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The Value of the Physician Extender to the Pain Practice


Physicians who are bearing the entire practice burden are a recipe for disaster, but they can lighten that load by hiring a physician extender.

You can’t go it alone, or at least you shouldn’t try anyway. Having physicians bear an entire practice load is a recipe for disaster both personally and financially, not to mention that your patients will suffer from your inability to provide an optimal level of care. So if you’re looking for a way to lighten your load, turn to a physician extender.

What is a physician extender?We’re talking about physician assistants, nurse practitioners, clinical nurse specialists, nurse anesthetist, and medical assistants.

The role of these individuals, especially in pain medicine has increased dramatically in recent years because of a focus on patient-centered long-term care. The chronic illness of pain necessitates it, and increasingly it’s becoming clear that the highest performing practices are those that have adopted such a model.

Thinking about bringing one on board, but don’t know what to expect? Here are some tips on how to successfully integrate them into your practice:

What to look for in a physician extender

  1. Good students will possess the intelligence and work ethic to succeed in this role
  2. Go with candidates who bring strong recommendations; you want nothing ambivalent. The candidate should stand out as desirable, not just okay.
  3. Though everyone has to start somewhere, if you can get someone with a few years experience in a suitable background, that will ease the transition period and lessen training time.
  4. Look for a willingness to be flexible. The more flexible they are, the more committed to your practice they are likely to be, allowing you to task them with things that detract from the more important aspects of patient care

What benefits will you see from having a physician extender on board?

1) Better patient care, both perceived and real - A PA/NP can successfully and effectively perform many of the tasks that a pain specialist can, including taking patient histories and physicals, inpatient consultations, and minimally invasive injection therapy.

This will allow one person to spend a greater amount of time with individual patients, and gives the physician the ability to allocate that extra time to the more difficult cases requiring their attention.

2) Continuity of care — Patients can now be seen while physicians are away from the office, but more importantly, as a PA/NP’s experience within a practice grows, that continuity of care will go on in the same style, rather than giving the patient an experience outside of their normal expectations and increasing the chances of a negative experience.

3) Improved risk management — The old adage, “Two heads are better than one,” applies here. The presence of a second person within the patient care relationship makes it less likely that important things will be missed. After many years with a particular patient, it can become easy to gloss over certain aspects of their treatment history and having a backup there can facilitate recognition of subtle changes that need closer examination. This can also help produce a faster response to critical needs.

4) A much needed break — Beyond improving care by allowing you to be more focused with your patients, a PA/NP can help improve self-care. Where you might not have had the time to take that full month off you’ve been talking about for the last five years, by shouldering an increased workload for that time, a PA/NP can provide you with the security to do so.

And if it’s not a question of time, but lost revenue, a PA/NP can make up there as well. In most cases the reimbursement rate is /-85% of a physician’s charge.

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Victor J. Dzau, MD, gives expert advice
Victor J. Dzau, MD, gives expert advice