Staging your Practice for Success – Incorporating PAs and NPs into Clinical Care Teams

Written by on July 31, 2012 in Practice tips - No comments


Lisa P. Shock, MHS, PA-C

In this time of health care reform, medical practices and health systems must find ways to provide high quality health care services while remaining cost effective. The health care

system is facing a shortage of primary care clinicians. This is critical when looking at health reform and examining the concept of increasing numbers of patients seeking access to medical care under a reformed system. Currently, there is a shortage of primary care physicians and the American Academy of Family Physicians predicts that, if current trends continue, the shortage of primary care physicians will reach 40,000 within 10 years.  Utilization of PAs and NPs may be part of the solution.  Studies suggest that the addition of a PA or NP to a medical practice may offer enhanced patient satisfaction, improved physician work-life balance, improved revenues and greater access to care for patients.

PAs and NPs are found in every medical specialty and in every health care setting.  When you incorporate a midlevel practitioner into your team and utilize them effectively, your practice will accommodate more patients. In addition, you will reduce patient waiting time, increase patient satisfaction levels, and improve overall practice efficiency. All of this adds up to more potential revenue for your practice.

Medical board rules vary slightly from state to state, but for the most part, PAs and NPs can perform many tasks traditionally reserved for physicians. These services often include:

  • Physical exams
  • Patient histories
  • Health screenings and preventive care
  • Assisting with surgeries, ER, and long-term care
  • Issuing prescription orders
  • Chronic disease management
  • And much more…

Consider these statistics:

■The typical PA brings in revenue of $231,000 with an average salary of $84,000

■An average PA or NP can boost a practice’s bottom line by $30,000 or more

■Training costs for PAs are one-fifth of an allopathic physician

By hiring a PA or NP, your practice will be more efficient.  This will result in improved access to high quality health care and improved patient satisfaction.

Utilization of PAs  and NPs is common across all medical specialties. Changes in medical resident workforce requirements as well as changing third party payor reimbursement models have encouraged the exploration of new ways of achieving high quality patient care across all specialties. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted limitations on total hours worked by residents in both inpatient and outpatient settings.  This mandate to limit work by training residents has created a need to fill patient care hours. PAs have no such work restrictions and since they are an affordable alternative, have been utilized in greater numbers, especially in the inpatient setting.

Traditionally physician-centered subspecialties, such as radiation oncology have recently increased utilization of non-physician providers. Studies have examined the implementation and development of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA), and have emphasized that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, their role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. Providing these valued services facilitates the physician’s ability to focus on the technical aspects of prescribing radiotherapy, thereby promoting quality patient care and increasing utilization and cost-effectiveness.

Real practices, Real Data  – A Proven Success Case Study

Utilization Solutions in Healthcare, Inc. (USH) staffed and implemented a midlevel provider into a single physician surgical subspecialty practice in 2010.  This resulted in increased patient access to care, improved efficiency, and, surprisingly, practice sustainability when the physician faced a personal crisis and was forced to limit his work hours over several month’s time in 2011.  The $2.1 million in annual practice charges was sustained when the midlevel provider effectively absorbed the practice workflow.  This led to an averted loss of tens of thousands of dollars for the organization and, now that the physician is back to full scheduling capacity, opens up several new opportunities for patient outreach and practice growth.  Analysis of practice revenues also revealed a greater than $50,000 profit generated by utilizing the midlevel within the same time frame.

Click here to download your complimentary copy of the case study.

About the author:

Lisa P. Shock, MHS, PA-C, is a seasoned PA who has practiced in primary care and geriatrics since her days at the Duke PA program in the late 90s. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs in the health care system.  Contact her with questions at


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