With a shortage of doctors leading to ever-increasing wait-times for patients, hiring a nurse practitioner or physician’s assistant may be in a medical practice’s best interests.
A recent survey by Merritt Hawkins found that patients wait an average of 22 days — and as many as 104 days — to see a dermatologist. Considering that the Association of American Medical Colleges (AAMC) projects a shortage of 130,600 physicians by 2025, timely access to health care does not appear to be a problem that is going to resolve itself anytime soon.
In order to reduce wait-times and maintain high-quality care for our patients, many dermatologists have taken to hiring nurse practitioners (NPs) or physician assistants (PAs) — collectively referred to as advanced practice providers, or APPs. Despite concerns that patients may be hesitant to trust someone whom they view as “not a real doctor,” a separate study by the AAMC discovered that 60% of patients preferred to see an APP immediately rather than waiting a day or more to see a physician.
Furthermore, patients not only grow increasingly comfortable with APPs after their first experience, but some even report forging stronger relationships with their NP or PA than with their doctor. Research conducted by the American Academy of Nurse Practitioners found that, especially among lower-income patients, NPs routinely outscore physicians in patient satisfaction metrics. A 2011 study indicated that 80% of patients felt their NP “always listened carefully” to their questions and concerns, whereas only 50% felt the same about their physician.
This is by no means meant to suggest that APPs can or should replace doctors, but rather that a well-trained, carefully integrated APP can be an excellent addition to any practice. By providing patient-approved, doctor-supervised care, APPs reduce wait-times, enable more patients to be seen, and often even bolster a practice’s bottom line.
What to Expect From an APP
The beauty of APPs is that they allow doctors to adjust their roles as need be, affording practices substantial flexibility in dealing with emergencies, uneven workloads, and off-peak (night and weekend) appointments.
Depending on state law, there are a number of delegation patterns to consider. In dermatology, doctors typically choose to see new patients themselves while allowing an APP to treat established patients, especially those with less complicated dermatological needs. Within this framework, APPs perform intake histories, staff the physician, assist with surgical procedures, answer questions submitted via online patient portals, and handle routine follow-up care for issues like acne, psoriasis, and warts. A well-trained, properly certified APP is more than capable of managing such tasks, and authorizing them to do so frees up the practice’s dermatologist(s) to attend to patients requiring a higher level of expertise.
In some circumstances, APPs have the opportunity to build their own patient relationships in addition to assisting with their supervising dermatologist’s needs. As of late 2015, 21 states and the District of Columbia had granted NPs full-practice authority, meaning patients can have full and direct access to the entire of scope of services that NPs are educated and trained to deliver. Dermatologists should always be available to provide counseling and oversight to even the most independent of APPs, but providers with decades of experience are more than capable of administering high-quality care without constant supervision.
Of course, every dermatology practice operates differently; but regardless of how duties will ultimately be delegated, most dermatologists have new APPs shadow them for several weeks or even months before granting them full autonomy. And while they may be in charge, dermatologists should work to foster a spirit of collaboration, with the understanding that everyone is working toward the same goals. Board Chairman of the American Academy of Family Physicians Reid Blackwelder reminds doctors that asking for input from APPs is perfectly normal, advising, “I always tell people to keep their minds open. Since we’re all committed to helping patients do better, we each have something to add.”
Understanding the Risks of an APP
As helpful as they as are, dermatologists should not treat an APP as the cure-all for their practice’s workload and scheduling woes. Doctors must draw up strict guidelines outlining the scope of their APP’s authority — particularly with respect to prescription-writing and signing patient records — that adhere to the dictates of both state law and insurer policy. Importantly, the stringency of these two overseers don’t always align, so doctors should never assume that a level of delegation sanctioned by the state is automatically acceptable to their insurer.
And although APPs are sued for malpractice at a lower rate than physicians, doctors should be aware that incorporating APPs into their practice can increase liability risks. Supervising physicians cannot be held directly liable for their APP’s negligence, but they are often named as co-defendants in malpractice suits. Since many physicians own their own practices, according to the Physician Insurers Association of America, settlements that exclude the physician are incredibly rare.
However, pitfalls such as these can be avoided as long as doctors do their due diligence and hire experienced, well-trained APPs. With the right people and a commitment to collaborative care, practices can receive a higher volume of patients by increasing efficiency during conventional hours and offering additional non-peak hours. Nurse practitioners and physician assistants are not only a fiscally shrewd investment, but a medically necessary one as well.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.