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 We are pausing publication of The Daily Briefing out of respect for the tragic passing of Brian Thompson. We will resume publication of this daily newsletter in the coming days.

Daily Briefing

Charted: How physicians really feel about NPs, PAs


As the health care industry experiences ongoing clinical workforce shortages, the push to allow physician assistants (PAs) and NPs to operate with expanded practice abilities is gaining more support—but many doctors still question their treatment decisions, according to a recent Medscape report.

Most physicians, PAs, and NPs have a positive working relationship

According to the National Commission on Certification of PAs, the American Association of Nurse Practitioners, and the Federation of State Medical Boards, there are almost 149,000 certified PAs, 355,000 NPs, and more than 1 million physicians practicing in the United States.

Of those physicians, almost 70% work for hospitals or corporate entities, the Physician Advocacy Institute reports. According to Medscape, these figures suggest that nearly 700,000 physicians work for a health system that also has PAs and NPs on staff.

Overall, physicians, PAs, and NPs say they have a positive working relationship.

Medscape found that 91% of physicians said their working relationship with PAs was "good to very good," and 94% of PAs said the same about their working relationship with physicians. In addition, 87% of physicians said their working relationship with NPs was "good to very good," and 92% of NPs said the same about their working relationship with physicians.

Physicians regularly question treatment decisions made by NPs and PAs

Medscape surveyed more than 750 physicians across more than 28 specialties. While most physicians reported being generally satisfied with the way PAs and NPs treat patients, many still regularly question the treatment decisions made by PAs and NPs.

For instance, 74% of physicians said they were "somewhat satisfied to very satisfied" with PAs' treatment of patients, and 71% of physicians said the same about NPs.

Yet, roughly 80% of physicians said they often or occasionally question treatment decisions made by PAs and NPs. And just 57% of PAs and 63% of NPs said they "often" or "occasionally" find themselves questioning a physician's treatment decisions.

Physicians have mixed feelings about expanding treatment abilities for NPs and PAs

Overall, physicians held both positive and negative opinions about expanding treatment abilities for NPs and PAs. In particular, 57% of physicians said they saw "both positives and negatives" associated with giving PAs more treatment abilities, while 47% had mixed feelings about expanding treatment abilities for NPs.

(Bean, Becker's Hospital Review, 11/29; McKenna, Medscape Evolving Scope of Practice report, 11/29)


Advisory Board's take

The 4 things keeping your NPs from practicing at top-of-license

By Allyson Paiewonsky

Amid the workforce shortages we face, now—more than ever before—it is essential to ensure top-of-license practice across the entire care team. Given present market pressures, a majority of provider organizations will be forced to maintain current staffing ratios while caring for increasingly complex patients. Providers can no longer afford to underleverage NPs' skills if they plan to survive in the current environment.

NPs want—and aren't afraid to leave if they can't—practice at top of license. And based on this report, almost a third of NPs are considering leaving health care, particularly as more of them struggle with burnout and other work difficulties. When asked about what contributes to their burnout, many NPs reported too many bureaucratic tasks (49%) and a lack of respect from their employees, colleagues, and other staff (43%). Leaders must create a platform for NPs to focus on high-value tasks and practice to the full extent of their training and licensure.

One of the major barriers that prevents NPs from focusing on their core responsibilities are pervasive misperceptions about their scope of practice. This barrier is highlighted in Medscape's recently published Evolving Scope of Practice Report, which found nearly 80% of physicians occasionally or regularly question an NPs' treatment decisions. Many health care leaders, physicians, and other care team members don't fully understand NPs' roles, which can hamper interprofessional collaboration and prevent NPs from providing the care they're qualified to deliver. There are four root causes of these misperceptions:

  1. Professional culture: Clinicians learn and practice their profession within a distinct professional culture that may not emphasize the roles of other care team members. Professional culture can also reinforce staff perceptions of hierarchy among different disciplines.

  2. Siloed goals and reporting relationships: Staff in each discipline generally report to leaders in the same discipline, which can prevent members of one discipline from understanding the priorities and goals of other disciplines.

  3. Profession-specific education: Staff in different professions earn their degrees separately and are not always educated on other disciplines' roles and perspectives. Additionally, students are not always given the opportunity to practice working as members of an interprofessional team.

  4. Misperceptions about legal scope of practice: Staff may incorrectly assume that caregivers in other disciplines have more legal restrictions on their scope of practice than they actually do.

To overcome these barriers and build trust in NPs' treatment decisions, it's essential to expand perceptions of the type of work NPs can and should perform. Enhancing physicians' and other peer professionals' understanding of the NP role will help ensure NPs have both the time and interprofessional support they need to practice to the full extent of their training and skills.


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