The case for and against physician extenders: 4 spine surgeons discuss

Written by Anuja Vaidya | August 09, 2018 | Print  |

Four spine surgeons weigh in on the ways in which physician extenders have been useful for their practice as well as the drawbacks of leaning too heavily on them.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: What are most pressing reimbursement challenges facing spine practices today?

Please send responses to Anuja Vaidya at by Wednesday, August 15, at 5 p.m. CST.

Question: What are the pros and cons of hiring physician extenders, such as physician assistants and nurse practitioners?

Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): The main pro of physician extenders is that they allow for the physician to focus on tasks more dedicated to patient care, while having a qualified and trustworthy person who is able to perform some of the more tedious work which is unfortunately becoming an increasing part of medical practice. This is vital to minimizing burnout.

The con is really the need for adequate supervision and the liability associated with extenders acting outside of this supervision. It is important to have a provider who is trustworthy and capable to minimize the risks. One of the most important qualities I have realized is having an extender who knows when they do not know and has no difficulty asking for an opinion or help.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: We don't use physician extenders in my practice. I enjoy making the important decisions about patients and keeping a close eye on developments and an eye out for potential problems. Extenders do allow you to be in more than one place at the same time. You can increase your productivity as well. I do feel that some physicians push the envelope in terms of the appropriateness of what they are managing on their own. Most doctors are responsible enough to know when to become more involved, but inevitably there are those that use physician extenders in lieu of attentive care.

Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): I have worked with a physician assistant for the past five years and find them very valuable to running a successful surgical practice. The only con is the expense, but a properly trained and utilized physician assistant will always "pay" for him or herself and more. They serve as excellent surgical assistants, help with inpatient postoperative care, help with preoperative counseling and postoperative follow-ups for my patients, and help with routine care for nonoperative patients with spine problems. It does take a good year to properly train a physician assistant before they could be used at their full potential, but it is well worth it, and my practice would be far less efficient without them.

Noam Stadlan, MD. Neurosurgeon at NorthShore University HealthSystem's Neurological Institute (Glenview, Ill.): For a busy spine practice, physician extenders (PAs or NPs) can be tremendously helpful in providing excellent patient care and allowing increased productivity by the team as well as lessoning the burden of routine tasks on the surgeons, which results in more time for patient care, research or other activities.

However, it is imperative for the physician to make sure that the extender is not being asked to perform duties outside of what their knowledge, experience or comfort allows, and to make sure that they are well trained and competent. Furthermore, there must be a collegial atmosphere, so the extenders know they can always reach out with any questions or concerns no matter what the time or situation. The extenders also must understand the physician will always support them in the decisions entrusted to them.

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