Expand your multidisciplinary practice with physician extenders.
Chiropractors interested in cost-effectively expanding their multidisciplinary practice face a difficult hiring decision. While bringing on an additional medical doctor or expanding current physician practice hours may seem like the logical choice, nonphysician practitioners, also called physician extenders (PEs), can provide a sound alternative.
There are two categories of PEs: physician assistants (PAs) and nurse practitioners (NPs). While they cannot practice independently, PAs and NPs can perform almost all the same tasks as 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 estimates that the U.S. will face a physician shortage of more than 90,000 by 2020. This figure is expected to reach over 130,000 by 2025. The trend is likely to continue as the number of insured patients increases under the Affordable Care Act. The looming shortage will call for an increase in PEs serving healthcare practices.
In addition, the level of education required to practice has led to an increase in the number of PEs, who can enter the healthcare system after only two to three years of professional training, compared to the approximately eight years required for medical doctors.
Approaches to patient care
The primary differences between NPs and PAs reflect the professional education each receives, which impacts their responsibilities in a multidisciplinary practice.
PAs receive training similar to that of medical doctors with an approach to healthcare that focuses on the study of disease. The nursing-centered model of education for NPs entails a more comprehensive approach that emphasizes health promotion. This focus makes the NP an excellent complement to chiropractic and helps the two professions coordinate in a multi- disciplinary setting.
NPs can bring a more holistic vision to patient care than PAs by addressing patients’ physical and social needs.
This philosophy of care allows NPs to fit naturally into the chiropractic multi- disciplinary practice and make a significant contribution to the patient experience.
As the healthcare system continues to shift toward a patient-centric model of care, satisfaction ratings have become increasingly important. Such metrics not only affect patient retention and the ability to attract new patients but may also have a bottom-line impact on reimbursement.
While NPs might be a more 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. In adding any new member to your practice team, clarify your practice model and hire appropriately.
One of the greatest benefits of adding a PE to your multidisciplinary team is the considerable financial savings compared to bringing on a medical physician or extending physician practice hours. The base salary for a medical physician is more than twice that of mid-level chiropractors. In addition, the cost for 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 PE lawsuits do arise, they often involve the failure of the PE to contact his or her supervising physician. This can be avoided by following the proper steps when integrating a PE into your multidisciplinary practice.
Putting it all together
PEs should 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 a 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, let him or her know that you will work to make necessary accommodations.
Ensure patients can discern whether they are being seen by a physician or PE by having name badges with NP or PA labels. PEs should identify them- selves using their respective titles. A difference in uniform (scrubs versus a white lab coat) can also help with clarification.
Both PEs and physicians must recognize the collaborative nature of their relationship, their scope of practice, and any limitations applying to their activities. An open-door policy is essential to the clear flow of information required in a multidisciplinary setting.
Obtain the 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 and must always have reliable contact information. Although 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 a PE can provide important feed- back and prompt a course correction before problems arise. With the right management, clearly written protocols, and ongoing training and education, a PE can be a strong addition to your multidisciplinary team.
Mark Sanna, DC, ACRB Level II, FICC, 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. He can be reached at 800-723-8423 or through mybreakthrough.com.