Category: Advanced Practice

Unsurprising News of the Week: Another Doc Is Against Full Practice Authority

Another week, another physician calling into question the ability of advanced practitioners to treat patients as the primary care shortage looms.

“Nurse Practitioners Can’t Do What Primary Care Docs Can Do” reads the headline of an MD-penned op-ed published this month by Managed Care Magazine.

The piece, written by Alan Adler, MD, a recently retired senior medical director for utilization management and precertification at Independence Blue Cross in Philadelphia, begins by setting forth three patient cases he had encountered: a 72-year-old man exhibiting concentration and memory issues, who Adler was able to diagnose with a large meningioma; a 50-year-old male who was experiencing loose stools, which Adler tied to a sugar-free candy habit after myriad GI testing; a man with an irregular heart rhythm, who had been suffering from fatigue and dizziness, who Adler had been able to help by identifying it was a case polypharmacy.

Adler then goes on to say the cases are “the intensely satisfying, salient episodes of intuition informed by our long hours of medical training,” before bringing up Nurse Practitioners and their quest for full practice authority in the face of the ballooning primary care physician shortage.

“[W]ould a nurse practitioner have recognized, diagnosed, and addressed the issues in the three cases I have just described? Are they comfortable delving into complex polypharmacy issues and stopping medications prescribed by physicians? Can they recognize Wencke-bach and its importance on an ECG in the office? I would argue probably not,” Adler debates in the piece, calling into question the ability of NPs to practice independent of physicians.

It is certainly clear that Adler, like many other physicians who have penned similar op-eds in recent months, opposes NPs as a viable solution to the physician shortage. However, like many others who have voiced their opposition, he falls short of offering an alternative, concluding his piece by calling for a model of care that has already been implemented across America and is proving to fall short of solving the problem: “I am not against new models of primary care. A primary care physician overseeing several nurse practitioners and physician’s assistants is an excellent way of increasing access to care without sacrificing quality.”

How do you feel about the op-ed and the constant opposition NPs and PAs face from physicians? Tell us below, or submit an op-ed of your own here.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Burnout Isn’t Just a Physician Problem

NPs and PAs are often touted as the solution to the growing primary care physician shortage, but at what cost? Burnout impacts them, too.

The growing primary care physician shortage has put an overwhelming strain on doctors in the United States, often in the form of burnout. A combined workforce of nearly 400,000 strong, Nurse Practitioners and Physician Assistants have been poised and ready to be, and often touted as, the most viable solution to the shortage. But at what cost? After all, NPs and PAs are not immune to burning out, themselves.

According to the International Classification of Diseases, which now classifies burnout as an occupational phenomenon, burnout is defined as “chronic workplace stress that has not been successfully managed.” Those suffering from burnout often experience feelings of energy depletion or exhaustion, increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job, and reduced professional efficacy.

Last fall, the Journal of the American Academy of Physician Assistants published the first report on national trends of burnout among PAs. The data revealed that 62.1% of PAs had enthusiasm for their work, while 21.4% reported some degree of cynicism, and 10.4% reported a low sense of personal accomplishment. The report also revealed that 12.8% had never left a position due to stress, but were considering quitting their current position due to stress, burnout, or a toxic workplace, and that 30% had quit once in the past due to stress. Another 11.7% of PAs had left more than one position due to burnout.

As for Nurse Practitioners, burnout in the nursing profession, as a whole, is well-documented. Nurses experience some of the highest risk and rate of burnout, with a third of all nurses in the U.S. reporting high levels of emotional exhaustion. Though Nurse Practitioners may outrank RNs, they seem to be experiencing similar levels of burnout. For instance, though the NP profession ranked #7 on U.S. News & World Report’s 100 Best Jobs list in 2019, it was also reported that NP experience above average stress and below average work-life balance.

Are you feeling burnt out in your role as an NP or PA? How do you combat work-related stress? Tell us in the comments below.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

States with the Most Jobs for PAs and NPs

Physician Assistants and Nurse Practitioners are some of the most in-demand healthcare professionals in the nation, but where is demand highest?

Physician Assistants and Nurse Practitioners are some of the most in-demand healthcare professionals in the nation, but where, in particular, is that demand? We analyzed data on our site and came up with the three states with the most available openings for PAs and NPs right now, as well as a selection of noteworthy openings for each position type.

