And that sets them apart--philosophically, at least--from nurse practitioners, who seek more independence.
And that sets them apartphilosophically, at leastfrom nurse practitioners, who seek more independence.
he turf battles aren't only between doctors and other health providers; NPs and PAs are engaged in one, too. That's because NPs are intent on breaking down the traditional medical hierarchy, but PAs have every incentive to maintain it. "We do the same jobs basically, but on a political level we are very different," says Nikki Katalanos, program director of the physician assistant program at the University of New Mexico. "PAs are very closely allied with physicians. We sit on committees at the AMA. Most of us feel it's a partnership we don't want to break. NPs, on the other hand, have battled hard to be independent."
There are also long-running arguments among PAs and NPs over who is better trained and who has the best rapport with patients. True, NPs bring a holistic approach to treating patients, says Katalanos, while PAs tend to be oriented more toward procedures and pathology owing to their training in hospitals and emergency rooms. But, in an experimental program, Katalanos is teaching NP and PA students together and finding that "students aren't that different from each other. Frankly, if we'd use a hybrid of PA and NP training, we'd turn out a much better practitioner."
Michelle Adams, one of two physician assistants working for four FPs in Jefferson City, TN, is typical of most PAs, who are content to practice under the direct supervision of physicians. "The majority of PAs see their role as helping out physicians and providing education to patients," she says. "I ask questions of the physician in our office six or seven times a day. We like practicing as part of a team; most PAs aren't interested in independent practice."
To many physicians, NPs and PAs are equally competent. Solo dermatologist Robert A. Norman, in Tampa, employs a PA and three NPs. "I haven't found much difference between NPs and PAs," he says. His PA and full-time NP do procedures in the office, and two part-time NPs evaluate and do procedures on patients in 200 nursing homes in Florida. It's a good deal for Norman, who spends 85 percent of his time in the office, even though a third of his income comes from the nursing home patients.
He admits, however, that some dermatologists are wary of training NPs and PAs in the specialty. "They worry that these practitioners will take jobs away from dermatologists, but I don't think that is likely," says Norman. "There is certainly a great need for dermatologists in Florida."
Economically, the NPs and PAs pay for themselvesin spades. Norman pays $60,000 to $65,000 for his full-time PA and NP, and each FTE generates at least $150,000 in net revenue. With time, he says, they can learn to do 80 to 85 percent of what he does.
FP Dewayne Darby of Jefferson Family Physicians in Jefferson City, TN, takes issue with NPs' and PAs' doing 80 percent of a doctor's work. "I put people in the hospital, see people in the emergency room, treat acute trauma, and do procedures," says Darby, who employs Michelle Adams. "Eighty percent is too high."
Where his PAs are of immense benefit is in relieving Darby and his three colleagues of the daily demands of patients in three nursing homes by responding to numerous phone calls and faxes. "Seventy-five percent of the time they can make a judgment on what to do," says Darby. "They help me do a better job of staying on time at the office. They also increase patient satisfaction, especially during flu season, because patients can get in to see them more quickly." And since both PAs are women, many female patients ask for them.
PAs may not covet independence the way NPs do, but that doesn't mean they are more reliant on doctors, says Katalanos. "I don't care what you are, when you are right out of school, you have to ask a lot of questions. But after working as a PA for 25 years, I rarely have to say to a physician, 'I need your help.' With enough time and experience, you learn what you can handle and what you can't."
. PAs: "Our role is to help out physicians".