Role of physician extenders on the managed care team

The use of physician extenders seems to be assured as health care reform efforts unfold at both the state and federal level. Movement to fixed budgeting and capitated reimbursement systems will encourage providers to be cost efficient whenever possible, and will accelerate the use of extenders as well as other lower cost allied professionals. As a spokesperson for Oregon's Sisters of Providence Health System said, "We have stopped investing in acute care. Our system is spending $30 million to ... establish ambulatory care settings. We need to prepare for increased numbers of patients in HMOs, more physicians who are employees, and the increased use of physician extenders." Proponents of physician extenders point to the fact that they charge less than physicians for similar services. Truly, several studies on the subject indicate that this assumption is correct. For example, a study from the Journal of Nurse Practitioners indicates that the cost of an office visit to see a nurse practitioner compared with a physician ranged from about 10% to 40% less depending on the nature of the visit (i.e., family, pediatric, gerontology, mental health, etc.). Another study has revealed that the average nurse practitioner in a family practice setting makes an annual salary of $43,600, compared to a family practice physician who makes over $110,000. While such statistics are compelling, they may not tell the entire story. For example, a study which compared APNs and primary care physicians indicated that the nurse practitioner saw fewer patients per week and spent significantly more time with each patient.(ABSTRACT TRUNCATED AT 250 WORDS)