Both Bednash and Hooker provide examples of how NPs and PAs already expand a practice’s capabilities. “You might have a cardiology practice with cardiologists providing the high-level, specialized care for patients with heart disease, and then have a team of NPs working with those physicians to oversee the other kinds of issues that patients have besides the cardiac ones,” Bednash says. “They are able to make sure that the care is very comprehensive and coordinated in a way that the other needs are not forgotten.”
Hooker describes a hypothetical urology clinic of four doctors who hire a PA. “The PA may say, ‘I’m a surgical PA’ but is never in the operating room,” he says. “He or she is taking care of the patients in the office. That either helps maintain continuity of care or tends to offload somewhat from primary care: ‘Oh, your blood pressure is up, let me get an ECG…. It looks like the ECG shows an ST depression. I think we’d better get you into your primary care doctor, but I’m going to start you on some antihypertensives today.’”
For Bednash, the larger issue involves “making sure that reasonable people in both disciplines [medicine and nursing] understand that there are tremendous access and care needs in this country that can only be met when physicians and nurses are allowed to practice to the highest level of their education, knowledge, and skills.
“To some extent, at some point, people are going to have to confront some of the biases about limiting scope of practice for NPs so they can do everything they are capable of doing,” she adds. “The old biases of some physicians have got to be laid to rest. The good news is, in a lot of places, they have been—but it needs to be more uniform.”
For his part, Salsberg agrees that mutual respect and understanding will be key. “We need to do more to prepare our practitioners, our physicians, to work in collaborative practice,” he says. “PAs, NPs, and physicians need to be educated and trained to work together, so that everyone coming out understands and respects the skills of all the other professions.”