What Can a PA or NP Do for Your Practice?


If your workload is no longer sustainable, it may be time to consider adding a certified physician assistant or nurse practitioner to your practice.

Fam Pract Manag. 2017 Mar-Apr;24(2):19-22.

Author disclosures: no relevant financial affiliations disclosed.

As the health care system undergoes tremendous change and the primary care physician shortage continues, family physicians are repeatedly being asked to see more patients in less time while providing greater care coordination than ever before. It is therefore not surprising that family physician burnout is on the rise. According to a 2015 Medscape report,1 more than 50 percent of family doctors across all age categories reported symptoms of burnout, making them more likely to abandon the profession or retire early.

One of the reasons for burnout strikes at the very core of the specialty: Family physicians care for everyone and take care of everything. Unfortunately, this “do everything” mantra can be self-destructive when there aren't enough family physicians to go around. Increasingly, resource limitations make it difficult to provide the best possible care for patients.

With the weight of ever-expanding practice demands placed squarely on physicians' shoulders, they need competent, motivated, and passionate colleagues to share the workload. Certified physician assistants (PAs) and nurse practitioners (NPs) can be a cost-effective way to meet this need.

PA and NP abilities, background, and qualifications

Before physicians can empower PAs and NPs to practice to the full extent of their licenses, physicians need to understand what abilities PAs and NPs have, their background, and their qualifications.

Services. In many clinical settings, PAs and NPs perform comparable services – preventive care, care coordination, prescription writing, chronic disease management, etc. They can also help practices address many bureaucratic and regulatory challenges, such as capturing data for quality-based payment programs. Individual interests and experience play a role in the services PAs and NPs perform, as does physician willingness to delegate responsibilities. Allowed services can also vary based on state laws, third-party payer regulations, hospital bylaws, and other factors. Prescription authority, and whether it extends to controlled substances, is one area that varies by location, so check your state's regulations for PAs and regulations for NPs.

Autonomy. One of the main distinctions between PAs and NPs is their relationship with physicians. PAs are licensed by state medical boards and always work as members of physician-led teams. In fact, the PA profession was founded by physicians, based on the principles of team-based care. Although PAs work autonomously, without requiring the on-site presence of a physician, they always work in collaboration with a supervising physician.

Most NPs also work in collaboration with a supervising physician who may or may not be on-site; however, 21 states and the District of Columbia allow NPs to work independently

About the Authors

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Dr. Kaprielian is professor and associate dean for faculty development and medical education at the Campbell University School of Osteopathic Medicine in Buies Creek, N.C. She has more than 30 years of experience working with PAs and NPs and served as 2015 board chair for the National Commission on Certification of Physician Assistants (NCCPA)....

Dr. Kase is the emergency department director at Togus VA Medical Center in Augusta, Maine, and a clinical instructor at the University of New England College of Osteopathic Medicine in Biddeford, Maine. He has worked with or supervised PAs and NPs for two decades. He is a member of the NCCPA board of directors and past president of the Maine Osteopathic Association.

Tammy Higgins is an advanced practice registered nurse (APRN) with 30 years of clinical experience in primary care, college health, hospital medicine, education, and cardiology. She is currently a cardiac specialist for Western Connecticut Health Network in Danbury, Conn. She is also president-elect for the associate medical staff at Danbury Hospital.

Author disclosures: no relevant financial affiliations disclosed.



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1. Phillips D. Burnout rates soar among family physicians. Medscape Medical News. Jan. 28, 2015. http://www.medscape.com/viewarticle/838878. Accessed Sept. 30, 2016....

2. State practice environment. American Association of Nurse Practitioners. https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment. Accessed Sept. 30, 2016.

3. NP vs. PA. Nurse Practitioner Schools website. http://www.nursepractitionerschools.com/faq/np-vs-physician-assistant. Accessed Sept. 30, 2016.

4. Shafer S. Online nurse practitioner degrees. Best Nursing Degree website. http://www.bestnursingdegree.com/programs/online-nurse-practitioner. Accessed Sept. 30, 2016.

5. About CME requirements. National Commission on Certification of Physician Assistants website. http://www.nccpa.net/ContinuingMedicalEducation. Accessed Sept. 30, 2016.

6. American Nurses Credentialing Center. 2016 Certification Renewal Requirements. http://www.nursecredentialing.org/RenewalRequirements.aspx. Accessed Sept. 30, 2016.

7. NP fact sheet. American Association of Nurse Practitioners website. https://www.aanp.org/all-about-nps/np-fact-sheet. Accessed Sept. 30, 2016.

8. 2015 Statistical Profile of Certified Physician Assistants. Johns Creek, GA: National Commission on Certification of Physician Assistants; 2016. http://www.nccpa.net/Uploads/docs/2015StatisticalProfileofCertifiedPhysicianAssistants.pdf. Accessed Sept. 30, 2016.

9. 2015 Nurse Practitioner Salary Survey. Advance Healthcare Network for NPs and PAs. http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/NP-Salaries-Continue-to-Inch-Upward.aspx. Accessed Sept. 30, 2016.

10. Nurse practitioner vs. physician assistant salaries by state. MidlevelU website. June 1, 2016. http://midlevelu.com/blog/nurse-practitioner-vs-physician-assistant-salaries-state. Accessed Nov. 16, 2016.


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