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    Moving the conversation forward on scope of practice

    As healthcare shifts toward value-based platforms, many primary care practices are adding advanced practitioners such as nurse practitioners (NPs) and physician assistants (PAs) to their rosters. As a result, medical practice collaboration is taking on growing importance.

    A recent survey from search firm Merritt Hawkins provides evidence of this trend, revealing that NPs and PAs, collectively, were the firm’s fourth-most requested recruiting assignment of the past year, up one spot from the 2014 survey. Just four years ago, neither PAs nor NPs were among Merritt Hawkins’ top 20 assignments, individually or collectively, according to the report.

    Nonetheless, the proper scope of practice for advanced practitioners remains a hot-button issue, with regulations and supervision requirements varying by state.

    At the heart of this debate, for many, is the length of training physicians receive compared with advanced practitioners, according to Jeffrey Gold, MD, a family physician and owner of Gold Direct Care, PC, in Marblehead, Massachusetts. “I definitely think there’s a place for [advanced practitioners] in the system, and in the direct primary care model that I’m doing; but there’s a very big difference between a two-year program and four years of medical school with a minimum of three years of residency where you’re on call pretty much every fourth night,” Gold says. “It’s not to say it in any deleterious way to [advanced practitioners], but there is a difference in the time that is spend on education, training, and building a knowledge base.”

    Physicians’ training helps them develop a mindset that considers more serious medical “zebras” that can masquerade as horses, Gold explains. Especially when care is fragmented, such as with care provided at walk-in clinics, the risk is greater that a cough an NP treats with a Z-pack, for example, might turn out to be a tumor, Gold says.

    Gold acknowledges that most NPs and PAs are very good at what they do and have helped fill a void created by a shortage of primary care physicians. Nevertheless, he would personally rather be treated by a doctor. “I hate to say it, but when I go to the doctor, I want a physician—and that’s what I want for my family,” Gold says. “It doesn’t mean that I don’t trust NPs, but especially if it’s something that I’m really worried about and I think is complicated, I want a doctor.”

    Next: Achieving the aims

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    • Anonymous
      Unless NPs and PAs can be sued personally for their mistakes, physicians should never agree to this collaboration.
    • Anonymous
      Unless NPs and PAs can be sued personally for their mistakes, physicians should never agree to this collaboration.

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