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A Partner in the Business: Practices see mid-level providers as valuable additions

by Gretchen Henkel •

At the otolaryngology department at Overton Brooks VA Medical Center in Shreveport, La., Moore practices with physicians and residents to triage patients to the appropriate provider. “As a PA [with 10 years’ experience in otolaryngology] I can facilitate the patient being seen sooner by the physician, which makes the patient and the physician happy.” [For more on physician assistants’ scope of practice, go to www.entpa.org.]

Acceptance of mid-level providers is growing, said Jose C. Mercado, MMS, PA-C, president of SPAO-HNS, who works with Scott H. Goldberg, MD, of South Florida ENT Associates in Miami. “Ten years ago, when the hospital called for an ENT consult and I showed up, the referring physicians were a little hesitant,” he recalled. Mercado takes care of most ENT hospital consults, like control of epistaxis and drainage of peritonsillar abscess. If surgery is indicated, Mercado shortens the patient’s wait time for the OR by performing the initial patient history and physical and ordering appropriate diagnostic studies in preparation for Dr. Goldberg. He takes first call at two major hospitals, and joined their credentials committees to help establish regulations for the utilization of PAs. There are now 12 PAs in one of the hospitals where he takes first call. “We’ve earned referring physicians’ trust and respect, one patient at a time,” he said.

Value to the Practice

A solo practitioner, Michael Sillers, MD, FACS, of Alabama Nasal and Sinus Centers in Birmingham, Ala., realized a year ago that he had peaked in terms of his own efficiency. “I knew I couldn’t grow the practice without some help, but I wasn’t quite busy enough for another physician,” he recalled. His solution was to hire a PA.

With five years’ orthopedic experience, Lindsey Leonard, PA-C, “was used to working hard in a busy practice,” Dr. Sillers said. He now sees patients in concert with Leonard and finds that the setup is working well. Due to Dr. Sillers’ payer environment, Leonard does not see patients independently. (Many of the Blue Cross plans, prevalent in his area, do not reimburse PA services directly.) Her typical duties, according to Dr. Sillers, include obtaining the history and performing the basic physical examination of new and established patients, reviewing test results, responding to telephone calls and elaborating on options discussed and recommended by Dr. Sillers.

The Training Question

Nurse practitioners complete two additional years of education and training to obtain their designation. The average physician assistant program is 27 months, at the end of which PAs must pass a certifying examination. NPs and PAs are then trained by the physicians who employ them, much in the way residents learn on the job. In an academic setting, NPs and PAs may train specifically in ENT. Many NPs may be members of the Society of Otorhinolaryngology and Head-Neck Nurses and acquire additional training by taking both physician and nursing CME courses.