Here five spine surgeons discuss the value of including physician extenders in your practice.
Physician extenders are healthcare provider who are not physicians but who perform the clinical activities typically performed by physicians. They include nurse practitioners, physician assistants and other advanced practitioners.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
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Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Sept. 7, at 5 p.m. CST.
Question: Do you think physician extenders are valuable? Why?
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: I think if used effectively, and trained well, they can be. I have been considering hiring one for a while now, but am concerned about my return on investment and how long it will take until they generate income for me. Also, they affect the personal touch that is characteristic of many practices. This should be considered before bringing someone on.
Other considerations should be — how much will their malpractice insurance be? How skilled are they? Or how familiar are they with your specialty? Can they help in the operating room, clinic or both? Will they need office space? Do you have to expand to accommodate? What about buying additional equipment? How much do they want to make? How much more will payroll taxes or 401k contributions be? And at the end of the day, will they do as good a job as you would?
Jeffrey C. Wang, MD, Chief, Orthopedic Spine Service, Co-Director USC Spine Center, Keck Medical Center of USC, Los Angeles: They are extremely important. Being in an academic center, we have different residents and fellows rotating in our services every two months. Having physician extenders allows patients to identify with a support staff that is constant and familiar, which puts them at ease. These extenders can develop expertise in areas and communicate with patients when we are in the operating room and answer questions. I see my patients developing strong relationships with my extenders and they feel more comfortable with the entire team.
Richard D. Guyer, MD, President, Texas Back Institute, Plano: Absolutely. Physician extenders are extremely important and will play an increasing role in the care of our patients. If they are trained to properly evaluate and treat patients in the same way as their physician supervisor, they will help their physician become more efficient without losing the personal touch. While I consider myself to have great bedside manner, my patients love seeing my physician assistant if I cannot. It has been my experience that physician extenders are loved by patients because they are not under the same time constraints, and they are compassionate and understanding. Again, it is choosing the right extender and training them that is most important.
Isador Lieberman, MD, Director, Scoliosis & Spine Tumor Center, Texas Back Institute, Plano: They are my right and left hand.
Plas T. James, MD, Atlanta Spine Institute: I think they're the best thing that ever happened in medicine! If you can train your PAs properly, there's nothing better than someone who knows your technique and your way of practicing medicine. In fact, it makes medicine better for everybody because it allows you to be able to extend yourself and not have to deal with the stress of having to be two places at one time, all the time. I think a good PA is probably better than having a partner, because they're your extender and they know your in's and out's, your personality type and your way of treating a patient. Like Batman and Robin, it takes a while to get that chemistry together but once you have it, there's nothing better for patient care and for the practice.