Physicians, it’s time to end the war against P.A.s and N.P.s

P.A.s and N.P.s

“P.A.s and N.P.s are taking over the healthcare industry!  I don’t want to lose my job to a mid-level provider!”  

How many times have you see that on social media posts or blog articles?

Setting aside the use of the pejorative term “mid-level provider,” I think it’s time for physicians to end the assault on the clinical practices of P.A.s and N.P.s.

I get tired of the self-importance that many physicians place on their role in the medical profession, as though physicians hold exclusivity on good clinical practice.  

I love being a physician, and I spent 14 years after high school training to do it well.  However, I’m not the only person qualified to deliver high quality medical care to my patients. 

Are you worried about P.A.s and N.P.s taking your job?  If you’re a good doctor, you should stop worrying.  Great P.A.s and N.P.s are everywhere, and I think it’s time physicians embraced them.  

P.A.s and N.P.s have excellent skills

It would be disingenuous for P.A.s and N.P.s to claim that their medical training is equivalent to that of a physician.  Does that make them less qualified to practice medicine?  Absolutely not!! 

My first rotation as a third-year medical student was in the trauma bay at University Hospital in San Antonio.  There was a P.A. there who ran the trauma bay every third shift, alternating with second year surgery residents.  

I learned a lot from Greg.  He was truly a skilled clinician.  He taught me how to suture, how to run a trauma code, and how to put in a central line.  

Now, not all P.A.s and N.P.s will be such an excellent provider, and I understand that.  News flash: I know plenty of doctors who aren’t so great either.  I think skill level has much more to do with the individual than their degree.  

On balance, physicians have more in-depth training and may be qualified for areas of practice that P.A.s and N.P.s aren’t qualified for.  That shouldn’t prevent us from accepting them as clinical providers.  

P.A.s and N.P.s make you more productive as a physician 

This is especially true in gastroenterology, but I think there is a role for a P.A. or N.P. in every specialty.  All of the P.A.s and N.P.s that have ever worked for me have been fantastic!  They absorbed knowledge like a sponge and became highly independent very quickly.  

Once they started functioning more independently, I was able to shift my time to be more procedure-heavy.  That enabled me to do the therapeutic interventions only I could provide.  My business productivity quickly increased by 30%, eventually up to 60% higher.  

Well-trained independent P.A.s and N.P.s will more than pull their own weight.  Working with them will make you more productive by increasing your focus on issues only you can address.  

America needs good P.A.s and N.P.s

As the Baby Boomers retire, we expect America to experience a major shortage of physicians.  It’s important to American healthcare that we find ways to expand our ability to care for more patients.  

With more and more physicians looking to go part-time, avoiding primary care jobs, and talking increasingly about retiring early, we need more P.A.s and N.P.s to pick up the slack, not fewer.  

I don’t think physicians can have it both ways.  We can’t say that P.A.s and N.P.s shouldn’t be allowed to practice in the same way we do and simultaneously try to work as little as possible.  That’s not sustainable for a national healthcare model.  

P.A.s and N.P.s as independent practitioners

This issue has generated a lot of controversy over the past few years.  I’ve seen a lot of petitions circulated to physicians to sign to try to block bills that would allow P.A.s and N.P.s to practice independently of physicians.  

I have some mixed feelings about this issue, I’ll admit.  

First, I think it would be unwise for P.A.s and N.P.s to go into independent practice immediately after training.  That’s especially true of the subspecialties like GI and endocrinology.  

As I said earlier, the length and intensity of clinical training is a lot less for P.A.s and N.P.s than for physicians.  I think P.A.s and N.P.s generally benefit from several years of practicing under physician mentorship to solidify their clinical skills.  

My P.A.s and N.P.s work under my supervision, but they function largely independently.  I trust them to make good clinical decisions and to come to me when they get stuck.  That’s based on years of experience and seeing them gradually increase their independence as their skill level grows.  

Second, I do think that it’s incumbent on P.A.s and N.P.s to recognize their limitations and not seek to operate outside their scope of practice.  

I’ve taken care of plenty of patients that had clinical issues that were missed by a P.A. or an N.P.  Yes, it’s frustrating.  But, guess what?  I’ve had that happen with patients under the care of physicians too.

I honestly don’t have a problem with P.A.s and N.P.s practicing independently as long as they practice according to their skill level and recognize their limitations.  I hold physicians to the same standards.

P.A.s and N.P.s aren’t taking your jobs

If you think they are going to take over your job, it’s time for you to adapt or to work with them.  

When I was on my OB/GYN rotation in medical school, I learned a lot from our nurse midwives.  They were great!  They could do most of the things the physicians could do, but they recognized their limitations and deferred certain cases to the doctors.  

Did that diminish the practice of the OB/GYN doctors?  I have to say, I don’t think it did.  Everyone knew their role and stayed in their lane.  It was efficient, productive, and safe.

Are you worried about losing your market share to a P.A.s or an N.P.s?  Why not hire them, train them, and work with them?  

Either do that, or just get over it.  

Trust me, there are so many patients that need care that even an independently practicing P.A. or N.P. won’t be able to corner the market.  

If that leads to increased delivery of quality healthcare for our patients, how can we not celebrate that?

Final thoughts

As a group, I find P.A.s and N.P.s to be conscientious, skilled, and compassionate.  They have a different skill set than us, and they will benefit from your mentorship and guidance throughout their practice.  

I’ve worked with them in the outpatient and inpatient setting, and I have no qualms about it.  In fact, I’d go so far as to say that I couldn’t do my job as well as I do without them. 

They make me more productive and efficient.  Our patients love them, and they offer excellent clinical care.  

Physicians, it’s time for us to stop demonizing P.A.s and N.P.s.  They’re not just “mid-level providers” or “physician extenders.”  They’re highly competent clinicians who will make the practice of medicine better for our patients and for our healthcare system.  

Let’s celebrate them, mentor them, and work with them so our patients get the excellent care they deserve when they need it.

Further Reading

Leave a comment below and share your thoughts on how we as physicians can work with P.A.s and N.P.s, instead of against them.

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Comments (2)

  • Wow! Thank you so much for your support! I am tired of hearing physicians saying bad things about APRNs and PAs. I am proud to have been an APRN over the past 26 years and have been blessed to work with physicians that truly collaborate with us. I agree that it is time to focus on taking care of patients!

    • Ann-
      I couldn’t agree more! We get so focused on defending our turf at times that we forget that the patients should be the prime focus. I thinks it’s high time we acknowledged that and start refocusing our efforts on just making healthcare better for everyone. Thanks!
      -Brent

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