With these challenges in mind, we decided to add a mid-level provider. To start, we hired a physician assistant, who basically took over the exiting provider’s panel of patients. We then added a nurse practitioner who was also trained in family medicine. 

It did take a while for many of our patients to get used to the new program.  At first, patients offered a visit with one of the mid-level providers would frequently insist on only seeing the doctor. However, over time, the providers earned patients’ trust and confidence and the patients adjusted. 

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Of course, it also helped, especially in the first year or so, to assure patients that the physician was also available to stop in for the visit if needed. While this was reassuring to our patients, I found that it was rarely necessary.

An important ingredient to making this kind of change work is to choose providers who fit the personality of your practice. In that regard, we found that hiring new providers who have just completed their training works best. While you may need to invest a little more time and energy in supervision and education, 

it is well worth it in the long run.  The providers will be more likely to provide care consistent with the physicians, and more likely to take on the characteristics of the practice. 

While we always strive to have sick patients seen on the same day that they call for an appointment, adding another provider to the practice schedule really opens up access even further. Doing so also helps the practice achieve patient-centered medical-home status.

We have been very fortunate with our mid-level providers. Adding them to our practice has only enhanced it. I feel confident that physician assistants and nurse practitioners will continue to play a growing and vital role in the future of family medicine and primary care.

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