What Roles Can NPs and PAs Play in a Practice? Part 1

Nurse practitioners and physician assistants can perform a variety of tasks that assist endocrinologists in their practices. Felice Caldarella, MD, an endocrinologist at the Center for Endocrine Health at Hunterdon Medical Center in Clinton, New Jersey, says his practice hired a nurse practitioner to see patients with diabetes who were starting a new medication or insulin and needed frequent follow-up, required intensification of therapy, or had weight loss challenges.

“New patients first see an endocrinologist, who performs an initial evaluation and creates a treatment plan,” Dr. Caldarella says. “Then, the endocrinologist decides if the patient would benefit from seeing a nurse practitioner. After seeing a nurse practitioner two or three times, the endocrinologist will assess the patient and decide whether the patient should continue seeing the nurse practitioner or not.”

The nurse practitioner doesn’t have her own panel of patients but instead sees them on an as-needed basis, Dr. Caldarella explains. In addition, unlike the endocrinologists, she has a more open schedule. “If a patient calls with a semi-acute problem or was recently hospitalized and needs re-intensification of therapy, the patient can see the nurse practitioner. She’ll consult with the endocrinologist as needed,” he says.

Before the nurse practitioner joined Dr. Caldarella’s practice, she had already worked as an inpatient diabetes educator. Her background in diabetes and weight loss management make her an ideal fit for his practice. “We are able to leverage her skills to help improve patients’ glycemic control with not only medication management, but also lifestyle optimization,” he says.

Marius Stan, MD, associate professor of medicine at the Mayo Clinic in Rochester, Minnesota, says the nurse practitioner at his practice follows patients with low-risk thyroid cancer, patients with benign thyroid nodules in need of monitoring, and patients with hypothyroidism. The nurse practitioner employs a straightforward algorithm in managing patients that can be easily implemented. “If patients develop concerning changes in their conditions, the nurse practitioner consults the physician initially involved and usually the patient is returned to his or her care,” he says.

According to Marilyn Tan, MD, clinical assistant professor of medicine (endocrinology) at Stanford University School of Medicine, and chief of the Endocrine Clinic at Stanford Healthcare in Stanford, California, nurse practitioners make a tremendous contribution. They see patients independently, answer patient questions by phone and email, educate patients, assist with prescription refills and laboratory orders, triage calls, process messages from patients, and help guide registered nurses and practice coordinators.

Richard Levy, MD, an endocrinology consultant affiliated with multiple hospitals in the Chicago, Illinois, area, including Rush University Medical Center, says he works for endocrinology practices that employ both physician assistants and nurse practitioners. These healthcare providers see patients; handle calls from patients, other caregivers, and insurance companies; write notes on patient charts; write letters to referring physicians and appeals to insurance companies; write prescriptions; and teach students. “They are smart, personable, task oriented, and have prescriptive authority,” he says.

Physician assistants and endocrinologists alternate seeing patients at North Raleigh Endocrinology & Diabetes Center in Raleigh, North Carolina, says Amit A. Patel, MD, an endocrinologist. They also help endocrinologists engage in quality and preventative measures.

Benefits Abound

Dr. Caldarella has found that a team approach to diabetes management is ideal because in addition to needing a treatment plan, diabetes patients may have lifestyle and psychosocial issues that need to be addressed.

The team approach allows for more eyes on the patient, so more information can be gathered to help pinpoint any barriers to care the patient might experience when trying to manage his or her diabetes. “Patients tend to tell different healthcare providers different things,” Dr. Caldarella says. “By having more contact with patients, healthcare providers can better understand a patient’s needs and challenges. In addition, patients may be more comfortable talking to a physician about certain things, and with a nurse practitioner about other aspects of their lives.”