Stop The War On PA's And NP's


By Brent Lacey, MD

I think it’s time for physicians to end the assault on the clinical practices of PAs and NPs.

Are you worried about PAs and NPs taking your job? If you’re a good doctor, you should stop worrying. Great PAs and NPs are everywhere, and I think it’s time physicians embraced them.

PAs and NPs have excellent skills

My first rotation as a third-year medical student was in the emergency department. There was a PA there who ran the trauma bay every third shift, alternating with second-year surgery residents.

I learned a lot from Greg. He was, indeed, a skilled clinician. He taught me how to suture, how to run a trauma code, and how to put in a central line.

Now, not all PAs and NPs will be such an excellent provider, and I understand that. News flash: I know plenty of doctors who aren’t so great either. I think skill level has much more to do with the individual than their degree.

On balance, physicians are qualified for areas of practice that PAs and NPs aren’t qualified for. That shouldn’t prevent us from accepting them as clinical providers.

PAs and NPs make you more productive as a physician.

This is especially true in gastroenterology, but I think there is a role for a PA or NP in every specialty.

As a gastroenterologist, a PA or NP can see a lot of patients in clinic, enabling me to shift my time to be more procedure-heavy.

Well-trained independent PAs and NPs will more than pull their own weight. Working with them will make you more productive by increasing your focus on issues only you can address.

America needs good PAs and NPs

It’s important to American health care that we find ways to expand our ability to care for more patients.

With more physicians looking to go part-time, avoiding primary care, and talking increasingly about retiring early, we need more PAs and NPs to pick up the slack, not fewer.

I don’t think physicians can have it both ways.

We can’t say that PAs and NPs shouldn’t be allowed to practice in the same way we do and simultaneously try to work as little as possible. That’s not sustainable for a national healthcare model.

PAs and NPs as independent practitioners

This issue has generated a lot of controversy over the past few years. I’ve seen a lot of petitions circulated to physicians to sign to try to block bills that would allow PAs and NPs to practice independently.

I have some mixed feelings about this issue, I’ll admit.

First, I think it would be unwise for PAs and NPs to go into independent practice immediately after training. That’s especially true of the subspecialties like GI and endocrinology.

My PAs and NPs work under my supervision, but they function largely independently. I trust them to make good clinical decisions and to come to me when they get stuck. That’s based on years of experience, and seeing them gradually increase their independence as their skill level grows.

Second, I do think that it’s incumbent on PAs and NPs to recognize their limitations and not seek to operate outside their scope of practice.

I’ve taken care of plenty of patients that had clinical issues that were missed by a PA or an NP. Yes, it’s frustrating. But guess what? I’ve had that happen with patients under the care of physicians too.

I honestly don’t have a problem with PAs and NPs practicing independently as long as they practice according to their skill level and recognize their limitations. I hold physicians to the same standards.

PAs and NPs aren’t taking your jobs

If you think they are going to take over your job, it’s time for you to adapt or to work with them.

When I was on my OB/GYN rotation in medical school, I learned a lot from our nurse-midwives. They were great! They could do most of the things the physicians could do, but they recognized their limitations and deferred certain cases to the doctors.

Did that diminish the practice of the OB/GYN doctors? I have to say: I don’t think it did. Everyone knew their role and stayed in their lane. It was efficient, productive, and safe.

Are you worried about losing your market share to a PA or an NP? Why not hire them, train them, and work with them?

Either do that or just get over it.

Trust me, there are so many patients that need care that even an independently practicing PA or NP won’t be able to corner the market.

If that leads to increased delivery of quality health care for our patients, how can we not celebrate that?

Final thoughts

As a group, I find PAs and NPs to be conscientious, skilled, and compassionate. They have a different skill set than us, and they will benefit from your mentorship and guidance throughout their practice.

They make me more productive and efficient. Our patients love them, and they offer excellent clinical care.

Physicians, it’s time for us to stop demonizing PAs and NPs. They’re not just “mid-level providers” or “physician extenders.” They’re highly competent clinicians who will make the practice of medicine better for our patients and for our health care system.

Let’s celebrate them, mentor them, and work with them, so our patients get the excellent care they deserve when they need it.


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