Demystifying Medicine One Month at a Time

Filling the void (… the young docs, vol. 2)

The CDC released a recent report (“data brief“) on the subject of physician assistants (PAs) and advanced practice nurses (APNs).

Physician assistants are a growing cadre of professionals who practice medicine under the supervision of doctors. Advanced practice nurses are registered nurses with advanced training, who work independently (but in collaboration) with doctors.

PAs and APNs are often referred to in health care-speak as “physician extenders,” a term I loathe. To me it implies that these professionals are somehow not fully formed human beings, but rather mere appendages of almighty doctors.

There was a lot of initial resentment toward PAs and APNs by doctors. I can still hear some of the claims:

  • They will take our patients, thus stealing our business.
  • They don’t have enough education.
  • Will patients really want to see them, with their “lesser” education and experience?
  • They can’t be trusted to prescribe mediation independently.
  • They’re not doctors.

Those cries have greatly diminished as their numbers have grown. Doctors in the private world relish working with “extenders,” because they help improve volume (i.e. patients seen) which brings in additional revenue. And because they earn less (presumably because they have less in the way of education [two years vs. four for medical school] and experience [one year internship vs. three years-and-beyond residency training periods], they are in fact quite economical for private physicians who hire them, or the larger groups (especially hospitals) that employ doctors.

In a prior brief, the CDC demonstrated that nearly 50% of office-based physicians work with PAs and APNs. The larger the practice, the more likely this is to be true.

The most recent brief, highlighted courtesy of V.S. Elliott in American Medical News, looked at “allied health workers” (PAs and APNs) working specifically in hospital-affiliated medical practices. The data shows a 50% increase in visits to these office sites in which a patient saw only a PA or APN over the most recent eight years.

I find this important for a couple of reasons:

  1. As we inch closer to health care reform, with several million uninsured people expected to enter the insured pool, allied health workers will be more frequently counted on to pick up the load, as the number of primary care doctors isn’t growing enough to meet demand.
  2. In addition, under health care reform it’s expected that one of the formats for improving delivery of health care will be the Accountable Care Organization (ACO). In this model, doctors will supervise teams consisting of nurses, PAs and APNs, who will see most of the patients. It is argued that this will be the most efficient, cost effective, and highest quality deployment of health care personnel.

Some beg to differ on those assumptions. My own feeling is that doctors don’t go to medical school to learn to manage teams of other professionals. Some of us may actually like it or have talent for it, but current medical education models don’t have any bearing on these skills.

It’s a tumultuous time to be in health care. Stay tuned.


Grand Rounds Coming Here

GlassHospital will bring you the internet’s Grand Rounds next week.

Submission Instructions

  1. E-mail submissions to our editorial board directly at <glasshospital> at <gmail> dot <com>.
  2. Put Grand Rounds in the subject line and give us a <brief> description of your blog.
  3. Please include your name (nom de blog is acceptable), the name of your blog, and the url.
  4. One entry per blogger.
  5. Posts between 400 and 1000 words are preferred; since the theme (below) is timeless, feel free to submit a new or old post.
  6. Posts are to be written for a general audience.
  7. If there’s a potential conflict-of-interest, either don’t submit your post, or disclose it.
  8. Stick to this week’s theme, at least in some indirect way. If it’s not obvious, don’t be shy about telling us why it fits.

This week’s theme:

‘Tis the season. Thus, we want readers and writers to reflect on what’s truly important to them. Our theme will be Finding Meaning in Medicine.

How do you find meaning in medicine? In your work? As a patient? As someone looking to improve the “system?”

What keeps you engaged, fresh, vibrant, learning, writing?

DEADLINE for submission is 11:59 PM Central Time on Sunday, December 11, 2011.

Looking forward to your submissions.



  1. Duncan Brewen

    Couldn’t have said it better myself.

  2. Anita Juarez

    I would like to thank you for the efforts you’ve put in writing this website. Actually your creative writing abilities has inspired me to get my own site now. Really the blogging is spreading its wings quickly. Your write up is a good example of it.

Leave a Reply

Your email address will not be published. Required fields are marked *

© 2021 GlassHospital

Theme by Anders NorenUp ↑