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Can NPs and PAs Help or Harm Burned Out Physicians?: Page 3 of 3

Can NPs and PAs Help or Harm Burned Out Physicians?: Page 3 of 3

Libby says other approaches may be more cost effective and offer greater potential to reduce burnout.  Options include using scribes to decrease the technology and data-entry burden, investing in care coordination using RNs who work to the top of their license to track and monitor complicated patients, and designing workflow models that let office staff relieve doctors from menial or redundant tasks.

Questions about quality should also be considered, according to Maples. "A NP or PA who is not qualified or has not been adequately trained can actually lead to less-than high quality care which can contribute to a further loss of connection to purpose," he says.  One result can be that work needs to be redone and connections may be strained with patients, families, or fellow caregivers.

Fisher acknowledges that some providers are likely to become territorial toward NPs or PAs if they view them as rivals for patient visits rather than partners in caring for patients. But he advocates the latter. "As medicine moves more toward a population- based compensation system, they will be vital to efficiently and effectively care for a panel of patients in a cost-effective and quality manner," he says.

Leveraging for Success

For physicians who do engage APCs, Miller says it's important to appreciate the responsibilities and risks associated with their role as "supervising physician."  In the hiring process, this includes verifying the employee's experience and credentials and notifying malpractice insurers to ensure there is coverage. Also critical is becoming thoroughly familiar with state laws and regulations that clarify the authority and scope of mid-level providers and any specific requirements for physician supervision.

"NPs and PAs cannot simply be dropped into the workplace, left unattended and expected to perform," Miller says. "I've known of situations where physicians, in their excitement at having the extra help, have prematurely deployed a midlevel provider without specifically defining their scope of practice or any practice limitations." Miller has also seen lack of a proper orientation to office policies and protocols and overall inattention to adequate supervision."  Similarly, she has observed cases where physicians mistakenly attributed more clinical expertise or experience to a PA or NP than the individual actually had at that particular point in their career. In such instances not only can patient safety be jeopardized, but also the risk exposure increases for all concerned.

Miller advises gradually enfolding the NP or PA into practice and then steadily increasing his or her independence as clinical competence is demonstrated. A written agreement should be executed detailing the scope of practice and the nature of the supervisory relationship. Typical points to be covered include the types of patients the NPs or PAs can see, the procedures they can perform, mechanisms for escalating concerns about patients and emergency protocols, among other considerations.

She says an orientation for an NP or PA should cover essential patient safety protocols such as recall and tracking systems, call backs, protocols for addressing and documenting non-adherence and communicating and documenting labs.  It should also address critical results and medical advice, managing and escalating patient complaints, improving health literacy, HIPAA, and the practice's social medical policy.

"It's a sizeable task," she says.  "But providing a well-organized and comprehensive orientation serves everyone."


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