Cover Story

The 'Pressure Valve' Option

By Charlotte Huff

Reid Hospital & Health Care Services launched its hospitalist program in early 2008 to such instant success that it has rapidly expanded, from two hospitalists to an anticipated 13 by this fall.

But the success has been tempered by the difficulty in finding primary care physicians who specialize in hospitalist work, says Thomas Huth, M.D., vice president of medical affairs at the not-for-profit hospital in Richmond, Ind. Reid, like most health care systems, is struggling with a shortage of primary care doctors. As the organization's leaders considered ways to ease the problem, one fact stood out: Not all medical treatment requires a doctor's direct involvement. "Seventy-five to 80 percent of what doctors do can be handled by someone who doesn't have an MD behind their name," Huth says.

So Reid recently hired two so-called "midlevel providers" and hopes to add two more as soon as possible. Many practices and hospitals are turning to nurse practitioners and physician assistants, sometimes called midlevel providers or physician extenders.

"The physician can see a lot more sick patients if he is not seeing the patients with strep throat," says Terry McGeeney, M.D., chief executive officer of TransforMED, a for-profit subsidiary of the American Academy of Family Physicians.

Midlevel practitioners can assist with basic medical care and serve as a "pressure valve" at busy practices, says Mark Hochstetler, M.D., vice president of clinical affairs for VHA Inc.'s central region.

Not all physicians are convinced that midlevel practitioners are "a big financial winner," Hochstetler says. They can command relatively high salaries and require on-site training‚ significant investments given the limits on how much patient care they can provide, he says.

However, Medical Group Management Association data indicate that nurse practitioners and physician assistants more than earn back their salary. Their median income is $80,365 and $87,649, respectively, while their median collections are more than double that figure, nearly $205,000 for nurse practitioners and $246,000 for physician assistants.

This article 1st appeared in the September 2009 issue of HHN Magazine.

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