Clinics turn to more non-physicians to boost efficiency

It's becoming much more common for non-physicians to provide care at the doctor's office.

Use of nurse practitioners, physician assistants and other "non-physician providers" increased more than 40 percent between 2010 and 2014 at certain physician-owned surgical practices, according to a national survey released Thursday.

Multispecialty and primary care practices owned by doctors also reported increases, as did all types of clinics owned by hospital systems, according to the report from the Medical Group Management Association.

Practice managers say non-physician providers help boost a clinic's efficiency by letting physicians concentrate on patients with more complicated needs.

"When I started working in medicine in the 1980s, it was rare to see a nurse practitioner or physician assistant in a clinic," said Laura Palmer, senior fellow with Medical Group Management Association, which is a trade group for medical practice administrators and executives. "Now, it's unusual not to see them."

The category of "non-physician provider" goes beyond nurse practitioners and physician assistants to include a variety of professionals, from midwives and psychologists to clinical social workers and physical therapists.

Most have a master's degree level of education, and some work under the direct supervision of a physician.

Gains were smaller at other types of clinics, according to the report, based on survey responses from 3,120 medical groups nationwide.

The trend is clearly at play in Minnesota, said Paul Berrisford, chief operating officer at Entira Family Clinics, a large operator of primary care clinics in the Twin Cities. Whereas a decade ago there were virtually no nurse practitioners or physician assistants at Entira Family Clinics, they now account for 15 percent or more of the providers, Berrisford said.

"It's going to continue to increase considerably," he said. "The idea is … you're using providers at the top of their licensure. A surgeon is not well-used doing physicals or follow-up wound care, where a physician assistant or nurse practitioner is well suited to that."

In a previous report, Medical Group Management Association reported that primary care nurse practitioners had median total compensation in 2012 of $94,062, compared with $207,117 for family medicine physicians. Surgical physician assistants in 2012 had median total compensation of $112,689, according to the trade group, vs. $367,117 for general surgeons.

Demand for non-physician providers is growing, the trade group says, as health insurance coverage expands under the federal Affordable Care Act.