My Practice's Next Hire: Nurse Practitioner or Physician?

I am beside myself. Just about a year ago, I hired a nurse practitioner (NP) to work in our office on a part-time basis. It was great for me financially. I didn’t have to worry about paying her benefits and, as she was being paid hourly, I didn’t have to worry about filling her schedule too quickly. I was hoping that over time, as she got busier, that she would transition to full time. Well, she will - just not here. She was offered a better opportunity elsewhere, and while she will still be working here one day a week (instead of two), I am going to have to look for someone to work full time.

The dilemma is: Hire another NP or another physician?

Here was my vision for the NP's role. She or he would see some of our follow-up patients. She would help with lab results, phone calls, and patient education. The patients would still “belong” to their respective doctors. I hope the NPs reading do not take this the wrong way, because I really do value their role in our patient’s care, but when a patient is referred to a specialist, I think it is important that the physician still be the principal healthcare provider. I have had patients who were concerned that I was “giving them up” or even leaving altogether when I told them that their next appointment was with the nurse practitioner. It reassured them when I told them that we would alternate visits between the NP and me. Having the NP see follow-up patients leaves me some room to see some new patients.

Having said that, we get calls for new patient appointments every day, and patients are upset that there is a wait. And again, when patients are referred to us by their primary-care physician, I feel obliged to have a physician see the patient and not an NP. It’s hard enough to get them to see my associate who has been here for over two years! And it’s not that they don’t like her (they haven’t even met her yet), they want the senior person, i.e., me.

This brings me to option number two:  a new associate. A new associate could see a lot of new patients, but only if patients are willing to see him or her. And some patients want to get their foot in the door by seeing “the other doctor” and then want to follow up with me, but I barely have time to see my follow-up patients, how can I squeeze in somebody else’s? And I’m not sure how I feel about having the new doc see my follow-ups for me. We have had an office policy of not sharing or swapping patients, primarily to avoid the situation I just described, and I am having a hard time justifying to myself doing the reciprocal.

So I need help, but have yet to decide what direction to go in. And I haven’t taken into account yet the financial side of the issue.