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NPs and PAs Working Together in Contemporary Medicine
By Robert M. Blumm, MA, PA-C, DFAAPA
Chairman, PA Advisory Board, Clinician1.com
Editorial Board, Advance for NPs and PAs
“Every memorable act in the history of the world is a triumph of enthusiasm. Nothing great was ever achieved without it because it gives any challenge or any occupation, no matter how frightening or difficult, a new meaning. Without enthusiasm you are doomed to a life of mediocrity, but with it you can accomplish a miracle.”
— Og Mandino
The year 1995 was a hallmark for nurse practitioners (NPs) and physician assistants (PAs), as a mutual discovery occurred. It was during the Clinicians Conference held in Connecticut that those of us who work in these professions discovered the unifying facets of our mission in health care delivery. We became acutely aware of how we complement each other, and we began interdisciplinary mentoring. Here we are fifteen years later, and we now have three journals that are specifically marketed to both professions. Barriers have been destroyed, and trust has become a foundational experience as we now embark on new journeys together.
Born from this mentoring was the integration of NPs and PAs into specialty areas such as Emergency Medicine, Critical Care, Cardiology, Surgery, Orthopedics, every sub-specialty and, more recently, Retail Health Care Clinics. As supervisors, administrators, and physicians soon discovered, advanced practice clinicians were now sharing their knowledge with each other. PAs contributed their knowledge and experiences that came from the medical model, while NPs displayed their significant skills in patient education and the fine points of experiencing training in the nursing model. We explored deeper understanding of compassion and discovered that our patients had a body and soul and required clinicians to be aware of physical, social, spiritual and psychogical aspects of their being. As the two groups of clinicians taught each other, their shared abilities created an improved model — clinicians with greater sensitivities and improved skills. I am proud, as a PA father, to anticipate my son Matthew’s graduation from Adelphi Nursing School with his BSN in December, thinking that one day he may join this band of APCs and translate his experiences for the good of both professions.
Retail Health Care Clinics have become a melting pot for the NPs and PAs who formerly practiced in Family and Internal Medicine, Urgent Care, and Emergency Medicine. I have noticed an increase of posts on Clinican1focused on this successful paradigm. What force drove nonphysician providers into a synergistic workforce with a new philosophy for the delivery of health care in America? Perhaps the most important force was the crushing reality of triage and patient selection based on severity of illness. Or perhaps it was the five-hour waits in suburban and inner city emergency departments (EDs) which will only become greater with 31 million added patients in the health care system. The federal government has passed new legislation to add dollars to the education of both professions, knowing that we will be a much needed provider as patients increase and the number of physicians decrease.
Is there any need to question why compassionate clinicians “mirrored themselves” and sought liberation? Ultimately, the same providers who forged a relationship years before now stand together to work toward a new vision. When NPS and PAs were approached by the founders of the Retail Clinics they were imparted a new hope that generated great enthusiasm. This excitement filled them with a renewed sense of destiny and a spirit of pioneerism. They understood that they were the embodiment of an idea that would change medical care in the United States. Some would leave their past careers and larger salaries in exchange for an opportunity to become instruments of this change. Some decided that as they were advancing either in age or experience that this would become an opportunity to meet the needs of patients as well as themselves. The dream became reality and the numbers increased as did the utilization of these clinics by a new generation of patients.
NPs and PAs who work in the Retail Clinic model have been trained by educational and corporate experts in subjects such as customer satisfaction, corporate culture, conflict resolution, and the concept that patient satisfaction is paramount. Each patient is treated with respect and appreciation. Studies have demonstrated that not only do patients return but they also recommend their friends and family. Surveys generated positive responses which even encouraged hospital systems to become involved and share in the “new” approach to family practice. The menu that originally was posted expanded into additional areas of care and service. Each practitioner and associate or secretarial assistant is responsible for upkeep of the clinic and for showing respect for each other in working together as a team. They convey pride in their role as trailblazers in this new concept of patient care. NPs and PAs work together with the availability for consultation with a licensed physician, who is responsible for a number of clinics.
Retail Health Care Clinics offer a transformation from a dying, antiquated system to a model where episodic illness is treated quickly and efficiently — at minimal cost. This epiphany in health care eliminates arbitrary waiting time, provides defined, low-cost fees for specific services, and is available locally in areas where people live and work. Most insurance plans are accepted and the hours are convenient. To provide continuity of care, an electronic medical record is sent to the patient’s primary care physician. Clinics such as Little Clinic, Take Care Clinics, Minute Clinic and others transfer more acutely sick or injured patients to Urgent Care Centers where a broader range of services is available. These clinics are associated by an active Convenient Care Association that provides management and administrative ideas, marketing, reduced price for equipment and much needed and productive educational seminars and conferences for the members of their staff.
The philosophy of the Retail Clinic is to treat acute, non-life threatening illness and recently some have become involved in the treatment of chronic illness. NPs and PAs in these clinics respect the patient/physician relationship and encourage all patients to have a primary care provider or an “office home.” As a result, many private physicians who once saw the clinics as a threat have not only changed their mind but now refer to the clinics when they are no longer having office hours. The clinics have become the solution to the needs of working patients who cannot afford to lose time or pay but still require medical evaluation.
The shared commitment to deliver quality care is the foundation for success that joins the owners, the management teams, and the NPs and PAs who are the caregivers. Can there be a partnership between Retail Clinics and more established methods of medical practice? The answer is a resounding yes. One system will undoubtedly feed the other. Hospital systems will create their own version of this successful treatment option thusly decreasing waiting times in the ER and allowing severely sick patients to receive prompt care at the hospital.
NPs and PAs have been integrated into this new system with the expectation of providing patients the highest quality of specialized care for common problems. Will this be a part of the answer to the expanded number of patients that have entered the system? Only a fool would close their eyes to this probability. Are there enough patients to meet the concerns and financial burdens of private physicians, hospitals as well as the convenience clinics? As the Sheriff from North Dakota said; “you betcha.” The assimilation of these clinics into the next decade of health care will demonstrate that the ingenuity and vision of a few people are all that is needed to meet the ever increasing demands of health care. I am optimistic concerning the blending of two different but similar practitioners or clinicians in sharing responsibility for healthcare in America.
 Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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