Advanced Practitioners Grow Practices, Patient Rapport

The Association of American Medical Colleges' Center for Workforce Studies reported the United States is in the midst of a perfect storm: an aging physician workforce, millions of baby boomers becoming Medicare-eligible, and millions more younger people becoming insured through the Affordable Care Act. The predicted aftermath is a shortfall of 45,000 primary-care physicians by 2020. The broadcasting of this and related statistics is partly responsible for an increasing buy-in by all stakeholders - including government, healthcare delivery organizations, provider education programs, the payer industry, and the general public - on the utilization of advanced practitioners.

NPs, PAs, and advanced practice registered nurses (APRNs) are hot items in the medical hiring world because of the increasing necessity of their skilled presence in private practice. Many already recognize that bringing these high-quality and cost-effective care providers on board can be a superior alternative to adding a physician.

But not everyone is well-versed in either the field's economic realities or the capacity of advanced practitioners to positively transform a growing practice. How does a private practitioner blend these professionals into a cohesive staff team and rest assured that patients will welcome them as bona fide medical professionals?

Keep communication open

The key, says Jean Hansen, CEO of Kansas City Internal Medicine, a multi-clinic practice, is "communication - upfront and often." Hansen recommends detailing the benefits of an advanced practitioner through a meeting or other communication to staff as soon as the decision is made about a new addition to the patient care team.

Transparency in hiring, whenever possible for a practice, can promote trust in administrative decisions and enrich staff loyalty. An astute practice manager works proactively to avoid any questions like, "What is the new hire bringing to the clinic that we don't already provide?" or to answer the question as soon as it arises. Do not presume existing staff are knowledgeable about advanced practitioner training and abilities, especially if this is the practice's first time to hire one.

Educate staff

Aside from the readily apparent benefit of having a less costly, additional decision maker on board, some staff might be assured to hear advanced practitioners bring legal benefits, as well. Dawn Morton-Rias, president and CEO of the National Commission on Certification of Physician Assistants, explains, "Practices experience greater liability without credentialed, licensed providers on board. In recent years, the legal tolerance level for non-credentialed providers has become very low."

It's also important to remember the needs of the newly hired advanced practitioner in the transition. Observable parts of the onboarding process will communicate messages to everyone involved. With each step, keep in mind the goal of a high-functioning team. Choices that appear unsystematic can appear arbitrary or haphazard. Hansen explains that advanced practitioners are integrated in similar fashion as physicians. "They are a provider who is credentialed with the payers, as well as oriented to our electronic health record, physician protocols, and business practices," she says.

NP Sharon Lockridge's role at a suburban occupational medicine clinic in Texas is strictly clinical, which frees up the physician to accomplish more administrative duties. The team approach also enables a two-pronged staff management process, which includes observation and review of clinical skills plus acculturation and social functioning of individuals. She credits the working environment's family-like atmosphere in part to the communication habits of the physician-administrator.

"He's very customer-oriented and clearly communicates that's our priority," Lockridge says, "and we maintain a policy of 'praise in public, correct in private' for everyone." She describes how a medical assistant (MA) initially felt threatened by the addition of the NP position, "But once the physician explained the difference in our roles, including my greater liability, the MA relaxed into the team again."

Educate patients

The next step in successful integration is patient education. Even more than with your staff, make no assumptions that your patients are fully informed about advanced practitioner training, skills, or roles in the clinic.

Practice management consultant Brian White of Tennessee-based Competitive Solutions, LLC, explains, "Proper communication can help prevent patients feeling as if they've been cast off to the ancillary provider. Once patients understand the role of the NP or PA, they will be receptive to the care provided by those individuals."

Be clear about the practice's needs

Before taking time to educate staff or patients, two administrative tasks are crucial to integration success:

• Develop clarity about the roles the advanced practitioner will perform within your practice;

• Decide who will be charged with being the primary point of communication about the new hire.

Morton-Rias has years of experience helping patients and staff fully embrace advanced practitioners. She estimates that in situations where things are not working out, where integration hits a rough patch, unfocused orientation of the new hire can often be blamed. If your staff are unable to clearly grasp their individual roles in the full team, that message comes across loud and clear in many ways, including patient adaptation to changes.

"You need to know the facts, yourself, about the professionals you're bringing on board," Morton-Rias says, "so you can communicate with confidence." This is important particularly in this era of Internet-savvy patients; some will want specific details on advanced practitioner training and licensure requirements.

Clarity of roles is also paramount. "To the extent that staff is comfortable, patients will be accepting. If the physician is under duress, patients pick that up," Morton-Rias says.

Well before recruiting begins, consider the following questions about advanced practitioners' roles:

• Will the advanced practitioner be managing her own panel of patients?

• Will the physician and advanced practitioner work as parallel colleagues?

• Will the physician and advanced practitioner function as collaborating teammates, actively coordinating care together?

Another bonus to onboarding advanced practitioners: You can sample before hiring. Morton-Rias strongly recommends preceptorships, and Lockridge gives high marks to locum tenens providers as ways to try out potential long-term hires.

"It's the perfect way to gauge your practice's capacity to provide support for every person on the team," Lockridge says. "Any signs of dissonance can be valuable learning experiences."

Advantages to hiring advanced practitioners

• Quicker to bring on board: The larger pool of prospects is a bonus for hiring time, even if turnover rate is higher, as some studies suggest.

• Cost-effective: Even as advanced practitioner compensation is on the rise, they are still paid roughly half of a physician's salary. Patients can appreciate that the presence of advanced practitioners may equal lower cost of care.

• Boost practice growth: Adding one advanced practitioner can double patient volume and result in increased revenue.

• Flexible: Comprehensive training of advanced practitioners assures a broad role capacity that can be well-utilized by resourceful practices.

• Patient satisfaction: Studies indicate patients give advanced practitioners higher marks than physicians for interpersonal care such as listening and rapport.

• Practice protection: Credentialed, licensed providers lessen legal risks in general.

Tracy L. Morrisis a freelance writer based in Houston, Texas. She's been a writer and editor for healthcare industry publications and websites, as well as a consulting writer for practices ranging from solo physicians to national corporate networks. She can be reached via editor@physicianspractice.com.

This article originally appeared in the March 2015 issue of Physicians Practice.