• Revenue Cycle Management
  • COVID-19
  • Reimbursement
  • Diabetes Awareness Month
  • Risk Management
  • Patient Retention
  • Staffing
  • Medical Economics® 100th Anniversary
  • Coding and documentation
  • Business of Endocrinology
  • Telehealth
  • Physicians Financial News
  • Cybersecurity
  • Cardiovascular Clinical Consult
  • Locum Tenens, brought to you by LocumLife®
  • Weight Management
  • Business of Women's Health
  • Practice Efficiency
  • Finance and Wealth
  • EHRs
  • Remote Patient Monitoring
  • Sponsored Webinars
  • Medical Technology
  • Billing and collections
  • Acute Pain Management
  • Exclusive Content
  • Value-based Care
  • Business of Pediatrics
  • Concierge Medicine 2.0 by Castle Connolly Private Health Partners
  • Practice Growth
  • Concierge Medicine
  • Business of Cardiology
  • Implementing the Topcon Ocular Telehealth Platform
  • Malpractice
  • Influenza
  • Sexual Health
  • Chronic Conditions
  • Technology
  • Legal and Policy
  • Money
  • Opinion
  • Vaccines
  • Practice Management
  • Patient Relations
  • Careers

How hiring a physician assistant or nurse practitioner could ease a physician’s work load, increase take-home pay, and more


If you are having trouble finding physicians to join your practice, dismayed by their demands or expectations at interviews, or concerned about their high cost or need to be a partner, hiring a physician assistant or nurse practitioner may be your answer.


If you are having trouble finding physicians to join your practice, dismayed by their demands or expectations at interviews, or concerned about their high cost or need to be a partner,  hiring a physician assistant (PA) or nurse practitioner (NP) may be your answer.

Hiring midlevels can ease the physician’s practice pressures, increase take home income, and increase patient satisfaction. A primary care entrepreneur can earn as much as a surgeon and more.

A real-life example

Enter Alfonso Alvarez (the names have been changed to protect confidentiality), a family physician and the sole owner of La Vida Health Center, S.C., a family medicine practice in Waukegan, Illinois.

When I began consulting Alvarez in 2010 he was already doing well. Statistics for 2009 from the National Association of Healthcare Business Consultants indicated that family practitioners were taking home $184,382 (33%) on $559,584 in receipts. The average practice had two physicians and about one-third of the practices used a midlevel provider. Alvarez would generate $809,000 and retain 35% of it. He was earning $100,000 more than the average using one full-time-equivalent PA.

So as an observer, I said: “If the meal is good why not go for seconds?” 

Alvarez hired a second PA, the limit in Illinois at the time. Then a providential change in state law allowing the physician to supervise up to five PAs was passed. Cycle time to fully busy was less than 6 months. Then Alvarez decided to hire a third PA. His take home income in 2010 increased by 29%.

In 2012, I devised a productivity incentive program that resulted in a huge boost in the productivity of the midlevel support staff. His PAs will earn more than $120,000 each this year while each will produce over $400,000 in receipts. He just doubled his office space and expanded office hours. His operating expenses climbed by 34% since 2010, and he added debt due to a large expansion of his office footprint. His take home income in 2013 will be significantly more than twice what he earned in 2010.

Now with the passage of the Affordable Care Act (ACA) and the creation of the Patient Centered Medical Home, (PCMH) the practice is looking to the “community health” model. Alvarez is adding an NP to help with care coordination and management of the statistical reporting requirements and implementation of the PCMH tools within his electronic health record (EHR).

Alvarez is one of many physicians implementing this model with success. The bottom line is that midlevel providers, if productive, do not cost a practice anything and can actually increase revenue.

Should you hire a midlevel?

Remember, the new competitor in healthcare delivery may not be your local hospital. It may be the CVS or Walgreens on the corner or an entrepreneur building a high-access clinic down the street in states that allow them.

Because of these competitive pressures, midlevels may be the best way to expand your practice, increase the amount of net income per square foot of space, and provide you with a lifestyle that creates more freedom of choice.

If you answer ‘yes’ to these questions, you may be the perfect candidate to hire a mid-level:

  • Do you know your state law and limits?

  • Is your practice fully busy?

  • Do you have a full waiting room at times during the week?

  • Do you have a day of the week that is “crazy?”

  • Can you double book and keep up?

  • (Are patient waiting times an issue?)

  • Are you booking new patients more than 3 weeks out?

  • Are you offering 30 hours of office clinic time per provider?

  • Are you having trouble recruiting another physician?

  • Can you spare an exam room

  • or two and/or expand hours?

  • Can you cover the first 4-5 months

  • of salary for a midlevel?

  • Can you filter for the hard worker

  • in your interviews?

The American Academy of Physician Assistants credential verification service, offered in conjunction with the American Medical Association, is a great tool for verifying candidate credentials. Two certifications employers should look for are the Physician Assistant National Certifying Exam (PANCE) for recent graduates and the Physician Assistant National Recertifying Exam for PAs who have been practicing for more than 5 years. 

Related Videos
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health