The Physician and Mid-Level Provider Relationship
Do you currently have a mid-level provider?
Yes, we have two mid-level providers, they are both physician assistants.
How many years have you had a mid-level provider working within your practice?
We began to use mid-level providers in our practice about 10 years ago.
What circumstances made you consider adding a mid-level provider versus adding an additional physician provider?
In considering how to bring additional value to the practice, we needed more providers to help manage patients in our office. We had a growing practice, and the in-office visits were increasing at a rate that was pushing out new patient visits beyond what we felt was acceptable. We also wanted the providers that were managing patients here to have the same care philosophy as the other ENT partners. We felt like it was a real opportunity to expand our availably, reduce our wait times and patient frustration with getting access quickly and most importantly, we wanted to be able to train the mid-level providers ourselves. Physician assistants aren’t usually specialized, so the opportunity to train them to our care model, align them with our guidelines & best practices and ultimately, position our provider team to be an extension of us as physicians.
In what capacity do you use your current mid-level providers?
Our physician assistants were hired with the intention for them to develop their own patient base and manage their own caseload. We wanted our patients to have greater access to our practice and to us as ENT providers.
Is there a selection criterion that you use when considering a mid-level provider in your practice?
There are many considerations when selecting any provider for your practice. For us, we wanted someone that was eager and motivated to learn, open to additional training, and had a great work ethic. Being able to train “on the job” for a mid-level within the practice allows for molding the care delivery model to one that is consistent from one physician to the other when they are practicing with more than one physician. It allows for standards to be established that are consistent to the office and patient need, not just to the interest of the physician partners.
Are there any limitations to the types of patients that you direct toward your physician assistants?
How a mid-level provider is used within a practice can vary greatly based on the specialties of the training physicians as well as other medical providers on the care-team, for instance, audiology and speech pathology. In our case, our PA’s have built their own patient load with reoccurring patients while assisting with practice growth by taking on new ENT patients, just as a physician partner would be expected to manage their schedule. We utilize our mid-level providers for most office-based procedures; however, we do put limits on some patient types, for example: airway obstructions and nose bleeds; but the limitations of each mid-level provider may vary based on their area of interests as well as experience, eye-hand coordination, and depth perception, as these are requirements when working in the ear, especially as microscope use is typically required.
What type of on-boarding process and training do you use when introducing mid-level providers to the specialty of ear, nose and throat?
How training is approached is determined initially by the experience of the mid-level provider. We were fortunate the first PA we added at our location had been working in the ENT specialty for some time prior to joining our practice. We were able to take the experience that she had from her prior employment and build on it. We focused more our assuring she was comfortable with the fundaments and then moved toward the care philosophy we have established for our practice. Our second PA came aboard without any experience in ENT. However, she had great familiarity with us as a practice, as she had worked on the administrative side of our practice as she was working on her PA degree. This gave us great comfort in hiring, as we already knew her, loved her work ethic and knew she would be open to our training and practice care philosophies. She was already a great fit with our team and our patients.
Is there a difference in microscope training skills for a mid-level provider versus an ENT resident?
As medical residents, most of your learning begins in the cadaver lab as well as working with patients in surgery. This is very different than the physician assistant that learns these skills on alive, alert patients. It takes practice to work under a microscope, but with a planned approach, “see one, do one, teach one” allows for direct and ongoing oversight until the mid-level provider has mastered the microscope.
How do you feel the mid-level provider brings value to your practice?
Adding mid-level providers to our practice allowed us to provide more comprehensive care and follow-up with our patients. Our patients often recommend our PAs as a primary provider to friends and family. This speaks to the quality of care our mid-level providers give to our patients.
When considering the different patient types and procedures that a PA can manage in your office, what do you consider in the training process as it relates to liability?
Just as physicians, mid-level providers may have skills that align with different types of procedures and treatments within the office. There are some limits we set for treating patients initially, airway obstructions and nose bleeds to mention a couple examples. Deciding how a PA will be used in a physician practice is determined by the skills of the provider, as well as the comfort of the physician that is supervising. They do ultimately work as a team.