Pediatricians face new challenges in hiring NPs, PAs

Pediatricians who practice primary care are less likely to work with so-called physician extenders than pediatric specialists, according to a new study that predicted an increase in employment of nurse practitioners (NPs) and physician assistants (PAs) in all pediatric practices.

Currently, more than half of the study survey respondents in general pediatric practices said that they did not work with NPs or PAs compared with about a third of specialists, and pediatricians are more likely to employ NPs than PAs. Researchers said that pediatric practices plan to increase the number of all midlevel providers in their practices in the next 5 years-if they can.

“Planned increases in the number of NPs hired and expansion of their scope of work might put subspecialists and general pediatricians in competition with respect to the recruitment and hiring of a limited pool of new pediatric NPs,” the researchers wrote. “Similar issues might arise with PAs.”

The structured questionnaire was sent to a random, national sample of 498 pediatric generalists (72% of the respondents) and 1,696 subspecialists (77% of the respondents) in the United States. Respondents answered questions about practice settings, employment, and the scope of work of NPs and PAs.

According to other recent surveys, pediatric practices seeking to retain or hire midlevel providers will face challenges related to rising compensation for the clinicians.

As of the end of July, PAs in pediatric offices averaged $100,000 annually, whereas NPs in the same setting earned $97,000. Five years ago, NPs in pediatric practices made less than $72,000 annually.

In addition to a substantially higher base salary, both midlevel providers now frequently earn individual performance and retention bonuses (nonproduction based) ranging from $3,500 to $5,000. About 28% receive incentives, including gain sharing and individual production-based bonuses, a trend that is on the upswing, according to Integrated Healthcare Strategies (IHS).

Nurse practitioners and PAs employed in medical specialty and surgical specialties make up to 10% more than their colleagues in all primary care settings. Advanced practice clinicians working in hospitals make 5% to 10% more than midlevel providers in office or clinic settings.

In 2010, there were approximately 75,000 PAs in clinical practice and 168,000 NPs. Five states-California, Florida, New York, Pennsylvania, and Texas-employ about a third of both groups.

Pediatric practices can learn more about where they stand relative to industry and regional trends and how to position themselves better in the competition for talent from the 2010 IHS Advanced Practice Clinician Survey. The 2011 survey is open for participation until the end of September; results will be released in December.

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