Dr. Pillsbury’s assessment is somewhat different. “Nurse practitioners have support of the patient as part of their primary modus,” he said. “They’re there because they were taught in nursing school to be patient advocates. They’re very good at interacting with the patients in a positive way—making them feel comfortable, getting little bits out of the history that someone else might skip— and a PA is, in generally, more focused on doing things.” He added that in his own practice and experience, patient satisfaction with NPs is “almost always high, and it can be more mixed with PAs.” What this points out is that the hiring physicians must be clear about what he or she is seeking for their practice and whether the role of PA or NP will best meet their needs.
Explore this issue:March 2007
“Because most of the bigger practices have nurse practitioners,” said Ms. Calandra, “the newer fellows, at least in pediatric otolaryngology, have been exposed to NPs and know how they work.” But the physicians who will have the toughest time working comfortably with NPs are those who feel compelled to control all aspects of the practice, she said. The physician who will best collaborate with an NP is the one who can delegate responsibilities. To feel most comfortable with an NP’s specific training and experience, Ms. Calandra said, ENT physicians should look for a candidate’s certification in otolaryngology; that is, CORLN. She is the current president of the National Certifying Board of Otorhinolaryngology and Head-Neck Nurses (NCBOHN).
Legal authority for nurse practitioners’ scope of practice varies by state. Prescriptive authority also varies from state to state; although NPs can prescribe in all states, some may have conditions for prescribing controlled substances. Individual state regulations are accessible from risk management departments and from the SOHN Web site (see Resources).
Ms. Calandra regularly lectures to ENT physicians on what to look for in an NP. At a recent national meeting of SENTAC, she participated on a panel of registered and advanced practice nurses. “The physicians were asking questions such as, ‘Will it cost me money to hire a nurse practitioner or does it save money?’ One of the physicians in the group said his practice had done cost analyses and found that after three months, the [value of the] nurse practitioner exceeds her cost.”
What Can a PA Do?
The tasks that physician assistants perform depend on their practice setting, education, experience, and state laws and regulations, but in general, PAs: