Integrated NPP systems can yield improved retention, quality of care, and patient satisfaction


Your article "NPPs to the Rescue" (May 2011, p. 24) contained one statement that is at strong variance with our experience: All your interviewees are said to agree that a 1:1 ratio of physicians to NPPs is optimally efficient and that "having one NPP work with more than one physician is not sustainable."

My group has used nonphysician providers (NPPs) for 13 years with great success and excellent retention, physician and patient satisfaction, and quality of care. We have presented nationally on the subject. We have always resisted the formation of separate "teams," and our system involves all 15 NPPs in our largest program working serially with all 35 physicians. This maximizes flexibility and helps to standardize and make uniform our practice styles and clinical methods. Also, it promotes a maximally flexible schedule, which we have found is a key to provider satisfaction.

Important to our system is a strong training program for new NPP hires, which allows them to function eventually with a good deal of autonomy. Also embedded in our culture is the notion that physicians and NPPs are both valued team members, and that NPPs are not asked to do work that physicians are unwilling to do. In fact, we tell providers that what physicians find satisfying and gratifying in practice are the same as those that NPPs look for, and that a strong collaborative relationship helps everyone benefit the patient. While it is clear that physicians are the clinical supervisors, NPPs and physicians are on an equal footing in many nonclinical areas of group management.

Another important piece of our system is that all billing is done by the attending physician. Thus, physicians are highly incented to work with NPPs, to seek cases on which they can collaborate, and to maintain cordial relations with their nonphysician associates.

This approach has resulted in an enormously capable clinical team and a high rate of provider retention and satisfaction.

As I heard a number of times at HM11 in Dallas in May, "If you’ve seen one hospitalist program, you’ve seen one hospitalist program." The same applies to optimal utilization of hospitalist NPPs.