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Consider hiring a new provider to boost efficiency at your practice


New patients expected under the Affordable Care Act may create a need for an additional nurse practitioner or physician at your practice. Here are tips for bringing on a new provider at your practice to boost efficiency.


New patients expected under the Affordable Care Act (ACA) will create more demand for nurse practitioners (NPs) and physician assistants (PAs). When the demand for appointments exceeds the reasonable wait time for patients, practices must consider their options. If the practice can afford to recruit a new provider, that is usually the first option.

Ideally there should be three months between the time when the provider and practice sign an employment contract and the employment start.

Depending on your state’s commercial carriers, it could take that long for the credentialing process to be completed and for the new provider to begin participating with the payer.

Whether you use in-house staff or an employment service to obtain the provider’s credentials, make sure you have written communication of the completion of the process and the granting of the credentials. If the NP or PA is coming from another state, it may also take him or her time to obtain a license. Check with your professional liability carrier if the new provider is covered under your policy. You should perform the same due diligence you would for a physician who joins your practice. 

It is also wise to have your new NP or PA enroll in a coding course, in order to ensure their skill at identifying the correct codes and preventing reasons for an audit.

Provide guidance

Do not expect the new provider to function independently at the beginning. Consider assigning your most senior and competent medical assistant to work with your NP or PA.

As your NP or PA becomes more comfortable and sees more patients, he or she will begin to develop their own practice within your practice. It is not uncommon for a patient who has seen their primary care physician to develop a relationship with the new provider. When they call the office, they may even ask to make an appointment with the new provider rather than the physician.

Consider scheduling a new patient for 45 minutes and a follow up for 15 minutes, and meeting with the nurse practitioner or physician assistant at the end of every day for three months or more. At that meeting the new provider presents to you the patient, the chief complaint, the workup that was done, and the reasons for labs or radiology tests ordered, the specialists referred to, the prescriptions written, and the instructions given. Through this educational interaction the hands-on knowledge base of the new provider will grow. He or she gains insight into what other questions or tests they may have ordered and what other instructions could have been given.

This process also allows the new provider to understand your philosophy in treating patients. It increases the patient’s confidence that in your practice there is continuity of care between providers.

Expand duties

Once the provider is comfortable, you can expand his or her duties. One practice I work with gives the PA management tasks. The PA now meets with the medical assistants regularly to review work, answer questions, and give an in-service presentation on a specific condition that the practice treats. 


Steven Peltz, CHBC is a practice management consultant with Peltz Practice Management & Consulting Services, LCC, in Brewster, New York. Send your practice management questions to

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