Survey Insights: NPs and PAs in Hospital Medicine

One of the most intriguing changes in hospitalist practice staffing over the past few years is the increase in the number of groups integrating nurse practitioners (NPs) and/or physician assistants (PAs) into workflows. When SHM surveyed HM groups in 2005, only 29% of respondents reported having NPs and/or PAs in their practices. In 2011, nearly half (49%) of respondents to the SHM-MGMA nonacademic survey have NPs/PAs in their practices; academic hospital medicine practices were only slightly lower, at 47%.

Of course, it is always important to keep in mind that the respondent pool for the SHM-MGMA surveys is broader than SHM’s historical survey base, which could lead to different results.

Nevertheless, my anecdotal experience from talking with hospitalists around the country, and the experience of SHM Practice Analysis Committee members, supports the conclusion that the proportion of practices using NPs/PAs is growing, and that the number of NPs/PAs per practice is also growing.

Last year, MGMA created new NP/PA specialties just for HM—“Nurse Practitioner: Hospitalist” and “Physician Assistant: Hospitalist.” Data were submitted for only 26 NPs and 23 PAs in these specialties—but hey, it’s a start. Very few practices submitted encounters or wRVUs for hospitalist NPs or PAs, so the only item for which enough data were submitted to report results was compensation, as shown in the table.

NPs in the sample were about evenly divided between hospital-employed and not hospital-employed; however, most of the PAs were hospital-employed. The only region in which enough of the NPs and PAs were located to separately report data was the Southern section. And the vast majority of both NPs and PAs in the sample worked in practices with a shift-based staffing model.

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All Practice Types Hospital-Owned Not Hospital-Owned NPs PAs

Practice Analysis Committee (PAC) member Scarlett Blue, RN, MSN, vice president of quality and clinical development at Atlanta-based Eagle Hospital Physicians, believes the growing number of NPs and PAs is an indication not only of the continued shortage of physician resources, but also of growing recognition of the value that NPs/PAs can bring to a hospitalist practice. She notes that although Eagle has had NPs/PAs in its practices for some time, the company recently responded to this growth by appointing a national director for hospitalist NP-PA services who is an acute-care nurse practitioner (ACNP) and a doctor of nursing practice (DNP).

Dan Fuller, president of IN Compass Health and a PAC member, concurs. “We’ve had varying success incorporating NPs and PAs so far,” he says. “But as a model, it makes sense. We need to find ways to extend the abilities of our physicians without sacrificing quality.”

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