We were sitting around the table at our monthly office meeting. Our new Physician Assistant (PA) brought up an encounter she had with a patient. The patient was unsatisfied with seeing her because he felt he was getting poor care. He wanted to see the doctor for his care. This led me to think about the value of PAs and nurse practitioners. The new term “physician extenders” has been put into place to try to convey the value of these practitioners. A physician extender includes any healthcare provider who is not a physician but is able to perform the typical activities of a physician. This includes PAs and nurse practitioners (NPs) who work in collaboration with an overseeing physician.
These practitioners used to be referred to as “mid levels,” however this conveys an inferiority which is not the case. PAs and nurse practitioners are a valuable part of the medical team. Many offices (ours included) are moving towards having a combination of physicians and physician extenders to provide care given the value and quality of care they provide. Physician extenders can do just about anything a doctor can. They can take medical histories, perform physical examinations, order diagnostic tests and studies, diagnose medical conditions, and implement a treatment plan in consultation with a supervising physician. They can prescribe medications in all states and counsel patients on health promotion.
I must admit that I didn’t use to have such fond feelings of physician extenders. Mostly this was jealousy because they were able to perform the same activities as me as a physician with less training. This changed after I worked more closely with them. My experience showed me that they were very capable primary care providers. They were experienced and competent and were able to function independently in a primary care roll to provide excellent care.
PAs are the first type of physician extender. PAs were only recently recognized as primary care providers with the Affordable Care Act. They can work as generalists such as in Family Medicine or they can specialize. Their training is similar to that of a doctor including in classroom didactics and hands on clinicals. It typically takes 2 years to complete and is broad covering all areas of medicine making them ideal primary care providers. They have a rigorous certification system consisting of completing a PA program and passing a national certification exam. They must also complete continuing education courses throughout their career to maintain their certification. They work closely with physicians as a collaborative team.
Nurse Practitioners are the second type of physician extender and they are very similar. NPs are initially trained as registered nurses and then complete a advanced master’s or doctoral degree program. These programs can take 1 to 3 years to complete. They undergo similar didactic and clinical courses to medical school for a physician. Their education is extensive and prepares them well to participate in primary care and specialty care. They have to complete their program and undergo national certification. They too need to complete continuing medical education courses throughout their career and work closely with physicians as a team.
As you can see, Physician Extenders are capable medical care practitioners and are a valuable member of any medical team. Medical care that used to be confined to only a physician has now extended to include these providers. There will always be those who want to see a physician. In today’s medical world, this will not always be possible. You will likely find yourself being seen by a physician extender at your doctor’s office or in the hospital at some point. Do not see this as a decrease in your care. To the contrary, this is allowing doctors to extend their reach in caring for more patients. PA’s and nurse practitioners are a wonderful addition to the medical team and are able to function in a collaborative and independent role to provide excellent care. If you currently see a physician extender make sure you thank them for their great care.