Physician Extenders – Expanded Access but With Less Training

People may not have heard the term “physician extender,” but they are likely familiar with the concept. It refers to mid-level medical personnel like nurse practitioners, physician assistants, or midwives who provide medical services in place of but generally under the supervision of doctors.

Advocates claim that these health providers, who may work in conjunction with a physician or in their stead, can offer more access to care and hands-on treatment than doctors are able to offer. But they are not trained doctors. While the medical care and treatment they provide is often equivalent to that which a doctor provides, their depth of experience and ability to diagnose uncommon or complicated presentations is less than a fully trained physician.

They are not doctors

Physician Assistants and Nurse Practitioners have a certain amount of medical training to do their work, but this training is limited in time and scope. Hospitals and clinics try to deliver medical care to as many people as possible because doctors are in short supply. The solution to providing as much care as possible, in the eyes of hospital administrators, is to delegate some responsibility to non-doctors. However, this can become a huge problem if the patient’s problems require that a physician become involved and doesn’t and a serious condition is misdiagnosed as a common minor ailment. Malpractice victims may find out too late that they were treated by someone other than a physician who was less qualified to evaluate them for their condition and were not provide appropriate care.

The reasons this can happen can include:

• Common Problems are Common: Physician extenders are experienced in treating common problems, and most times are able to actually diagnose common presentations of common diseases. But uncommon presentations of common diseases or uncommon diseases that present with common symptoms can be misdiagnosed sometimes leading to detrimental outcomes.
• Poor Pre-Employment Screening: Desperate administrators may take the time to verify that the potential hire is certified, has a strong work history, and recommendations from previous employers or educators. But the need to staff is great and finding enough properly trained personnel can be difficult. In these situations, quality care may suffer in order to meet the demand for care.
• Failure to supervise: Hospitals and clinics may not properly supervise because the physicians are overscheduled or handling cases that appear more complex. Often there are agreements under which PAs and NPs are to work with physicians in an office, clinic or hospital. when these processes are followed, proper care is provided.
• Systemic problems: Regardless of laws and regulations, hospitals, clinics and health care providers may have holes in their health care system’s design and procedures. typically, a mismatch of providers and number of patients requiring assessment are the root cause of systemic errors.
• Lack of communication: The doctor’s time is at a premium, so physician extenders may hesitate in sharing information about the patient because they do not want to seem annoying or burdensome to the physician. This is a common cause of preventable errors. Physician Assistants and NPs Need to remember that bringing a question to a physician’s attention is not a sign of incompetence but rather diligence. The only bad questions are those that are not asked.

Patients would rather see doctors

Those who cut corners will often pay the price later — the same holds true, unfortunately, with medical care. Doctors go to medical school to learn how to provide optimal medical care at the highest level possible. Physician extenders are not as trained as physicians and are less able to recognize an uncommon presentation as a result. Provided the physician extenders are aware of the limitations of training and are encouraged to bring questions to the attention of their collaborating physicians, they are a valuable part of health care delivery. Failure to recognize this can lead to negligent care and medical malpractice.