Healthcare providers grow physician extender staffs to meet demand

The future of healthcare employment might lie with physician extenders, as cost and physician bandwidth spur hiring.

Almost every health system in the country is suffering from rising operational costs and declining physician populations, and most are finding a cure in hiring physician extenders.

Whether they be nurse practitioners, midwives, physician assistants, or other similar job roles, these healthcare professionals are stepping up to help fill the void caused by physician shortages, and to expand the services that physicians can offer.

“Looking back 10 or 15 years ago, probably less than a quarter of providers were using extenders broadly. Today you would be hard pressed to find a large hospital staff that is not using extenders in some shape or form,” said Kulleni Gebreyes, director of health services at PricewaterhouseCoopers.

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Both PricewaterhouseCoopers and ECRI Institute cited physician extenders as one of the top healthcare industry trends for 2015. Physicians will hand off more and more work to extenders as digital monitoring and expanded responsibilities under risk-based payments grow.

The physician shortage is certainly the key factor at many hospitals, Gebreyes said, but an even greater factor is the desire to reduce cost. The cost-per-hour difference in who is handling a given task can be substantial.

“If you think about healthcare; labor costs are anywhere between 50 to sometimes 70 percent of your costs,” Gebreyes said. “So when you look at extenders, here is a way to provide service at a lower cost per labor.”

Physician extenders lengthen the reach of the physician in terms of number of patients seen and services offered. When the system works well, physician extenders will not only enhance revenue for the organization, they will hopefully increase patient satisfaction as well.

According to recent research from the Medical Group Management Association, the number of non-physician providers has increased by 11 percent since 2008. These providers may monitor fragile diabetics, see cancer patients between visits, set bones in the ED or close for the doctor after surgery.

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But typically, when a healthcare provider refers to physician extenders they have two primary job roles in mind – nurse practitioners and physician assistants. Nurse practitioners may actually take offense at the term, Gebreyes said, since they may have broad authority in some states and be able to make care decisions without the need of physician sign-off. That is not the case for physician assistants, who must work with a physician in all cases.

Certainly not everyone with the title of physician assistant or nurse practitioner is a physician extender, either. These are hand-picked teams, with members selected on their skills and expertise.

“If you’re thinking of using these extenders in the primary care setting you really want people that have clinical thinking skills, have a broad clinical background, and have been trained in how to actually manage and promote health,” Gebreyes said. “When you’re looking for extenders on your surgical team you want people who are technically skilled but have experience doing one particular thing for a long time.”

Extenders that are strong on patient experience, clinical skills and thinking skills are becoming the face of healthcare for a growing number of patients.

“Patients are more likely to be seen quickly by extenders, and they probably spend more time with patients,” said David Taylor, vice president of regional services at CoxHealth in Springfield, Missouri.

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A growing number of nurse practitioners and physician assistants are also earning advanced degrees and getting better trained. Patients are receptive to spending more time with these healthcare providers, especially as they may get faster treatment and more provider face time. And physicians like the idea of being able to turn over many of their less critical care duties to others.

These last points are very important to the success of an extender program, said Gebreyes.

“Finance executives should determine what problems they’re trying to solve are,” Gebreyes said. “Are they looking at cost pressures? If it’s a capacity issue, then you really want to think about how much autonomy this extender should have. Also, how much can they do without direct supervision? We want them to be able to function as independently as possible. Finally, you have to measure against efficiency and quality, and not just focus on the cost.”

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