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Physicians finding plenty of NPs, PAs -- but at a price

Physician extenders are pouring out of schools at near-record numbers, and the demand for their services is keeping up.

By Mike Norbut, amednews staff. May 5, 2003. - Correction

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The rising supply of nurse practitioners and physician assistants not only has made it easier for office-based physicians to recruit them, but it also has allowed practices to create specific job descriptions and land the candidates they wa nt.

It is not just an employer's market, however. Because the demand for physician extenders is keeping up with the supply, physicians aren't finding many bargain-basement deals.

With their graduation numbers increasing, nurse practitioners and physician assistants are becoming more plentiful, and with their clinical roles expanding, their versatility and cost effectiveness make them attractive to practices.

NPs and PAs are becoming more specialized, making them desirable to multispecialty groups and primary care practices alike.

Practices often look to these extenders to fill a specific niche.

PCC Community Wellness Center, a collection of three federally qualified health centers based in Oak Park, Ill., just west of Chicago, is looking for a bilingual nurse practitioner to specialize in diabetes care, said Mark Loafman, MD, MPH, a family ph ysician and the group's medical director.

The response the center has received to its advertisements has been encouraging, especially compared with attempts to fill the position in the past.

"It tells us we're in a little better position this time to find someone," Dr. Loafman said. "I think we can be a little picky right now because I think there are people out there."

Looking for physician extenders in general seems to be less of a challenge for practices now. Assisted recruitments were down dramatically in 2002 compared with previous years, according to an annual report by Allied Consulting Inc., a professional rec ruitment firm affiliated with the Irving, Texas-based physician recruitment firm Merritt, Hawkins & Associates.

Most health care employers apparently found an abundance of NPs and PAs last year, so were able to hire on their own, said John Hawkins, Allied's executive vice president.

Registered nurses still in short supply

Meanwhile, the search for registered nurses is becoming more difficult. Allied's assisted recruitments for that position nearly quadrupled from the year before. The well-documented nursing shortage has even forced some practices to change their employm ent models.

PCC Community Wellness, for example, has started to search for licensed practical nurses and medical assistants to fill basic physician support spots, moving registered nurses to cover triage duties, Dr. Loafman said.

Economic principles were evident in salary increases in the Allied report as well.

Average salaries for recruited RNs increased 16.3%, from $43,500 in 2001 to $50,600 last year, according to the report. NPs and PAs, which are included in the same category, saw a salary increase of 3.9%, from $63,500 in 2001 to $66,000 in 2002. (See correction.)

"The market is producing a lot of NPs and PAs," Hawkins said. "In the early and mid-1990s, they were a commodity. If you could find them, you were lucky."

Now, they are pouring out of school in near-record numbers. The American Academy of Nurse Practitioners reported about 5,700 program graduates in 2001 and 5,400 in 2002, and it expects at least that many graduates this year. The American Academy of Phy sician Assistants reported about 4,400 graduates in 2001 and 4,300 in 2002, and it expects about 4,600 graduates this year.

However, the demand is keeping up with the supply: only 1.2% of respondents in the AAPA's 2002 annual census reported being unemployed and looking for work, said Steve Crane, PhD, MPH, executive vice president and CEO of AAPA.

While it only would take a slight decline in demand to disrupt this balance, Dr. Crane said with more specialists interested in hiring and an aging population needing PA or NP services, that isn't likely to happen anytime soon.

"The job market is expanding," he said. "There are newly emerging areas, like cardiovascular care. That's why the prospects for physician assistants and nurse practitioners are so good."

Salaries going higher

Officials from both the AANP and the AAPA said salary figures from the Allied report are too low. Respondents to the AAPA's 2002 census had a salary mean of $72,241, up from $63,168 in the 2001 census.

The AANP is planning to survey its members this spring, but the results from its last survey, in 1999, had a salary mean of about $62,000, said Jan Towers, PhD, a nurse practitioner and director of health policy for AANP.

Even with a higher salary range, these professionals still can be a bargain, officials said.

Nurse practitioners and physician assistants can generate revenue at a pace close to that of a physician and at a considerably lower salary, their professional groups said. They also can receive Medicare reimbursement at 100% of the physician fee sched ule if they bill under the physician's provider number, or at 85% if they bill independently.

"I think the world is still waking up to the value of these providers," Dr. Towers said.

But not every practice sees physician extenders as bargains. Mark Barnhill, DO, a pediatrician and medical director of Iowa Health Physicians, a practice with 55 clinics based in Johnston, Iowa, near Des Moines, said his group decided last year to stop hiring NPs or PAs. The main problems, he said, were that extenders can't cover night calls for physicians and there are increased liability issues for physicians who supervise them.

"We went through a phase where we did look to mid-level providers as the answer, but we quite honestly have become disillusioned," Dr. Barnhill said.

For smaller practices, however, a physician extender may be the answer to staffing needs.

K. Burnell Schaetzel-Hill, DO, a family physician in Olympia, Wash., is looking for an NP or PA to work part time, with the hope the position may soon become full-time. He said he's afraid becoming a boss to another physician could change the environme nt of his solo practice, but he still needs someone who can establish rapport with a patient base.

"The downside to a physician assistant or nurse practitioner is often when patients sign up with a doctor, they expect to be with the doctor," Dr. Schaetzel-Hill said. "What I need is someone who is going to carry a level of focus and personality to be attractive to patients."

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