One of the silver linings of the COVID-19 pandemic was the way in which it renewed public appreciation for healthcare providers. Among those on the frontlines, a sense of “we’re all in this together” developed, helping to lift spirits when they needed it most.
Of course, it wasn’t only physicians fighting COVID on the frontlines. Nurse practitioners (NPs), and physician assistants (PAs) were called on in new ways. Governors and state legislators passed measures to loosen restrictions placed on these advanced practice providers (APPs). As a result, they were empowered to do everything in their ability to test, diagnose, and treat patients in emergency rooms, COVID units, and ICUs around the country. Now, more are wondering if APPs are underutilized. Could they be a viable solution to the growing physician shortage – or at least fill more of the gaps?
While there’s no doubt that APPs can help to meet patient demand, debate has intensified around the appropriate scope of practice and level of supervision. As vaccine rollout continues and the volume of COVID-19 cases falls, the temporary measures boosting the autonomy of NPs and PAs are beginning to expire. Will this debate impact the demand for advanced practice providers? It’s highly unlikely.
Scope of Practice Debate Carries On
Even pre-COVID, experts pointed to APPs as a key component in minimizing the impact of the physician shortage, one that is expected to reach a deficit of 139,000 doctors by 2033. As the aging population requires increasing healthcare services, APPs are able to offer continuity of care to patients during a temporary physician vacancy. Nurse practitioners and physician assistants are trained to provide many of the same services as physicians, often at a lower cost to the insurer and lower overhead for the practice.
The suggestion that PAs and NPs can replace physicians in certain care settings has long been a point of contention. Representing the concerns of physicians around the country, the American Medical Association has fought scope of practice expansion at the state and federal level for over 30 years and shows no signs of conceding.
Certainly, physicians have more education and training than APPs. However, on the other side of the debate, some say the regulations that prevent APPs from performing the services they have been trained to do unnecessarily limits access to care to the detriment of the population.
Despite the ongoing debate around scope of practice, many physicians are more than happy to share the patient load with NPs and PAs, just as many APPs are content with the status quo on scope of practice and supervision requirements. Patients, too, are happier when APPs are part of a care team. Many patients feel that these providers take more time with them during a visit and are more empathetic than their physicians.
Regardless of where you land on the debate, organizations must ultimately determine the best staffing mix for their particular environment. In most cases, a combination of physicians and APPs will be necessary to provide optimal care for patients.
Considerations When Hiring Advanced Practice Providers
If there is still any doubt, a recent report by MGMA states that practices that utilize APPs continually perform better financially than practices that do not. Even with this data at hand, there are still several things to consider when hiring advanced practice providers:
- How will your physicians feel about the hiring of APPs? Will they embrace the additional help or feel their hiring threatens physician jobs?
- State regulations require APPs to have some level of supervision or collaboration with physicians. Will your physicians view hiring APPs as yet another responsibility added to their plate?
- How will your organization measure the ROI on hiring APPs? While hiring advanced practice providers costs less than hiring physicians, in most cases, APPs are reimbursed at a lower rate. Determine how many patients the provider will need to see in order for hiring them to make financial sense.
- Know the restrictions placed on APPs in your state and understand that the current status may change.
- Engage APPs consistently for long-term retention. These providers need to feel they serve an important role as part of the patient care team and as part of the internal team culture. Including them on your website, encouraging them to lead meetings, invite their feedback on ways to improve operations and patient satisfaction, and provide time off to pursue additional education and CME courses.
While there is much to consider, hiring APPs can potentially give organizations a strategic advantage. The ideal staffing mix will vary by organization, but the addition of NPs and PAs can increase profitability, improve patient satisfaction, and even ease physician burnout caused by lengthy vacancies.
As a trusted recruitment partner, Jackson Physician Search can help you find the talent you need to optimize your staffing mix. Whether you are looking for a physician or advanced practice providers, our recruiters are ready to serve. Contact us today.
7 Things to Know About Advanced Practice Providers
1. Who are Advanced Practice Providers?
Advanced Practice Providers (APPs) include Nurse Practitioners, Physician Assistants and Advanced Practice Registered Nurses (Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and Certified Nurse Midwives). While their salaries are similar, their training is different. NPs are registered nurses who have a master or doctorate degree, while PAs often have a medical training background such as surgical.
2. How Many Advanced Practice Providers Jobs are in the US?
Approximately 125,000 PAs are currently working in the US
Approximately 263,000 NPs are currently working in the US
3. …In the Future?
According to the Bureau of Labor Statistics Occupational Outlook, growth projections for advanced practice providers are much faster than the average for other professions. Projected growth for APRNs over the ten-year period 2019-2029 is 45%. Over the same period, physician assistant jobs are projected to grow by 31%.
4. How Much Do Advanced Practice Providers Jobs Pay?
The Occupational Outlook notes the median pay for Physician Assistants at $115,390 ($55.48 per hour) and for APRNs $117,670 ($56.57 per hour).
5. What Can Advanced Practice Providers Do?
Despite national accreditation, the services an APP is licensed to perform are dictated by state regulations. PAs require some kind of physician supervision in every state, though they do have prescribing privileges and a fair amount of autonomy. Many only consult their supervising physician when the PA deems it necessary.
Nurse Practitioners can practice independently and be reimbursed for services under CMS guidelines. In 22 states, NPs have full practice authority, meaning they have the ability to practice to the full extent of their education and training. This map highlights states with temporary measures in place.
6. How are Advanced Practice Providers Reimbursed?
Services provided by APPs are typically reimbursed by Medicare at 85% of what would be paid for a physician performing the same service. “Incident-to” services may be paid at 100%. Because they bill independently, APPs allow a practice to increase its patient volume and grow revenue.
7. Why are Advanced Practice Providers So Important?
Advanced Practice Providers are essential to meeting the healthcare needs of an aging population and expanding access to healthcare in underserved areas. There are simply not enough physicians coming out of medical school to fill the healthcare needs of society, and while advanced practice providers cannot replace physicians or solve the physician shortage entirely, they can provide many services and free up physicians to focus on more complex conditions.
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