How do you work with non-physicians (NPs/PAs)?

[drg123]

---

Members don't see this ad.

How do you all effectively work with NPs and PAs in your practice?

Do you have them see follow ups only?
Or initials and follow ups, and have them send you procedures so you can spend most of your time on that?
Something else?

Benefits and disadvantages of any of the above options?

 

[SpineandWine]

I have them mostly see follow ups
- exceptions- I do my own MRI follow ups, RFA follow ups
- I do all new patients

Disadvantages/ sometimes you see them over procedural book or not give right option- hard to keep track of each follow up
Advantage- access for new patients, higher percentage of times doing procedures

 

[SSdoc33]

Not very well....

 

[SSdoc33]

F/u on patients i dont want to see. Patients who need interpreters. Paperwork kt f/u for auths. Simple if A then B scenarios.

And you will still clean up their messes.

 

[SpineandWine]

depends on the PA- I split mine with spine surgeon and he’s actually very good reading MRIs and utilizing MRIs for determining surgical planning.

Downside- he is led to believe (which is in part true) that foraminal stenosis and central stenosis causes axial back pain- over diagnose this as cause of back pain as opposed to Facets, myofascial pain, etc.

Honestly, if you get fresh PA, they are blank slate so you can teach them common scenarios as long you can stomach them not working for a month, following you and you teach them how you’d deal with patients

 

[clubdeac]

Guy in my practice uses them for all new and follow up patients, essentially every clinic patient. He says their clinical acumen is as good as and sometimes better than most physicians. All he does is procedures, or at least he is trying to practice that way 😒

 

[SSdoc33]

depends on the PA- I split mine with spine surgeon and he’s actually very good reading MRIs and utilizing MRIs for determining surgical planning.

Downside- he is led to believe (which is in part true) that foraminal stenosis and central stenosis causes axial back pain- over diagnose this as cause of back pain as opposed to Facets, myofascial pain, etc.

Honestly, if you get fresh PA, they are blank slate so you can teach them common scenarios as long you can stomach them not working for a month, following you and you teach them how you’d deal with patients

and then they decide to leave in about a year. lather, rinse, repeat

 

[Ducttape]

there are several different ways of using them.

if you want to use them "to their maximum potential" (per non-clinical admin), then they see everyone, new patients on down to follow ups. i hate that model and refuse to use it.

they work most efficiently to me as an extender: they see follow ups exclusively - post injection patients, those on stable long term doses of meds (whose primary will not take over these meds), the few COT patients, long term injection patients...

and then they decide to leave in about a year. lather, rinse, repeat

agree.

generally speaking, the APPs that are satisfied in this role are older, more experienced, and do not want to "save the world". it is harder to get new grads to buy in to this model.

 

[BobBarker]

Mbb f/u, refill rx

But still plenty of mistakes with these and in this state they can’t prescribe controlled substances so not that helpful as you still have to get in the majority of their charts for some reason or another.

No new patients.

 

[BobBarker]

But these easy visits are quick and satisfying.
It has been ages since I have done a Mbb f/u but I have been the last two months. Enjoyable doing them. Gives me some level 3 visits as well to make me look more “average” on paper in my billing.