Nurse Practitioners

1. California

Number of NP Jobs Available in California: 427

Average Annual NP Salary in California: $126,890

Noteworthy Openings in California:

Click Here to Search NP Jobs in California

2. New York

Number of NP Jobs Available in New York: 350

Average Annual NP Salary in New York: $118,550

Noteworthy Openings in New York:

Click Here to Search NP Jobs in New York

3. Washington

Number of NP Jobs Available in Washington: 235

Average Annual NP Salary in Washington: $116,350

Noteworthy Openings in Washington:

Click Here to Search NP Jobs in Washington

Physician Assistants

1. California

Number of PA Jobs Available in California: 207

Average Annual PA Salary in California: $118,500

Noteworthy Openings in California:

Click Here to Search PA Jobs in California

2. New York

Number of PA Jobs Available in New York: 116

Average Annual PA Salary in New York: $117,060

Noteworthy Openings in New York:

Click Here to Search PA Jobs in New York

3. Connecticut

Number of PA Jobs Available in Connecticut: 71

Average Annual PA Salary in Connecticut: $126,320

Noteworthy Openings in Connecticut:

Click Here to Search PA Jobs in Connecticut

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

How to Talk to Patients Who Oppose Vaccines

Measles disappeared from the U.S. in 2000. Now, it’s back, with 1,172 cases across 30 states. Here’s how to talk to patients about the importance of vaccines.

As of August 1, 2019, the CDC reported 1,172 cases of measles across 30 states, the greatest number of cases reported in the U.S. since measles was eliminated from the country in the year 2000.

It is commonly known among healthcare professionals that the best way to protect against measles and many other preventable diseases is to vaccinate. However, since 2001, the number of people who did not receive vaccines for preventable diseases has quadrupled, thanks in part to what is commonly known as the “anti-vax” movement. The movement, which has been around for more than a hundred years, has found its foothold in pseudoscience and misinformation disguised as advocacy. At the very least, anti-vaxxers have made it harder for medical professionals to do their jobs and, in what is arguably the worst-case scenario, they and their message have put lives in jeopardy.

But not everyone who does not vaccinate is staunchly anti-vaccines—some are hesitant, others are misinformed. Still, speaking to them about vaccines may be challenging for even the most seasoned provider. Here are some tips that might make the conversation go a bit more smoothly.

Listen to Their Concerns

No one wants to feel like they are being strong-armed or railroaded. Though their concerns may be medically invalid, they are still personally valid to them. Be sure to listen to what they have to say, with empathy and without interrupting, so you know their concerns and, in turn, how to respond to them.

Counter with Facts

They may bring up misinformation as part of their concerns, such as claims that certain vaccines are “linked to” autism or SIDS. As you likely know, there is a barrage of evidence against these unfounded claims. It is your job as a medical professional to provide them with science-based facts to alleviate these concerns.

Stand Firm, but Know You May Not Win

It may take more than one conversation to quell all of their concerns and allow you to administer vaccinations. Be prepared to have the conversation the next time they come to see you, and be sure to explain the risks involved in their decision to not vaccinate in the meantime, as well as precautions they can take to keep themselves, their child, and/or the public as safe as possible while unvaccinated.

What other methods have you found to be effective in speaking to patients about vaccines? Leave them in the comments below.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Suicide Risk Among Nurses Higher than Non-Nurses

Nurses are at a higher risk of suicide than the general population according to the findings of the first national investigation into nurse suicide in over twenty years.

Nurses are at a higher risk of suicide than the general population according to the findings of the first national investigation into nurse suicide in more than two decades.

The study, which was published in Archives of Psychiatric Nursing, found that suicide incidence was 11.97 per 100,000 female nurses and even higher among male nurses, with suicide claiming 39.8 per 100,000. Both figures are significantly higher than that of the general population, which is 7.58 per 100,000 women and 28.2 per 100,000 men. Overall, the suicide rate was 13.9 per 100,000 nurses versus 17.7 per 100,000 for the general population.

In all, over 400 nurses per year die by suicide, and according to the study, nurse anesthetists and retired nurses were at the highest risk.

“We are overworked and stressed, and on the edge of the breaking point at any given moment,” said Ariel Begun, BSN, RN, who was willing to speak with us regarding the alarming rate of nurse suicides. “In the last 10 years I have seen the expectations of nurses increase and the staffing and quality of supplies decrease. Nurses have been told they need to do more with less for years and it keeps getting worse.”

When asked how the healthcare industry and its employers can better support the mental health of nurses, Begun had a lot to offer.

