In April, we talked about the contributions of nurse practitioners (NPs) and physician assistants (PAs) to hospital medicine, citing benefits such as lower facility costs, shared workload with physicians, ease of recruiting, and increased patient satisfaction.
But what about NPs and PAs in emergency medicine? We know they can have a role to play, and, so, what does the future hold regarding their participation?
From an industry perspective, there is sometimes still a disconnect as to how beneficial these roles can be for the ED team, which mandates the need to understand, embrace, and optimize a workflow model that values NPs and PAs.
How NPs and PAs Benefit the ED
In reality, many of the same benefits that hospital medicine programs accrue from having NPs and PAs are available to emergency medicine as well, says Jill L. Hunt, PA-C, Section Director of NP/PA Services for Schumacher Clinical Partners.
"A number of the benefits NPs and PAs provide hospital medicine such as lower costs, shared workload, and increased throughput are also true for emergency medicine,” she says. "HM and EM really go hand-in-hand."
Hunt notes that there are some areas of differentiation, however.
"Throughput is even bigger on the EM side," she says. "For us, it's all about watching quality metrics like door-to-provider and door-to-disposition. Quality issues are increasingly important as we move towards Value-Based Care.”
Another difference involves surge planning, those times when the ED is at maximum capacity.
NPs and PAs are oftentimes out front, according to Hunt, as a provider in triage capacity. They are able to quickly assess and identify patients with higher acuity and send them for examination by a physician, while they see lower acuity patients who may not need to be admitted.
"The extra staffing can make it possible for patients not needing a bed to be seen more quickly," she says. "This cuts down on wait times and LWOTs and makes patient care in the ED more efficient and expeditious."
Hunt indicates there is also a patient satisfaction element to the role NPs and PAs perform in the ED. While physicians may have less time to spend with patients in high volume or high acuity situations, NPs and PAs may be able to make some extra time, contributing to improved patient experiences and higher patient satisfaction scores.
Physician Shortage Increases Need for NPs & PAs
The Association of American Medical Colleges forecasts that in 15 years the United States will face a deficit of up to 159,300 physicians. The American College of Emergency Physicians (ACEP) reaffirmed that saying, “there is currently a significant shortage of physicians appropriately trained and certified in emergency medicine.”
This makes the use of NPs and PAs even more necessary and emergency services, physician group practices, and hospital administrators have all turned to this provider group to meet increased health care demands.
Like physicians, NPs and PAs are licensed separately by all 50 states. As such, each state decides what duties or tasks NPs and PAs can perform under the terms of their license (“scope of practice”).
However, while the scope of practice of physicians is nearly identical from state to state, that of NPs and PAs varies widely. Some states allow NPs and PAs to practice with little or no physician supervision while others grant them very limited autonomy.
That autonomy or lack of it is an especially salient issue where urgent care is concerned, Hunt says.
"Many urgent care facilities and critical access emergency departments particularly those in rural areas, don't have a physician on site," she says. "It's become more and more difficult to find doctors who are willing to practice in rural areas. That's where NPs and PAs can fill the gap and do so in a role that offers a higher level of autonomy."
The Future of NPs and PAs in the ED
All signs point to the substantial and sustained growth of the nurse practitioner and physician assistant professions.
U.S. News and World Report Best Jobs Rankings for 2017 show that nurse practitioners hold the number two spot for the best 100 occupations in the United States. The U.S. Bureau of Labor Statistics (BLS) states that nurse practitioner employment is projected to grow 31 percent through 2026.
Physician assistants are also expected to play a bigger role.
Becker’s Hospital Review, reporting on a comprehensive study from the National Commission on Certification of Physician Assistants, found that the profession grew by 35 percent in just five years. At the end of 2015, there were close to 109,000 certified PAs practicing in the U.S., up from fewer than 75,000 in 2009.
Like nurse practitioners, BLS projects that employment of physician assistants is expected to grow 37 percent by 2026, much faster than the average for all occupations.
The evolution in the profession is well-timed, not only from the standpoint of need due to the doctor shortage but also acceptance among physicians and patients, Hunt says.
"As time has passed, physicians and patients have come to have a better appreciation and understanding of the role of the NP and PA," she says. "Education on who we are and what we do has reduced opposition, and physicians have learned how to effectively partner with us.”
How Schumacher Views NP/PA Role
While some healthcare professionals see NPs and PAs merely as "physician extenders," SCP has a very comprehensive understanding of the importance of their role, recognizing it to be a foundational part of the healthcare team structure.
"In the face of today’s healthcare challenges, your job responsibilities are exponentially increasing," our website says. "Your role supports physician shortages, you have prescribing rights, and you help manage patient loads. As the healthcare model continues to evolve, it is clear that NP/PA care is an important part of the nucleus for that model.”
The SCP NP/PA leadership model vividly illustrates this emphasis. Hunt is one of five Directors covering various areas of the U.S. who manage anything NP and PA-related, including scope of practice, collaboration, supervision, and education.
SCP also includes lead NPs and PAs in the annual Medical Leadership Conference where they interact with Medical Directors from across the enterprise, which gives them to the opportunity to discuss what each team member needs from the other to optimize a collaborative relationship.
"Once you have a good NP or PA working beside you, you will never want to work without one,” Hunt concludes. “With the ever changing demands of healthcare, I feel fortunate to partner with Schumacher as I move forward with my career."
To learn more about working with SCP as an NP or PA and see the openings we have available, click here.