Physician Practice

4 questions to ask about whether to hire NPPs

Physician Practice Insider, August 21, 2017

Do you see room in your practice for a productivity advantage? “My background is emergency medicine, and our facilities were always very attentive to wait times,” says Christopher Hanifin, PA-C, chair of the physician assistant department at Seton Hall University in South Orange, N.J. “When a patient arrived in the waiting room, a clock started. If the patient was not seen by a provider within 15 to 20 minutes, we heard about it.”

While most practices “probably do not have as sophisticated a tracking system,” continues Hanifin. “It is easy to look at the online review sites and see if there is a perception of long waits. Patients do not want to wait 40 minutes in the waiting room and then another 20 minutes in the exam room. If patients are complaining – even jokingly – about wait times, it is worth looking into whether they are being well served by current staffing levels. Does a practice really want its own patients thinking they will be seen more quickly by a stranger in an urgent care center?”

How do you want to grow? Usually you hire to grow your practice. But, particularly in a small practice, your choice of provider type determines the direction of your growth. “For a solo practitioner, if you hire another physician, that changes the dynamic,” says Simon Frey, founder of Pivot Health, which does placement for advanced non-physician practitioners (NPPs). An NPP “is a good option for maintaining your operating model – doing the same things but with greater efficiency.”  

Are you in the right state? Scope of practice laws for NPPs vary from state to state. Nurse practitioners have full practice authority – that is, they can operate independently of their physicians – in most states. (See the state-by-state map under “resources.”) In some states like Alabama, however, the law is more restrictive, so “having an NP is just like having an RN at a greater cost,” says Frey.

Physician assistants don’t have full practice authority in any state, says Frey, “though there’s a lot of lobbying for it.”

Is your specialty or patient population a good fit? “One of the key benefits of using NPs and PAs is they’re able to deliver care comparable to that of a physician, particularly in primary care,” says Frey. Primary care is “the low-hanging fruit,” he says, because unless your state is restrictive your NPP can do a lot of the work your physicians are doing.

If you’re a specialty practice, the amount and type of work the NPP can do for you will vary. While most NPs are certified in an area of primary care, some have very distinct specialties, such as adult-gerontology acute care nurse practitioners (AG-ACNPs). PAs tend to specialize around specialties like internal and emergency medicine, Frey adds, but some specialize in surgery; if you’re an ortho surgeon and your PA can scrub in with you, that can be a huge advantage.

Also, consider how much work in your practice can be delegated to NPPs. If you have many patients with diabetes who have complex needs, says Hanifin, a PA “can easily become the practice’s diabetes manager and follow glucose levels and ensure patients have appropriate testing for renal function, foot exams and ophthalmology visits. All this takes a great deal of time for a clinician.”


This article was originally published in Part B News.

Most Popular