“Do it or quit. This is how it is.”
Jacqueline Hanna, MD, is another pediatrician who was also replaced by non-physician providers. Hanna told me she took a job at a pediatric urgent care in Texas right out of residency in 2011. “I didn’t know anything about supervising NPs at the time, and I didn’t really need to, since when I started there were 13 physicians and only one nurse practitioner,” she said.
But gradually that ratio began to change. Hanna noted that every time a physician would leave the group, he or she would be replaced with a NP or physician assistant (PA) rather than another physician. “I found this very frustrating, but even worse, we were told by our administration that supervision was not an option. Do it or quit. This is how it is,” she said.
Hanna told me physicians were not given any compensation at all, and no administrative time to review charts, much less to do actual supervision. “I was in a state of high anxiety,” she recalled. “I couldn’t physically see every patient that I was supposedly supervising, and I worried about patients being harmed.”
Hanna felt patients were harmed. “I noticed that patients were bouncing back to the urgent care more often. The administration didn’t see this as a problem – in fact, it was a financial incentive,” she said.
Ultimately Hanna left the organization because of the supervision conflict, but she has found that most jobs in her field in Texas require her to supervise NPs and PAs. “I really don’t have any option. Every job offer I have had requires supervision. I just make sure that I can interview the midlevel first, and then I am very hands-on about supervision. I also make sure that I get compensated for my work.”