n the recent past, the government was evaluating the concept of Medical Homes with Primary Care Physicians (PCPs) serving as the active navigator of their patient’s health care. This was an innovative theory; but in practice, it was highly unlikely to have a substantial impact on the delivery of care. At the same time as the government was proposing this solution to the conundrum of care availability, the reimbursements doctors were receiving for various services, procedures and tests were reduced. This reduction meant PCPs would have to see more patients to maintain a level of income commensurate with the sacrifices they have made in their lengthy education.
There was an interesting article on medscape.com this week “NPs and PAs: Growing by Leaps and Bounds.” The article indicated that while the number of physicians is increasing by over 1%, the numbers of Nurse Practitioners (NPs) and Physician Assistants (PAs) are growing even faster at a projected rate of 6.8% for NPs and 4.3% for PAs. This influx of non-physician providers is another indication of the rapidly changing landscape within the American health system. This as another example of American ingenuity – to find solutions to complex problems while allowing an evolutionary process to occur.
NPs and PAs can spend more time with the patient. Their caseloads are designed for them to allow almost twice as much time with each patient as a physician would have. This leads to the patient having the ability to express their concerns more effectively as they feel less pressured during the visit. A recent study showed physicians tend to interrupt their patient every 3 seconds, while an NP would make a comment every 12 seconds. In the environment of an exam room, this level of attention is very helpful to creating a patient friendly atmosphere. In patient satisfaction studies, making the initial point of contact with an NP or PA is increasing patient satisfaction.
The increasing use of artificial intelligence as a diagnostic tool is also changing the way healthcare is delivered. Much like the automobile industry has changed. When you take your car in for service, it is astonishing how they plug-in a set of diagnostic tools and, with pinpoint accuracy, diagnose the problem. We are certainly headed the same direction in healthcare. With increasing miniaturization of technologies, phone applications are now possible. You can now take a two lead EKG with your phone and forward it instantly to a doctor.
Advances in diagnostic tools, combined with the increasing sophistication of NPs and Pas, are disrupting the old care delivery process in a positive way.
Good listening has always been the best diagnostic tool. Now patients will have more time to communicate their concerns. When you combine the time available to listen of the NPs and PAs with the technology breakthroughs that are continuing to emerge, patient satisfaction should continue to increase.
In no way does this change delivery or denigrate the fundamental role that physicians play in assuring that we are receiving the best healthcare possible. They remain the center of the delivery system around which all of these providers and new technologies revolve. This just allows more patients to be seen, and PCPs to be able to devote their time more effectively.
