Nashville, TN where I live and work is a healthcare hub. With a number of large national healthcare corporations in the city along with several major hospitals, there’s an interesting mix of business + medical practice. It’s always interesting to be exposed to the larger business side of the healthcare community rather than just the patient-facing side I see in my day to day practice as a nurse practitioner.

Occasionally, given Nashville’s booming healthcare biz, I get wind of big trends that are sweeping through the industry. Recently, I heard about a few new practice models that we’ll soon see nationwide. These models center around specialty practices where patient care is managed almost exclusively by nurse practitioners and physician assistants.

Sure, there are a number of NPs and PAs already in specialty practice. From cardiology and orthopedics to urology and dermatology, the sky’s the limit when it comes to the settings where nurse practitioners and physician assistants are currently employed. In most cases, however, specialty practices employ primarily physicians with fewer NPs and PAs. With new models of care, we will start to see specialty practices where NPs and PAs are the ones providing the vast majority of services. The reason? It’s all about finances.

Imagine a cardiology practice, for example, where NPs and PAs see all of the patients. Most cardiology patients do fall within the NP/PA scope of practice, after all. The practice owner saves hundreds of thousands of dollars per year operating the clinic because it pays NP/PA salaries rather than those commanded by specialty physicians. What about patients requiring surgery which is outside of the NP/PA scope of practice? The practice contracts with a hospital who provides a physician to see surgical cases. This MD comes to the clinic, say one day/week, and the hospital benefits from the business relationship in that surgeries are high dollar procedures. The model effectively maximizes the abilities of NPs, PAs and physicians.

We’ve seen nurse practitioners and physician assistants increasingly utilized in primary care. While NPs and PAs are entering specialty practice as well, new business models that maximize the capabilities of advanced practice providers are cropping up across the country. Get ready for the new frontier of specialty practice – clinics staffed exclusively by NPs and PAs.

How have you seen specialty practice change with the use of nurse practitioners and physician assistants?


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