Inbox: Can Overworked Physicians Really Benefit from NPs, PAs?

Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month we are excerpting a slideshow regarding physicians’ dedication to practicing medicine and a podcast on patient empathy. The articles have been edited for space and are followed by comments made by readers at PhysiciansPractice.com.

Can NPs and PAs Help or Harm Burned Out Physicians?

Some practitioners see significant potential for PAs and NPs to reduce the burnout problem. Others, however, are not convinced.

In an informal February survey on SERMO, the social network for physicians, respondents were asked if they believed the use of PAs and/or NPs can help in reducing or avoiding physician burnout. Fifty-three percent indicated that they do help alleviate work load pressures, while 25 percent said that they create more work and confusion. Thirty-one percent of respondents reported having had issues supervising PAs and NPs in their practice. Some 28 percent indicated that their use raised questions of who has authority in the practice, and 13 percent reported an increase in feeling territorial about their work.  At the same time, 27 percent reported that the use of PAs and NPs had a positive impact on their practice.

Ronald says: "Good PAs and NPs can be tremendous assets. However, if poorly trained, they are nightmares. As medical director at a small [primary care] clinic, we have hired 10 midlevel providers over time. There is oversight needed and reimbursement is less for the same services rendered my MDs and DOs. Make sure the chemistry is right, and be aware that the hiring [of NPs and PAs] comes with added responsibilities. The added supervisory duties can go beyond care delivery and quality measures to time consuming HR issues and the like."

Danziger replies: "This website seems to be supported by NP and PA organizations to convince readers that they are as good as physicians. I have heard of doctors who employ them say that they would be happy for them or their loved ones to be cared for by them. Why, then, do I take care of NPs and PAs when they are sick? They go to physicians, not to each other when they become ill. During these visits, [NPs and PAs] invariably try to diagnose and treat themselves, often invoking irrelevant information and will sometimes argue their point when it is uninformed and not in sufficient depth as would be the case with a better trained person, such as a physician.

[NPs and PAs] are wonderful when they work according to their training and experience but they often overstep their credentials and think they are physicians.

Also the term midlevel is misleading. [NPs and PAs] are not mid-way in becoming a physician or anyone else. Why not call them a PA or NP?

Patients can be confused by the credentials of a person wearing a white coat. Many institutions are requiring the proper title of the person inside the coat. No, I do not think I am better than anyone else, but I am different in my training and responsibilities.

Outside of big cities, NPs and PAs seem happy with their jobs and do not want to be professionals they are not trained to be (this information is from residents I know who have left the big city and are working in small towns where everyone is respected for who they are and what they can do)."

ACA Replacement Plan Ripped Apart by Medical Groups

Late Monday, Republican congressmen released a 123-page bill dubbed the American Health Care Act as a way to repeal and replace the Affordable Care Act (ACA). The controversial bill has been met with significant resistance from prominent medical groups.

The bill would keep some aspects of the ACA including the ban on preexisting conditions, allowing young adults to remain on their parents' coverage plans until the age of 26, and banning lifetime limits on health insurance. It replaces the subsidies that the ACA provided for low-and-middle-income families with a tax credit, ends the Medicaid expansion program in 2020, and increases the amount insurers can charge older consumers compared to younger ones from three times the amount to five times. The AHCA would also eliminate the current mandate that all Americans purchase health insurance or face a fine. It does however ask insurers to charge a 30-percent increase in premiums for consumers who allow their healthcare coverage to lapse for two consecutive months.

John says: "'Our goal is absolutely to make certain that individuals have the opportunity to select their physician.' What does this have to do with TrumplessCare? [Senator Price is] as out of touch with humanity as Trump and Ryan. Just another plan pushed down the throats of physicians who don't support it for people who have access already. When will those clowns learn? You are correct, NEVER, because they are essentially braindead hypocrites."

Onyi replies: "But the real question is what our new president, Vladimir Putin, thinks of the 'amendments' to the ACA. If Vladimir doesn't like this plan it's dead on arrival. If he however, supports this plan it'll be rammed through Congress and enacted by the end of this month."