Incorporating Mid-Level Providers to Your Practice?

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I feel confident that PAs and NPs will continue to play a growing role in the future of primary care.
I feel confident that PAs and NPs will continue to play a growing role in the future of primary care.

Several years ago, our office was faced with a situation. One of our founding partners had decided to leave private practice and go into medical education. While not a disaster — these things are common among medical practices — we did now have a void that needed to be filled.

We already knew that there would be challenges. In prior years, we had interviewed a few physicians in anticipation of our practice growing. Eventually we were going to need more providers. 

That was when we learned that it is not so easy to recruit family physicians. There are several reasons for the difficulty.

First, our practice is in Rhode Island. While Rhode Island is a wonderful state in many ways, physician reimbursement by insurance companies is not one of them. Physician reimbursement in Rhode Island actually is about 15% lower than it is for physicians in our neighboring states, Connecticut and Massachusetts. Meanwhile, cost of living and taxes are essentially the same for all three states. 

While a 15%-lower physician reimbursement may not sound like a lot, when you consider that the cost to practice medicine in the other states is similar, this number does not take into account those expenses. So it is more like the physicians in Connecticut and Massachusetts have a 30% increase in salary over Rhode Island's physicians.

Another factor is the serious shortage of family physicians in this country. With many medical schools putting out only a handful of family physicians per institution per year, there are not enough providers available. Given the cost of investment one makes for medical school, it is hard to attract a larger number of medical students to the field of family medicine. Salaries for family-care physicians can be as low as one-third the salaries of specialty physicians.

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