The Smart Medical Practice

How Advanced Practice Nurses Saved America’s Healthcare


How physician extendors can help your practicePatients today are often underserved, but it’s hard to place too much blame on physicians. Most primary care doctors are completely overworked and exhausted, and they can’t seem to get much relief from that state. The Affordable Care Act, aging baby boomers, and retiring physicians are creating a perfect storm that’s completely overwhelming the health care industry. Millions of additional patients with fewer primary care doctors to serve then means something has to be done, –quickly.

Fortunately reinforcements are arriving from within America’s healthcare system that promise to help ease the burden faced by both physicians and patients alike.

Physician Extenders – also commonly called physician assistants, or PAs – and Nurse Practitioners (NPs) increasingly have a surprisingly larger scope of duty and responsibility in providing today’s healthcare, and depending on the setting, they are treating patients with no physician oversight.

There are now more than 151,000 such Advanced Practice Nurse Practitioners (APRN), significantly more than the estimated 100,000 family physicians in the United States, and they are authorized to prescribe in all 50 states and the District of Columbia. As well, there are 87,000 Physician Assistants who are able to act independently as primary care physicians in underserved areas.

Last year alone, over 902 million prescriptions are written by APRN’s, and in 2011 under the Affordable Care Act, CNMs’ allowances were raised to 100% of physician fees. Statistics for 2011 show that growth in APRN approved Medicare charges continues to exceed Part B growth for all other providers. But some state laws, take Massachusetts, Michigan, and Pennsylvania for instance, limit what NP’s are able to do in practice, but all states limit extened-physicians to non-invasive medical treatment, or primary care.

A current scope of practice bill in the California Legislature is facing opposition from several fronts. Some Nurse Practitioners don’t support the bill because of changes to freedom they already have to practice, and also because of increased medical liability insurance requirements.

There are also vast differences in the amount of training NPs receive versus what physicians get. While NPs train between 3,500 and 6,000 hours, physicians require 21,000 hours of hands-on in-person training. However, NPs have the benefit of typically being more patient focused as opposed to medicine/science focused, which can make them good choices in managing chronic diseases.

But will using NPs and PAs be a cure all to help ease the steady influx of new patients? Statistics show the opposite, as the number of NPs who work in primary care are falling. In 1996 it was over 50 percent, but by 2010 it was near 30 percent. Like physicians, many NPs and PAs are going into specialties that focus on areas of interest and where the pay is better.

The Business Side of Things
Advanced Nurse Practitioner and Physician Assistants who suddenly find themselves practicing primary care medicine must also prepare for a baptism of fire in regards to the ‘business of healthcare’. They will face the same shrinking reimbursements, high operating costs, onerous and burdensome compliance issues that are faced by all physicians today; and they’ll come to rely heavily on the same practice management, clinical software, and medical billing software used by their physician counterparts.

Electronic Medical Records and electronic ePrescribing software offer important checks and balances that help healthcare providers make fewer mistakes and help them run a more streamlined practice and deliver better patient care. Practice management software used by most physicians to chart and bill insurance electronically are essential tools of the trade that PAs and NPs will have to quickly adopt as they move into primary care roles.

Practice Management and Revenue Cycle Management software allow practitioners to focus more time on patients and less time on paperwork; as well as helping run a smoother practice and achieve better clinical outcomes for the patient.

It is clear that more has to be done to ease the situation and keep needed practitioners interested in primary care. The country needs them, patients need them, and indications are that the pressure is not going to let up any time soon, in fact the ACA states that an additional 51,000 primary care practitioners are required by 2015.

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