Leaders: Hospitalist Stands Up For Nonphysician Providers
Dr. Mitchell Wilson is a physician who spends a fair amount of his time advocating for the rights of nurse practitioners and physician assistants. Dr. Wilson, chief medical officer for Eagle Hospital Physicians in Atlanta, is a national expert on how to incorporate NPs and PAs into hospitalist practices with the goal of improving patient care, the bottom line, and physician satisfaction.
He helped develop the first-ever survey of nonphysician providers for the Society of Hospital Medicine and serves as an adviser on hospitalist medicine to the American Academy of Nurse Practitioners and the American Academy of Physician Assistants. In an interview, he shared his thoughts on how nonphysician providers can be part of the care team and why this trend is growing.
HN: How did you first get interested in incorporating PAs and NPs into hospital medicine?
Dr. Wilson: I became interested in incorporating PAs and NPs into hospital medicine early on in my career. I was assigned a PA as a result of a health-system acquisition, and as my inpatient practice expanded, I began to rely on the PA a lot more, and we learned how to provide inpatient care as a doctor/PA team. It quickly became evident to me that through incorporating a PA or NP, doctors gain the opportunity to extend their reach and oversight to more patients and greatly expand the capacity of the care they can provide. Through my work at Eagle, I have found that in the right environment, the addition of a PA or NP has the potential to significantly increase the hospitalist program’s efficiency and improve outcomes.
HN: Adding nonphysician providers to a hospitalist group is not a one-size-fits-all proposition. So how do you know if hiring PAs and NPs will actually work in your group?
Dr. Wilson: The single greatest determining factor of whether the hiring of a PA or NP will work for any given group is the doctors on the team. It is important to carefully and candidly assess the doctors’ previous experience and their willingness to work with PAs and NPs. The doctors’ personalities and management skills also are important factors to consider when hiring a PA and NP. Doctors who have the ability to serve in a more managerial or supervisory role tend to work better with PAs and NPs than do the doctors who prefer to be highly involved in the day-to-day details of their cases. Also, the culture and patient make-up of a hospital can play a part in the success of a PA or NP implementation.
HN: Do you see less reticence these days on the part of hospitalists to partner with nonphysician providers?
Dr. Wilson: There is more acceptance within the health care industry that the use of PAs and NPs is a workable model for healthcare facilities. It really depends on the system in place at each individual hospital. PA and NP programs can benefit both small and large facilities, helping to manage workloads and allowing the flexibility to adjust to admission variations. However, you also will see less willingness to incorporate PA and NP models in practices where the compensation model is work-effort based. Whether the impact on compensation is perceived or real, if a significant component of a hospitalist’s compensation is based on production metrics, sharing cases with a PA or NP will not be high on the priority list.
HN: What’s driving the trend to make PAs and NPs part of the team in the hospital?
Dr. Wilson: There are three main factors driving the trend to use PAs and NPs as part of the hospital team: workplace shortages, educational supply, and legislation. There is a large demand for hospitalist services to optimize length of stay, participate on hospital committees, lead quality–and process–improvement initiatives, and provide efficient, cost-effective care, but there is a short supply of hospitalist physicians to provide the services. Access to quality education is providing a solution to that demand by the continued emergence of qualified PAs and NPs in the marketplace. And let’s face it, there’s a subset of hospitalized patients who don’t require day-to-day physician involvement. Societies and associations are magnifying that emergence by pushing for the advancement of PA and NP practices. I believe that PAs and NPs are an important part of the inpatient health care landscape.
HN: How will the implementation of the Affordable Care Act and the move toward team-based care change how hospitalists work?
Dr. Wilson: It is difficult to determine what the Affordable Care Act will actually be in the future, but no matter what the government program becomes, it is important for all physicians and their hospitals to coordinate care in order to efficiently utilize resources while minimizing complications and optimizing outcomes across the continuum of care, from inpatient to outpatient and possibly back to inpatient. Hospitals will continue to be held more and more accountable for that team-based coordination and management of resources.