Hiring a Physician Assistant or Nurse Practitioner

In recent years, Chiropractors have been adding MD/DO to their practices and as the practice got busier they consider adding more MD/DO but Adding another physician to your practice can help but adding a physician assistant (PA) or nurse practitioner (NP) may be an even better solution.

A PA or NP can increase your practice’s accessibility, productivity, and revenue while contributing to excellent quality and patient satisfaction. Since NP/PA salaries are typically considerably less than for a physician, the business case for hiring a PA or NP is often easier to make for the practice when compared to bringing in a physician. NPs/PAs are trained to provide a wide range of clinical care which includes the ability to conduct patient evaluations diagnose conditions, develop and implement therapeutic plans, and provide preventive health services and counseling. These health care professionals can also handle many types of office visits, do certain procedures, support hospital and nursing home rounds, take after hours call, and contribute to care coordination/population management initiatives for the entire practice.

Adding a PA/NP or a Physician

Once you have decided to hire an NP or PA (as opposed to a physician), the choice between an NP or a PA may be dictated by the availability of qualified applicants. For others, the practice may have a specific preference. To help in deciding PA or NP, later sections of this article describe the training and typical scope of practice for nurse practitioners and physician assistants.

Chiropractic Physician– NP/PA Teamwork

Just as it would be for adding any new clinician to the practice team, it is important to have open and frank discussions with a prospective NP/PA colleague. It is especially important to discuss the intended role for the NP/PA within the practice to be sure that the expectations of both parties align with the training, skill, knowledge and comfort level of the candidate. Experienced NPs and PAs may have previously managed their own panel of patients within a practice. Some NPs may have operated independently of a physician as is allowed in some states. Physician Assistants and Nurse Practitioners may have subspecialty training and/or unique procedural skills. A good understanding of roles and responsibilities, as well as scope of practice, are critical to ensuring that your practice team and patients benefit as much as possible from adding a PA or NP.

If you decide to hire an NP or PA, educating the entire practice team about the roles and responsibilities of the new team member is critical. Further, the practice needs to develop a communication strategy for patients just as it would do for a new physician. But since some patients will be unfamiliar with NPs and PAs, the marketing and promotions effort should explain how this new clinician fits into the practice and what services he/she can provide.

A letter to your patients telling them of the new provider is one good strategy. Introducing him/her to your existing patients during a visit is another way to ease the transition into your practice – especially if the NP/PA will be seeing patients of other physicians in your practice.

The Hiring Process

One strategy to find qualified candidates is to contact training programs directly. The respective professional organizations have job search resources for employers and candidates. Recruiters can also be a valuable tool in the hiring process by removing many of the administrative tasks involved in hiring a new employee.

Another facet of making sure that your candidate is a good fit for your practice is experience level. You may wish to hire a candidate with substantial experience already; someone who could easily step into your practice and begin work with minimal training. A recent PA or NP program graduate may require more mentoring and may not have as wide a range of skills when first hired, but as they gain experience, their scope will broaden according to the experience the practice provides. Some physicians prefer to hire new graduates and teach them their personal practice style. New graduates also tend to have lower starting salaries.

When interviewing the candidates there are a couple of different things to remember. The first is to develop a specific list of interview questions. This will enable you to discuss ahead of time with your medical and administrative staff that will be involved in the hiring process what are the most important characteristics of a candidate in your search. A standardized list will also allow you to easily compare the responses of one candidate to another. Another interview recommendation is to have key staff members, both administrative and medical, involved in the interview process. While it is important to make sure the candidate’s skills match your needs, it is also important to ensure that the candidate and your staff will work well together.

When you have chosen the successful candidate the next step is to extend an offer to him/her. This can be done much as it would with a new physician, and the contracts your practice already uses for new physicians can be the basis for the contract with your new provider. It is important in the contract, in addition to the issues that would be addressed in a physician’s contract, that you also address the relationship you expect the new provider to have with your staff. Also, the contract and scope of practice must comply with state practice laws and regulations for the type of non-physician provider you are hiring, such as regarding scope of practice and supervision.

Physician Assistants Education

The typical Physician Assistant program is a two-year program that accepts applicants who already have a bachelor’s degree and experience in the health care field. PA programs also include clinical rotations in addition to classroom work. Rotations include internal medicine, family medicine, obstetrics and gynecology, pediatrics, general surgery, emergency medicine, and psychiatry. Physician assistant students complete on average more than 2,000 hours of supervised clinical practice prior to graduation. PAs are not required to do an internship or residency. Their practice specialty is determined by the specialty of the supervising physician(s).

Supervisory Relationship

The physician assistant scope of practice is defined by education and experience, state law, facility policy, and physician delegation. State laws allow physicians broad delegatory authority. This allows for flexible, customized team care. Any service the PA provides should be within their skill set, and within the skills of the supervising physician. A summary of State Laws and Regulations can be found at http://www.aapa.org/PAlaws.

Another important component in hiring a PA will be your supervisory relationship, which does not necessarily require that the supervising physician be physically present in the place where the services are rendered. However, the physician and the PA must be in contact. This contact is meant to ensure the safety of the patients, and to enable the PA to consult with the physician whenever they feel it is necessary. It is important to remember that the physician is ultimately responsible for the care of the patients.

Nurse Practitioners Education

A Nurse Practitioner (NP) is a registered nurse with both advanced clinical experience and an advanced degree. A registered nurse is generally recommended to have extensive clinical experience before applying to a Nurse Practitioner program. These programs either award a post-master’s degree certificate or a master’s degree.

Nurse practitioner practice emphasizes a holistic approach to patient care with particular attention to disease prevention, health promotion and risk reduction. NPs practice in a nursing model. NPs and PAs have similar clinical skills.

Supervisory Relationship

As Registered Nurses, NPs hold independent licenses to practice nursing. Individual state practice acts generally govern the rules and regulations under which NPs practice. Because practice acts are state specific, regulations for NP practice vary considerably from state to state. Thirteen states and the District of Columbia require no formal practice relationship between NPs and physicians. Other states require either a collaborative or supervisory relationship between NPs and physicians. To find out the specific rules in your area contact your state’s Board of Nursing. Contact information can be found at the American Academy of Nurse Practitioners’ website, www.aanp.org or www.acnpweb.org, under regulatory information.

Physicians should draft the guidelines for the physician-NP relationship which meet the needs of their practices.

I hope you found the above information helpful, as always you should contact a qualified healthcare attorney for state specific questions.

If you have questions please feel free to call me at 267-251-5275. We can help you find PA/NP/MD

Brian Torchin