There is no doubt a crisis-level shortage of primary and specialty care physicians is developing. Research by the Association of American Medical Colleges (AAMC) projects a shortage of 17,800 to 48,000 primary care physicians and 21,000 to 77,100 non-primary care specialty physicians by the year 2034. One solution to combat this developing issue is to integrate Advanced Practitioners (APs) into your medical practice to increase the ability to provide quality healthcare services to more patients.
Types of Advanced Practitioners
Several positions fall within the Advanced Practitioner category, including Physician Assistants and Clinical Nurse Specialists. The Physician Assistant (PA) and Nurse Practitioner (NP) are in the highest demand because they can provide so many different types of healthcare services.
- Physician Assistants (PA) – PAs are medical professionals who deliver a wide range of services, including examining patients and diagnosing certain illnesses and injuries; ordering and interpreting diagnostic tests; prescribing medications; giving treatments like immunizations; maintaining patient progress records; providing patient counseling; and assisting with chronic care management.
- Nurse Practitioners (NPs) or Advanced Practice Registered Nurse (APRN) – APRNs are trained to assess patients; diagnose certain conditions; order and interpret medical tests; prescribe medications; and collaborate with medical team members. They also play an important role in triaging patients to maximize efficient use of the physician’s time.
Proven Importance of Advanced Practitioners to Medical Practices
As of May 2020, the Bureau of Labor Statistics (BLS) estimated there were over 125,000 PAs employed nationally and over half (54 percent) worked in physician offices. There were over 211,000 NPs employed nationally and 48 percent worked in physician offices. Other common employment locations for Advanced Practice Providers include hospitals and offices of non-primary care practitioners, like therapists.
The PAs and APRNs are essential to delivering quality healthcare in Connecticut. Per the Department of Labor occupational statistics, there were 2,310 Physician Assistants employed in Connecticut as of May 2020. A PA is certified by the National Commission on Certification of Physician Assistants (NCCPA) after undergoing intensive training.
According to the Connecticut Nurse Practice Act, the Nurse Practitioner is recognized as a primary care provider in the State of Connecticut. State health care services were relying on 2,630 Nurse Practitioners at last BLS count. The APRN is fully accredited by a national certification organization, like the American Academy of Nurse Practitioners.
The above statistics demonstrate several important facts about Advanced Practitioners (APs).
- APs can play a large role in closing the gap in the delivery of healthcare services to people across the health services spectrum.
- APs can provide vital preventive healthcare services to patients, leaving physicians to assess, diagnose and treat the more complex medical conditions.
- APs are essential to meeting the healthcare needs of an aging Connecticut population. The Connecticut Commission of Women, Children and Seniors says Connecticut is the 7th oldest state in the nation. As of 2020, the large majority of state counties already have populations that consist of 17-20 percent or more of people aged 65 or older. From 2010-2040, the population growth of people aged 65 or older is projected to be 56.69 percent. The demand for access to healthcare services will grow proportionally.
- APs can increase medical practice revenues.
How To Integrate Advanced Practitioners Into Your Existing Medical Practice
Since the passage of the 2018 Connecticut Public Act No. 18-168, there is no restriction on the number of PAs that can collaborate with a physician. There is also no restriction on the number of APRNs or other types of Advanced Practitioners.
Here are basic guidelines as to how to smoothly integrate Advanced Practitioners into your practice.
#1: Identify the Advanced Practitioners Needed to Fill Service Gaps
Each medical practice is unique in terms of the service gaps to narrow. Identifying those gaps drives the type and number of Advanced Practice Providers. As mentioned earlier, Physician Assistants and Nurse Practitioners perform a wide range of duties. For example, at Physicians Alliance of Connecticut, they can practice in dermatology, internal medicine, family medicine, geriatrics, surgery, nephrology and gastroenterology plus other areas.
#2: Define the Relationship Between the AP and the Physician and Coworkers
When Connecticut passed the 2018 law eliminating the restriction on the number of PAs, a keyword change was “supervision” to “collaboration.” The physician needs to clearly define the collaborative relationship of each Advanced Practitioner to the physician, the amount of direction the physician will provide and the relationship to other staff members.
A survey of APs integrated into a California academic medical center was conducted to identify how relationships and workflows could improve. As reported in the Journal of Interprofessional Education & Practice, 25 percent of responding APs said they were dissatisfied with their current role in terms of full utilization; 34 percent said the physician saw the same patients over 50 percent of the time and 48 percent said physician and coworkers’ support prevented them from practicing their full scope of duties. These AP concerns are easily addressed with good procedural planning and communication, including training coworkers on the AP’s responsibilities.
Closely related to defining the relationship of the AP to other medical professionals is defining the specific responsibilities of the AP. There should be no confusion as to required duties. Clearly defining job responsibilities is key to the retention of the medical professional.
#3: Design Medical Office/Facility Processes to Include APs
When adding one or more Physician Assistants and/or Advanced Practice RNs, work and patient flows will change. You will need to redesign the care processes to direct patients to the appropriate AP. Policies and procedures should maximize utilization of the Advanced Practice Provider which, in turn, maximizes efficiency, expands patient access and care and increases revenues.
#4: Orient the AP to the Medical Practice
Every medical practice has a practice style, policies and procedures, performance expectations and patient interface expectations. Orienting the Advanced Practice Provider helps the person adapt to the new environment as quickly as possible and minimizes the chances of misunderstandings occurring. Everything from computerized medical and charging systems utilization to recommended specialists for patient referrals needs addressing.
#5: Build the AP’s Scope of Practice into the Coding and Billing System
The APs will need to coordinate their services with other medical team providers for charging purposes. The medical practice should ensure a system is in place to accurately code AP services for correct billing and insurance reimbursements. There is a risk of duplication of charges or undercharging unless there is coordination.
PACT, a Partner of Hartford HealthCare, Relies on Advanced Practice Providers
Advanced Practice Providers play an important role in ensuring PACT multi-specialty providers can provide quality healthcare services to patients. If you are an Advanced Practitioner and want to share in the PACT vision of delivering patient-centered and innovative healthcare, apply to one of our open jobs today.
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