Optimize the use of midlevels in your practice

The bringing on of a physician assistant (PA) or nurse practitioner (NP) to help serve your patients' needs should not be a haphazard process. Rather, to achieve the efficiencies you desire and keep your patients and new hire happy, the PA or NP's role must be clearly thought out and defined.

This planning involves finding a careful balance in how much you want the new provider to do. On one hand, delegating too much to midlevels or doing so in the wrong way could lead to legal trouble for the physician and practice. On the other hand, these professionals may get restless if not given the opportunity to practice to the fullest scope of their licenses.

"First and foremost, be familiar with the state laws," Marsha Siegel, a nurse practitioner in Cheyenne, Wyo., and president of the board of the American College of Nurse Practitioners, told American Medical News.

For example, NPs can prescribe in all 50 states, but can prescribe controlled substances in only 47. PAs are generally supervised by a doctor. NPs, however, are more likely to work in collaboration with a physician and can practice independently in 16 states. State penalties for not following the rules can include fines and criminal charges.

Next, consider what specific tasks you need help getting done, as PAs tend to carry out more procedures, while NPs usually spend more time providing evaluation and management.

Finally, in crafting your new provider's job description, provide written answers to questions such as the following:

  • Will the NP or PA be expected to take call?
  • Will the NP or PA have his or her own panel of patients, or will they be shared with the physician?
  • Will the midlevel handle only urgent care, chronic care or both?
  • Will they provide services that are separately billable or those that allow physicians to see more patients and increase collections?

To learn more:
- read the article in American Medical News