AAOS Now

Published 3/1/2008
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Charles E. Rhoades, MD

Integrating PAs into your practice

Physician extenders benefit you and your patients

Many orthopaedic surgeons are using physician extenders, such as physician assistants (PAs) or nurse practitioners, in their offices. These relationships can be very beneficial to patients, physicians, and the general public in responding to the ever-increasing number of people who need orthopaedic care.

If you are considering adding a physician extender to your practice, careful thought and planning can enhance the success of this endeavor.

Patients benefit from physician extenders
Integrating a physician extender into an orthopaedic practice primarily benefits your patients because it gives them greater access to the clinic. Patients may have the opportunity to sit and talk for a longer period of time with a physician extender than with an orthopaedic surgeon. They can ask many more questions and get an educated answer based on orthopaedic science, the individual needs of the patient, and the available resources of the specific orthopaedic practice. The physician extender can elevate the level of service to every patient in the practice.

You benefit as well
Access, efficiency, improved communication, revenue generation, and enhanced services are among the ways that physician extenders benefit an orthopaedic practice.

With the aging of the baby boomer population, the national shortage of orthopaedic surgeons, and the increasing number of orthopaedic services that can be offered to the public, the need for access to orthopaedic care far exceeds the delivery capacity. A physician extender can be a very effective and efficient way to give more people access to the orthopaedic clinic.

A PA can make your office much more efficient. Physician extenders can perform many activities that require advanced medical education. They can enable the orthopaedic surgeon to focus on more complex problems while they provide care for more routine problems.

Physician extenders also can greatly enhance patient communication. A physician extender may be able to spend more one-on-one time with the patient, explaining preoperative and postoperative care, reviewing the care of injuries, and responding to questions when the surgeon is unavailable.

A PA can be an additional provider and bill separately for certain services in most states. Their ability to use their educations and bill for their services makes them positive revenue generators in most practices.

Finally, the physician extender can greatly enhance the overall service experience provided to the patient. This service can be reflected in more accessible appointment times, more time to speak with the provider, more timely returned phone calls, and a more personal, one-on-one relationship.

Issues to consider
When adding a physician extender, orthopaedic surgeons need to be aware of several issues, including licensure, insurance, care planning, and professional education/development.

PAs and nurse practitioners must hold an active license to practice medicine in the state in which they work. Different states have different requirements; some states also have restrictions regarding what PAs can do.

In addition to licensure, medical liability is an issue. Most states and hospitals require a minimum amount of medical liability insurance for every licensed provider. Each PA must have a separate medical liability policy, although the rates are usually a fraction of those charged to orthopaedic surgeons.

Do not neglect to establish a supervisory agreement or collaborative care plan. This document details the working arrangements between the PA and the practice. Among the issues that should be covered are the following: lines of communication, methods of communicating with physicians, scope of practice, limitations of practice, locations of practice, and working environment. The agreement must be executed and signed by the primary supervising physician and the physician extender.

Be sure to set aside a specific budget and time for continuing professional education for each physician extender. They are professionals, and benefits should include membership in a professional society and sponsored attendance at educational meetings.

In a similar vein, show respect for the education and professionalism of individuals who have earned Certified Physician Assistant and/or Licensed Nurse Practitioner degrees. They are colleagues in delivering health care; treating them as such fosters a healthy professional relationship. Their professional development is as important as yours.

Physician extenders can be a valuable addition to your practice. When properly integrated into the practice, they can provide greater access to patients, greater efficiency for the office, greater professional satisfaction for the orthopaedic surgeon, and a positive revenue flow.

Charles E. Rhoades, MD, is a member of the AAOS Practice Management Committee. He can be reached at crhoades@kcoi.com