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The Nurse Will See You Now…

Visiting a doctor’s office? Very likely you’ll be seen by a nurse practitioner or physician assistant

By Deborah Jeanne Sergeant

In recent years, patients have experienced an increase in seeing advanced healthcare professionals (AHPs) — also known as “physician extenders” — for routine doctor’s visits and acute care.

The shortage of physicians has been a driving factor in the uptick in AHPs, which are comprised of nurse practitioners (NP) and physician assistants (PA).

Pediatrician Robert Dracker, president of the Onondaga County Medical Society in Syracuse, views AHPs as “essential complements to care. They spend a lot of time with patients and talk with them and that’s important. A physician won’t be able to sit there and talk with patients so long.”

He views their role as best in coordination and conjunction with a physician but not as a replacement for a physician.

“They don’t have the educational background you have to have tas a physician,” Dracker said.

The insurance reimbursement for an AHP is lower than that of a physician’s, which makes care provided by AHPs attractive for insurance companies to cover.

Although many nurses earn their nurse practitioner education after gaining years of experience working as an RN, Dracker said that a NP or PA have no required residency before practicing. (As a rule, he always worked alongside an AHP for three months before allowing them to see patients and then remained available for any questions.) Physicians complete a longer degree plan and a required internship before practicing medicine.

As of April 1, 2021, there were 19,348 licensed PAs and 32,418 NPs in New York state. PAs function as dependent practitioners under the supervision of physicians who are legally liable for what they do.

NPs are responsible for their actions while they practice and in New York are not required to practice under a physician if they have more than 3,600 hours of experience and have a written agreement with a collaborating physician or have a collaborative relationship with a physician.

Samantha Sassone, a doctorate nurse practitioner, practices at Natural Face Clinic in Syracuse and serves as an assistant professor of nursing at Le Moyne College in Syracuse.

“Sometimes, they want to see the physician but I think a lot like seeing the NP as they feel it’s more patient-centered,” Sassone said. “We’re a trusted, loving, caring profession and they see a NP as a nurse at one step above. I have patients who request for me or want to follow up with me.”

She thinks that part of the reason is that new patients typically see NPs first and for follow-up care. Sassone views the NP relationship with the physician as collaborative as the NPs often shares care of patients.

“We’ve realized that there is space for everybody because patients are sicker than they’ve ever been before,” she said. “Many see multiple specialists. When they get out of that acute phase, it’s NPs and PAs that monitor them.”

AHPs also screen for numerous health issues, including skin checks and mental health. She instructs students at Le Moyne to manage patients for issues until they can get to a specialist because so many specialists have extensive waiting lists.

“If we have a patient with new onset hypertension, we can manage that in an outpatient setting,” she said. “We’d send them to a cardiologist. In the meantime, we still have to deal with what’s in front of us. We’re getting good at filling the gap. Once the patient is into a specialty, we manage them again.”

Mary Springston directs the HRSA primary care training program at Le Moyne’s PA department and has directed the healer’s art program at the school. She is a clinical associate professor and director of the Clinical Advancement Science Center.

While the physician shortage has been an ongoing issue, “the pandemic drove this home,” she said.

With so many physicians going into the more lucrative specialty practices, fewer are left in primary care. Some specialties like geriatrics and pediatrics also tend to be less remunerative because providers need to spend much more time with patient education and care than with other specialties. Seeing fewer patients equals less money coming into the practice.

The shortage of physicians has been a driving factor in the uptick of nurse practitioners and physician assistants.

Many physicians choose to work as a hospitalist rather than in primary care because the hours are more consistent.

“A lot of AHPs have been following providers into specialties,” Springston said.

Bottlenecks in education have also prevented more providers from entering the ranks.

Insufficient healthcare educators and residency slots for new physicians have made it challenging to bring more doctors into healthcare. Springston said that busy providers find it extremely difficult to oversee students in their practices.

Like Sassone, Springston said that many patients choose to stick with an AHP after their initial visit, although patients have the right to choose their provider. Springston has worked as a PA since 1993, when PAs and NPs were relatively new.

“I think it’s more accepted now,” she said. “You don’t have to explain what a PA or NP is. Most people are aware of the job that we do and the quality of our work.”