A good friend, a colleague, a fine and trustworthy PA, was recently hired by a sub- specialty group. Before accepting the position she had multiple meetings and email exchanges with the leader of this group. She asked tons of questions about what she would be doing, who she would be working with, etc. The job description of the position was written specifically for her. But from day one of her new gig she ran into all kinds of mysterious opposition from other physician members of the practice. They refused to refer patients to her. They flat out told her they didn’t think she should have been hired. The nurses, who originally thought she would not require any nursing support, were hostile and inflexible when told that she would require the same support the physicians received. After 7 weeks of meetings, re-doubling efforts, multiple nights of soul searching, and seeking out advice from every possible mentor, my friend and the practice parted ways.
This was upsetting as you might imagine. The turn of events had a very deleterious impact on my friend’s self esteem and confidence. It was expensive, and time consuming and a complete and utter train wreck.
Now you would think this rarely happens, but if you talk to any number of NP and PA’s you will hear these same types of stories over and over. One of my PA colleagues describes how she was hired by a major academic medical center to be assimilated into the inpatient medical teams, along with residents and fellows. No one knew what she could do, or what she was supposed to do. She says she ended up being consigned to being “Fax B***h,” faxing forms and requests for medical records. She fought the fight for eight months before quitting in disgust.
The costs of hiring and training are weighty, but to avoid these mishaps several things have to happen:
1. Know why you are hiring an NP/PA. Sure I know just having one of us around is glamorous and compelling but we actually like to use our brains and take care of patients. We are far less enthusiastic about being clerical support. You have to know why we are being hired and we need to know why we are being hired.
2. Make sure all of the stakeholders support the NP/PA hire. If you love the idea of the addition of an NP/PA to your team great! But if everyone else is filled with loathing and trepidation multiple parties are going to get burned and It’s going to hurt.
3. If people haven’t worked with NP/PA colleagues before, a little education couldn’t hurt. Have someone who has had successful integration talk to you about what worked and what didn’t. Just having the “magic designation” initials behind your name doesn’t guarantee you know what NP/PA providers do or how to work with them.
4. Make sure you hire an NP/PA with the right skill set, or be willing to invest the time and energy and support for adequate training. A brand new NP with minimal inpatient experience is going to take at least eight months to really get close to being productive. Even an “old hand” needs more time than an MD hire.
I hope these tips help prevent the wreckage of hire oops fire.
Tracy Cardin, ACNP-BC, SFHM is the Associate Director of Clinical Integration at Adfinitas Health and also serves on SHM’s Board of Directors. Prior to this, she was the Director of NP/PA Services for the University of Chicago and worked in private practice for a group of excellent pulmonologists/intensivists for over a decade. She has been a member of SHM for over ten years and has over twenty years of inpatient experience, which seems incredible as she cannot possibly be that old! Her interests include integration of NP/PA providers into hospital medicine groups and communication in difficult situations.
In her free time, she likes to run and lift, read and write and hang out on the front porch of her semi-restored Victorian house with her dear family and friends while drinking a fine glass of red wine and listening to whatever music suits her whimsy.