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Nurse practitioners and physician assistants are both advanced-practice providers with considerable autonomy, but they’re not interchangeable. Each brings something slightly different to the table, and if your practice is considering hiring an advanced-level practitioner, it’s important to understand the differences so you can hire appropriately for your need.
Because medical facilities are coping with increased patient loads, a shortage of physicians and an increasing need to keep costs under tight control, both nurse practitioners and physician assistants are in high demand. In many instances, these clinicians can make the difference between a practice that struggles to meet its patients’ needs and one that operates smoothly and efficiently.
Is your facility considering hiring a physician assistant or nurse practitioner? If so, here is what you should know about the similarities and differences between the two, and what to consider when deciding which is right for your needs.
What physician assistants and nurse practitioners do
Physician assistants spend their days diagnosing patients’ illnesses and injuries, performing physical examinations and providing patients with treatment plans. They perform services that doctors may provide, but always under the supervision of one or more physicians.
Nurse practitioners diagnose and treat illnesses and injuries too, but they place a stronger emphasis on preventative medicine and promotion of health. In many states, they can practice without physician supervision (called full practice authority).
Why practices hire physician assistants and nurse practitioners
Physician assistants and nurse practitioners have advanced education and credentials that allow them to have greater scope and autonomy than their registered nurse colleagues. Assuming a facility can justify the salary of a nurse practitioner or physician assistant, and that the healthcare team is committed to integrating them into the practice fully, they can make several things better. They can improve care quality, allow easier patient access and boost practice revenues.
Medical facilities that reap the benefits of having a nurse practitioner or physician assistant on staff are the ones that have thoroughly considered the business case for creating the position. For some practices, like those with frustratingly long wait times for non-urgent care services, the business case is clear, because the alternative is dissatisfied patients seeking care elsewhere.
Other times, the business case is not as clear, such as when you want to grow the practice, or when you want to focus more patient attention on education and preventative care. Typically, an advanced clinician like a nurse practitioner or physician assistant needs to generate around $250,000 to $300,000 in annual revenue to deliver a positive return on investment, whereas a new primary care physician would need to bring in almost double that to deliver a positive return on investment.
Understand your state’s laws on practitioner level of autonomy
State laws determine whether nurse practitioners can function independently or whether they must be under the supervision of physicians. In some states, nurse practitioners can work without physician oversight, diagnosing, treating and prescribing. In other states, they can diagnose and treat patients, but require physician oversight to prescribe medications. In still other states, nurse practitioners require physician oversight to diagnose and treat patients and to prescribe medications.
Physician assistants have full prescriptive authority in all but a handful of states, and in most states, the scope of their practice is determined on-site with a written agreement between the supervising physician and the physician assistant. Further information on state laws governing physician assistant responsibilities can be found on the American Academy of Physician Assistants website.
Salary and demand for physician assistants and nurse practitioners
Physician assistant salaries average around $102,000 per year (approximately $49 per hour), while nurse practitioner salaries average around $105,000 per year (approximately $50 per hour). In 2016, there were 104,050 physician assistants in the U.S., whereas there were approximately 150,230 nurse practitioners practicing in the U.S.
Demand for both nurse practitioners and physician assistants is expected to grow at a much faster rate than the average for all jobs due to a physician shortage in many regions and an aging population that requires more healthcare services.
Specialties, authority, and best-fit workplace settings
NPs often focus on primary care, as well as women’s health, geriatrics, and pediatrics. They can specialize in other areas, such as psychiatry, orthopedics or urgent care. PAs may specialize as well, with emergency medicine, surgery, oncology, cardiology, and internal medicine being popular choices. Specialist physician assistants generally earn more than non-specialists.
Nurse practitioners may be employed in a variety of healthcare settings, including hospitals, physician offices, schools, long-term care facilities, clinics and summer camps. Physician assistants, too, practice in a variety of healthcare delivery settings. Typically, you’ll find them in acute care practices, outpatient centers, and private practices.
Which should your practice hire?
Rarely is there a single right answer for whether a nurse practitioner or physician assistant is better for your practice. Rather, you’ll have to consider the tasks you want them to do, what your goal is in hiring them, and other factors, like state laws and tradition in your healthcare provider network.
There may also be regional preferences to consider, and the experience you have in working with one or the other type of healthcare professional. Healthcare providers that have hired PAs in the past tend to hire PAs in the future, and the same holds true for providers that have hired NPs.
It is wise to consider multiple factors, including state laws and the level of autonomy you expect. It may be wise to interview both physician assistants and nurse practitioners, because sometimes the “best fit” person may not be the one you expect.
Nurse practitioners and physician assistants are not interchangeable, but both play an increasingly important role in medical practices that want to improve patient access, strengthen patient relationships and continue to grow.
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