RX for Practice Overload?

Dr. Hooker worked in a variety of settings throughout his 32-year career as a dual researcher/clinician. While with Kaiser Permanente’s Northwest Division in Portland, Ore., he practiced with two staff rheumatologists. The three decided that all of Hooker’s charts would be reviewed by one of the rheumatologists. “The Kaiser policy did not require this. Our rationale for that was good supervision. PAs were still a novelty at that time [1978], so we were just being prudent,” he says. What they found after two years is that all three developed familiarity with each other’s patients, so covering for their colleagues was easier. They also found that their areas of interest dovetailed. Dr. Hooker was procedures oriented, so he performed the majority of joint injections and muscle biopsies; one of the rheumatologists had a special interest in fibromyalgia, so he saw the majority of those patients.

Dr. Hooker’s colleagues always saw his notes, and he sometimes would ask for a hallway consult if an intriguing or puzzling case came up. “We felt like we were catching omissions better as a team,” he says. “We thought that three heads were better than one!”

Left to right: Christine M. Mitchell, LPN, Smith, and Dr. McMillan.

Commitment Required

Hiring a PA is both a monetary and a time commitment. PAs’ salaries depend on geographic region and range from $60,000 to $112,000.³ Health benefits, professional liability insurance, pension funding, professional society dues, and continuing medical education funding are also included in the compensation for full-time PAs.³

Whether hiring an experienced rheumatology PA or someone who has worked in another specialty, there will be a learning curve as the new hire learns your practice’s procedures. Smith came “highly recommended” but had not yet practiced as a PA when Dr. McMillan hired him. Hiring a PA fresh out of school can have its advantages and disadvantages, says Dr. McMillan. The advantage was that he could train Smith in the fashion he wanted. But, just as with anyone you’re teaching, the process can be time consuming. “I started bringing [Smith] along with the basics, had him do basic reading, saw patients with him, and discussed those patients,” Dr. McMillan says. “He’s been with me since 1999 now, so he knows a lot of rheumatology.”

Setting the Tone

When physicians hire PAs, they should take certain steps to be sure that they will be well integrated into the practice, says McTigue. The practice should have a policy ensuring that patients have the right to consent (or not) to seeing a PA, and frontline staff should buy into and endorse the PA’s role.