Practice Management

Four Key Issues That PAs and NPs Want Physicians to Understand

Consider these insights to optimize the role of PAs and NPs in the health care team

An NP or PA smiling

Physicians may not always be aware of important issues affecting physician assistants (PAs) and nurse practitioners (NPs), both crucial members of the health care team. Jonathan Sobel, DMSc, PA-C, president of the American Academy of Physician Assistants, and Joyce Knestrick, PhD, C-FNP, president of the American Association of Nurse Practitioners, offer key insights on this topic.

PAs and NPs don’t want to be physicians. But they do want to practice to the full scope of their education and training, both Knestrick and Sobel emphasize.

In recent years, some physicians have voiced concerns about the expanding legal authority of PAs and NPs to practice independently to fill important health care provider shortages. But as Sobel explains, “It’s not about PAs looking to compete with physicians, it’s about removing barriers that keep us from being utilized the way we should be utilized.”

PAs and NPs want respect. They want to be recognized for the value they bring to the health care team. “PAs know what their expertise is in, and they want to be treated as colleagues as opposed to just following directions,” he says. Language matters, too. “Do not call us mid-level providers or physician extenders,” Knestrick says. “Call us what we are: NPs.”

PAs and NPs can get caught in the middle during patient management. “For example, one day I might be in the operating room with the surgeon, and the next day I am taking care of the patient in the ICU with the intensivist,” Sobel says, and disagreements may arise among providers about how to best manage the patient. “That can obviously lead to patient safety concerns,” he adds.

“The leader of the health care team should be chosen based on the patient’s wants, needs, and conditions,” Knestrick says.

PAs and NPs are not the same. “NPs are RNs with a master’s or doctoral degree in nursing, and our education is based on the nursing model,” Knestrick explains, whereas PAs usually train alongside physicians in a medical school setting. All NPs choose a specialty when applying for their advanced degree, whereas PAs train as generalists and may later choose a subspecialty. “In truth, when they both graduate, there is not as much of a distinction as you might think,” Sobel says, emphasizing that both professions have evolved side by side over the course of the last 50 to 60 years.


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