For hospitalist programs entertaining the notion of hiring a midlevel provider (and for those midlevel providers interested in joining a hospitalist program), there are barriers to such a relationship. One inherent problem is that most hospitalists do not understand how to work with midlevel providers. Many hospitalists are unaware of the midlevel providers’ education and training.
I am not surprised. Most hospitalists did not work with midlevel providers during their training. There are not only differences in education and training among nurse practitioners (NPs) and physicians’ assistants (PAs), but many state licensing boards also limit their scopes of practice in a different manner. I find that many hospitalists want their midlevel providers to do the scut work hospitalists don’t want to do or feel they don’t have time to do.
I feel this is an expensive way to hire someone to do discharge summaries, put in orders, and make follow-up appointments. One does not need a midlevel education and training to perform those tasks. I suspect most midlevel providers—like hospitalists—find these tasks unsatisfying if it is the majority of their job description. Hospitalist programs would be better served if they involved midlevel providers in the care of patients. But this will require additional training to help hospitalist understand the level of supervision that is necessary for midlevel providers.
For hospitalists who work with midlevel providers, I find too often that many provide too much or too little supervision. Neither is appropriate. Another barrier in some parts of the country relates to the compensation of hospitalists and midlevel providers.
In the Northeast and on the West Coast, for example, we find smaller differences between hospitalist and NP salaries. Since NPs bill at 85% of physician billing, it may not necessarily make financial sense to hire NPs when one can hire a physician at slightly higher cost.
I hope I have not dissuaded you from pursuing a job in hospital medicine. I believe the development of roles for midlevel providers in hospital medicine is critical to the continued expansion of hospital medicine in this country.
I implore hospitalists and midlevel providers to work together to explore and establish models of care that will provide sustainable career opportunities for midlevel providers in hospital medicine. TH