MDNews - Minnesota

PaR am eDi c s an D PRi maRy c aR e PhYSiCiaN aSSiStaNtS aNd nurse practitioners aren't the only non-physician professionals providing primary care today. in many areas, especially in rural and underserved regions, paramedics are undertaking a form of primary care, visiting "frequent flyers" of ambulance and emergency room services to provide procedures such as blood pressure readings and glucose tests. Some also perform home safety inspections and make physician referrals. Examples of the ongoing changes: + los Angeles County officials have considered making paramedics "physician extenders" for underserved patients, according to California Healthline. + Some Colorado emergency services personnel + In Nebraska, the University of Nebraska Medical Center predicts that the state, with a population of 1.8 million, will need 23 additional PAs and 21 more primary care NPs by 2014. The numbers are minimal, but they amount to a more than 7 percent increase in the non-physician provider force in the state. "Growth in temporary placements is a sure sign of shortage," says Phil Miller, Vice President of Communications with Staff Care. "People use temps to maintain services and care while seeking permanent, hard-tofind professionals." Singleton notes the same trend in permanent-placement staffing. "Of about 3,000 searches a year, nurse practitioner and physician assistant searches requested grew by 164 percent from the past year," he says. "That's 200 percent for NPs and 127 percent for PAs." Partially explaining the squeeze, Singleton says, is that non-physician providers, like their physician colleagues, often go into specialty fields with less demand. Also, PAs and NPs tend to pursue more opportunities for parttime work, he says. recruitment, retention Strategies With demand outpacing supply, how can a physician practice, hospital or other healthcare organization stay competitive in recruiting and retaining PAs and NPs? "Acknowledge and respect what we have to offer," Golden says, speaking of NPs. "Being included in the organizational governance is key. Compensation also demonstrates respect. That could mean a similar benefit package to those awarded to physicians, even including simple things like parking spaces. Especially when you look at bigger organizations, things that are going to get NPs to come to you and stay with you are continuing education, vacation packages and demonstrating respect for the professionalism the person is bringing." "Tuition assistance and professional development are helpful," Ladden adds. "The administration and the middle-level managers create the culture of a system around respecting people's expertise and allowing them to ... reach the top of their education and training." "To me it's about the practice setting, the primacy of the workshop," Miller says. "You can't control your location … but you can control the financial offer, the hours a person will work and the flexibility of their schedule, which is attractive to clinicians today. It's not an insurmountable challenge, [but] you have to use a variety of strategies to ensure adequate staffing. Take a global perspective … and be creative." follow up hospital discharges with in-home help with blood work and wound care, reports the Journal of Emergency Medical Services. + in fort Worth, Texas, some paramedics with medStar have been trained as advanced practice providers. Each has an assigned patient panel from among frequent 911 callers. These advanced practice paramedics provide crisis intervention, basic medical care and community services referrals, according to the Journal of Emergency Medical Services. "i am seeing patients who are accessing the 911 system because of the complete lack of primary care," writes Jason berman, fire lieutenant for Thurston County, Wash., in a report published by the federal Emergency management Agency. berman advocates that rather than spend money transporting non-acute, non-emergent patients to the emergency department, local districts should use fire services paramedics as a primary care option for underserved patients. "[for example], if you could get a diabetic patient up to speed in his or her own home with education and basic monitoring, you could provide that cost-effectively versus a trip to the emergency room," he says. "Simple missions where you can [draw on paramedics' skills and interface with physicians via] technology will be huge. We have technology now where physicians consult with specialists thousands of miles away. That could be leveraged in the field. i could What is the role of NPs and PAs in providing primary care in your practice or health system? Join the discussion at mdnews.com. ■ potentially get face time with a physician, receive orders for patients and provide them with a level of care without physically bringing them in." MdNewS.CoM ■ MD News Twin Cities | 41

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