“First, fix the systemic problems in healthcare. Starting with patient to nurse ratios being lowered, and increased staffing for support of the department and to ensure someone is available to help in emergencies. We should not consider barebones staffing to be the norm. We also need to provide better resources for nurses to care for patients without having to use the cheapest thing on the market. Additionally, we need better hours and shift options. We should not need to work to the point of jet lag mental conditions, where our basic thought capacity is diminished to the point where we have trouble remembering to care for ourselves.

“Guilt is also a driving factor for nurses. We don’t call out when we are sick because we know the department will be hurt by us not being there. We don’t get decent breaks and we work to the point of dehydration and kidney failure potential. Toss in Neurogenic Nurse Bladder, a condition that develops because of the nurse’s lack of bathroom break time. Can’t pee, I might miss a call from the doc, or my patient might code while I am away.

“In regards to mental health specifically, it would be nice to have group support sessions where nurses can get together and talk about the issues they have. Resources for home-work balance need to be available, too. I always thought that a group yoga session would be a nice thing to have as a way to get your day started in a healthy manner. The first lesson I learned in nursing school was, now is not the time to try to quit any vices you have, in fact you might as well double down on them, because they are going to be what helps you get through your day. Nurses are taught to do the things that we then need to teach our patients not to do. Nurses are not taught coping strategies for how to handle their stress. They are only taught that it is a thing and you can’t escape it.”

If you are having thoughts of hurting yourself or others, we encourage you to seek help by calling the National Suicide Prevention Lifeline at 800-273-8255 or by texting 741741 to have a conversation with a trained crisis counselor via the Crisis Text Line.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

How Do You Deal with “I Want to See a Doctor”?

What do you do when a patient has the audacity to say, “I want to see a real doctor,” thus calling into question your qualifications?

By Jessica Levinson

Earlier this year, while working the front desk in a specialist’s office that employed PAs, MDs, and DOs, it was a sentence I heard pretty frequently—“I want to see a doctor, not a PA.”

Though we followed company policy and told patients they would be seeing an advanced practitioner during scheduling, and though there was a clearly displayed sign in the waiting room informing patients that the practice employed PAs and NPs, patients would often claim they were not made aware and often said that they never would have scheduled an appointment and that they would not have wasted their time coming to the appointment, if they knew they were not seeing a physician, often in more colorful language.

Having written scores of articles for this very blog about the comparable or better care advanced practitioners provide, I cringed every time—while I also tried to convince patients to keep their appointments and see the advanced practitioner on staff. Sometimes, it worked. Sometimes, it didn’t. Mostly, I wondered how PAs and NPs dealt with the question themselves.

I asked one of the PAs on staff this very question. She said, in summation, “I’m not going to force them to see me. If they want to see a doctor, they’re welcome to. It’s just going to be a few weeks before they can get that appointment.”

As the physician shortage continues to grow and, in turn, to leave gaps in access to care, her sentiment seemed pretty spot on. Often, when scheduling patients, I was able to offer same day appointments with the PA or NP, but would need to look as far as three weeks out for a ten-minute time slot with the MD.

To me, it is more important to have whatever my medical issue is handled by someone who knows more than myself and a Google search, no matter their title. However, some will continue to want to be cared for exclusively by physicians. When they do, how do you find yourself responding? Tell us in the comments below.

Jessica Levinson is HealthJobsNationwide.com’s Social Media Manager and Brand Ambassador, who also moonlights as a best-selling poet and freelance writer.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Yet Another Physician Speaks Out Against PAs, NPs

As the physician shortage worsens, there is no shortage of physicians speaking out against the idea of PAs and NPs being comparable substitutes.

A physician-penned op-ed published online this week entitled “NPs/PAs ‘Just as Effective’ as Physicians? I Don’t Think So” casts a negative spotlight on PAs and NPs, yet again.

The piece, which was written by Starla Fitch, MD, an ophthalmologist, speaker, and personal coach, brings up the oft talked about physician shortage and all but ridicules the idea of advanced practitioners as a comparable substitute, with Fitch stating in the piece, “With all due respect to our healthcare team, I beg to differ that going through four years of college and completing an additional two years – sometimes online, no less – can truly be “just as effective.””

Fitch takes issue with calling PAs and NPs equal to physicians, but admits support is needed by other members of the healthcare team.

