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tients’ blood counts are checked, prescriptions
are written, and any toxicities or symptoms
are managed within that fast-track program.
The infusion clinic is another place to embed a PA or an NP: If a patient has an allergic
reaction, needs premedication before receiving infusional therapies, or has symptoms
that need to be managed during infusion, the
PA or NP can manage those cases. Running
symptom management clinics for patients experiencing nausea or pain, as well, falls within
an APPs’ scope of practice. The physicians,
then, can focus their attention on creating
treatment plans for new patients.
Rather than
replacing or
undermining what
the physician
is doing, APPs
can enhance
productivity.
We are equally
invested in
patients’ success.
Barriers to Success
To be successful in these endeavors, all parties involved must be open to change. In my
experiences, there are three common barriers
to success.
First, physicians may not fully comprehend the APP scope of practice – an obstacle
easily overcome with a little bit of homework
into each state’s practice environments.
The next barrier is a lack of commitment
to team-based practice. If you are a lone wolf,
working with a PA or NP is not going to be a
rewarding experience for you. When physicians work as a team with APPs, they must
have confidence that they are interacting with
professionals who have complementary skills.
Everybody must be committed to delivering the best-possible patient care, including shared performance goals and mutual
accountability to each other and the patients.
This requires excellent communication and
ongoing mentorship and support. This goes
both ways – between the physician and APP
and between the APP and physician.
Concerns about productivity are the
26
ASH Clinical News
third barrier to success that I witness among
physicians who are wary of integrating APPs
more thoroughly into practice or handing off
responsibilities. Again, with a bit of education and a shift in perspective, it is a barrier
that can be quickly overcome. Many physicians may view the NP or PA as a competitor
instead of a team member – particularly in
a system where providers are being measured as individuals. For example, if you are
in a practice with 10 physicians, and every
physician is being seen as an individual, the
physician is predisposed to view an NP or
a PA as a competitor taking away from the
physician’s patient encounters, relative value
units, and case volumes.
What I prescribe is a change in perspective. Instead of viewing it as an individualbased practice, think of it as a team-based
practice. Look at your metrics of productivity and value from a team standpoint. Take
this example: Before working with a PA, an
individual physician may see 30 new patients
per month and produce 3,000 RVUs. With a
PA joining their “team,” together they may
see 48 new patients per month, bumping the
RVUs up to 4,500 per month.
Rather than replacing or undermining
what the physician is doing, APPs can enhance productivity. We are equally invested in
patients’ success.
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The Ideal Physician–APP Dynamic
The ideal relationship is a team-based model,
where the APP and the physician have shared
goals, mutual accountability, team-based
productivity metrics, and are committed to
working as a team with mentorship; support;
and open, ongoing communication.
Yes, there are patients who require the
physician’s expert knowledge and care, but
there are also patients who can be seen and
cared for by the APP; and then there is a
whole group of patients who can benefit
from shared care from both the physician
and the APP. With a collegial physician–APP
relationship, everybody – including the patients – wins. ●
Todd Pickard, MMSc, PA-C, is director of the
Physician Assistant Administrative Programs
at the University of Texas MD Anderson Cancer
Center in Houston, Texas.
references
1. Towle EL, Barr TR, Hanley A, et al. Results of the ASCO
Study of Collaborative Practice Arrangements. J Oncol
Pract. 2011;7:278-82.
2. American Association of Nurse Practitioners. “State
Practice Environment.” Accessed June 18, 2015, from www.
aanp.org/legislation-regulation/state-legislation/statepractice-environment.
3. American Academy of Physician Assistants. “State Practice
Profiles.” Accessed June 18, 2015, from https://www.aapa.
org/threecolumnlanding.aspx?id=328.
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July 2015