Physician Extenders

Physician extenders are individuals that aid physicians in the practice of health care. They primarily include physician assistants and nurse practitioners. Most states [Page 433]require that they practice under the supervision of a physician who is on the property; however, they do generally have the right to gather history, complete physical examinations, order appropriate tests, diagnose and design an appropriate treatment plan, and prescribe medications.

Physician extenders can typically generate charges and payments at the same level as a physician, but salaries are much less than a physician. Training is generally extended beyond a bachelor's program but less than medical school training. Physician assistants and nurse practitioners often are trained and eventually work in a field that is more specific than general medicine. They often serve in rural areas to increase the accessibility of patients to care, allowing physicians such as primary care providers to hire additional physician extenders at a lower cost and as an easier-to-find alternative to another physician. All areas of health care are becoming accessible to physician extenders. They often serve as primary care providers as well as assistants in specialized areas of medicine.

Physician extenders are gaining in popularity as a profession because of their increasing utility, decreased training time compared with physicians, role in increasing accessibility of medical care, and financial advantage to the health care industry. Increasing acceptance of physician extenders by the public and by health care providers has led to a greater role in health care today. The physician assistant profession is generally thought to have begun in 1965 at Duke University, where the first training program began with four military corpsmen. It is a vibrant and growing profession today. Nurse practitioners are generally registered or bachelor's nurses with a master's degree in nursing. Both professions require a sponsoring physician. Specific state requirements dictate the amount of supervision needed by the sponsoring physician. Both professions find their greatest demand in underserved areas of health care, especially rural areas.

Physician extenders increase efficiency for practices by freeing up physicians to concentrate on more difficult cases. They can decrease the patient load of a physician allowing the physician to care for more patients in less time. They often serve a vital role in patient education, which leads to better compliance with treatment plans. Patients seem to be generally pleased with the care they receive from a physician extender with improved access and decreased waiting times, and seem to trust that their physician is aware of the care offered by the physician extender.

Many practices have found particular usefulness for physician extenders in performing time-consuming tasks that improve patient care but do not traditionally generate great amounts of revenue such as patient education and preventive health care. The key to the success of physician extender usefulness is a trusting, coordinated relationship with the physician team leader. Applying concepts of team management to patient care with physician extenders will help create a new paradigm in medical care. Physician extenders are now shaping that paradigm by their various strengths and weaknesses.

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