“I’m not arguing against having the support of other healthcare members. Trust me. The shortage is real. And we need to find solutions,” Fitch writes, continuing on to say, “But please don’t say, we are “just as effective.” I realize that there are many duties that nurse practitioners and physician assistants can do with skill and authority. And the reasons why primary care physicians are declining is multifactorial, for sure. As I see it, though, putting physicians and our skill side-by-side, on equal footing, with those who are not physicians only serves to drive a deeper wedge between the healthcare folks who need, at this crucial time, to come together.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Female PAs Still Paid Less than Male PAs

Female PAs earn $.91 to every dollar male PAs earn according to the newly released findings from the AAPA’s annual salary survey.

The results of the annual AAPA Salary Survey have been released, and they offer a stark look at pay disparities between male and female physician assistants.

The survey, which obtained responses from more than 8,000 PAs, found that full-time female PAs were, on average, being paid $13,380 less than their male counterparts, and that they were less likely to receive bonuses than male PAs—a rate of 40% for women and 53.4% for men. Even when taking into account other factors that could be expected to affect compensation, the survey found a 9% difference in pay between female and male PAs—or, to put it bluntly, female PAs earn $.91 to every dollar earned by male PAs.

The AAPA attributes this, in part, to more males entering the 52-year-old PA profession earlier than females, thus giving them more experience and seniority, which the survey found to result in higher compensation. However, the AAPA also notes, “The total compensation discrepancy begins almost immediately upon entering the profession—there is a disparity between male and female PAs in the first years of practicing as PAs. This difference may be exacerbated as PAs progress through their careers, since increases in pay are often based on increasing the previous salary by a certain amount, and new employers often base a PA’s starting pay in part on their previous salary. A compensation disparity that begins on a PA’s first day on the job could have lifelong implications for the PA.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

A PSA on How to Address PAs

A physician assistant took to Twitter this week to offer up a PSA on how to address PAs, something that many still manage to bungle.

A physician assistant took to Twitter this week to offer up a public service announcement on how to address PAs, an issue that seems to frequently arise, and one that many still manage to bungle.

“Physician assistant” seems like a straight-forward enough title. However, some still add ‘s to the end of “physician”, as if implying a physician’s ownership of a PA, as opposed to the PA being a colleague of the physician. To help avoid this, David J. Bunnell, MSHS, PA-C created a handy graphic that you, too, can share to help educate the public on how to correctly refer to PAs.

“PAs mean no disrespect to any other healthcare professional. We all share the same mission to help patients feel better and live longer,” Bunnell said when asked about his tweet, and we couldn’t agree more.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

5 Reasons to Give Travel Positions a Try

For those with a sense of adventure, travel positions need no other selling point. If you don’t have a natural love of travel, though, here are five other reasons to consider travel assignments.

Not a lot of careers come with the ability to travel the country and get paid for it, but there are quite a few in the healthcare arena that do. Physicians, advanced practitioners, nurses, therapy professionals, and more are afforded the unique opportunity to accept contract positions, often also referred to as locum tenens, at hospitals and clinics all over the United States, from sea to shining sea. For those with a sense of adventure or a love of travel, this needs no other selling point. However, here are five scenarios in which you may want to give travel assignments a try, if you need more convincing.

If You’re Relatively New

Travel positions provide a good opportunity to figure out what you want to specialize in, in which setting, or even what area of the country you want to live in. Since travel positions are predominantly contracts that are two or more months long, you’ll have plenty of time to see what you like, or don’t like, before fully committing to a permanent position somewhere and setting down roots.

If You’re Feeling Burnt Out

A change of scenery can do wonders for the seasoned clinician who is struggling with the all too common pains of burnout. Working with different populations of patients, or even different coworkers, in different places can help to alleviate the feeling of stagnation. Travel positions typically also afford more work-life balance and less intensive schedules, which allows you to focus more on the things that truly matter in your life—not just documentation.

If You Want More Money

Locums positions typically offer higher salaries than permanent positions, sometimes as much as 30-50 percent more. If you are trying to pay off a student loan, or just want to tuck some money away for a rainy day, signing on for a few travel positions is likely to get you out of the red.

If You Want a Trial Run

Travel positions allow you to try out a wide range of settings and patient populations, often with the option to take on a permanent role within the practice you are filling in at. If you are thinking of pivoting in your career, this is a good way to “try before you buy,” so to speak, that will allow you to make an informed decision about where you want to settle in for the long-term.

If You Want to Make a Difference

Locums positions are often available in remote and underserved areas, allowing you to significantly impact the lives of people who need your skills the most. From the most secluded towns in Alaska to small town America, you’ll be able to provide quality care for those who would not otherwise have adequate access to care.

Ready to give it a shot? We have over 40,000 travel positions available on our site right now, if you want to take a look.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.