arise. If a patient seems uneasy about being seen by a PE, let them know that you will work to accommodate their request to be seen by a physician.
Be sure that patients know when they are being seen by a physician and when they are being seen by a PE. You can avoid confusion by having name badges that indicate NP or PA. PEs should identify themselves to patients using their respective titles. A difference in uniform (scrubs vs. a white lab coat) between PEs and physicians can also help clarify their different roles.
Both PEs and physicians must recognize and accept the collaborative nature of their relationship, scope of practice and its limitations. An open-door policy is essential to the clear flow of information required in the multidisciplinary setting. Obtain signatures of both the PE and supervising physician to document their understanding of the correct protocols. PEs cannot be apprehensive about disturbing their supervising physician. The PE must always have reliable contact information for the supervising physician and not hesitate to use it. While most PEs are highly reliable team members, supervising physicians should regularly check on their work habits. Asking patients and other practice team members about their experience with the PE can provide important feedback that can permit a course correction before problems arise. With the right management, clearly written protocols and ongoing training and education, a PE can make an excellent addition to your multidisciplinary team.
Dr. Mark Sanna is a member of the Chiropractic Summit, the ACA Governor’s Advisory Board and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching (www.mybreakthrough.com/MDP 1-800-723-8423).
