Who ya gonna call? – by Dr. Alan Laird, chief medical officer

Most of us who were young in the 1980s would answer that question with, “Ghostbusters!” But there is a growing question about who you are going to be able to “call” (more accurately “see”) when you need medical care. In a recent report prepared for the Association of American Medical Colleges, the projected shortfall for all physicians by 2025 is 46,000 to 94,000; for primary care it is 14,900 to 35,600.* So insurance or not, access may be an issue.

How then do we answer the pressures of growing medical needs? One of the answers has been the rise of the non-physician practitioner. There have been many names to describe this group of providers: physician extender, mid-level provider, advance-level practitioner, advance-practice provider … to name a few. I know I have displeased some, mentioning those names. The fact of the matter is, there is no single term to call this group of professionals that everyone is happy with. So my apologies to any offended parties if I am using a term you are uncomfortable with. There are many professions that fall into this grouping, and each has its own education requirements. The list can be extensive, but for purposes of this article I will refer to the two groups we work with at Orange City Area Health System on the clinic side: Nurse Practitioners (NPs) and Physician Assistants (PAs). These are not the only non-physician practitioners we work with at the health system, but they are the two types that work hand-in-hand with our physicians to provide care at our clinics. It takes significant work, study, and training to become one of these professionals. Both professions require a college degree, medical care- giving experience, and training after college. The post-bachelor degree (NP or PA) requires classroom as well as clinical experience (hands-on training) for at least two years (and usually more). After graduating from an approved post-collegiate program, both professions require passing a certification examination before they can start practicing. Additionally, just like physicians, both professions require ongoing continuing medical education and periodic recertification. So while both PAs and NPs follow a path not dissimilar to physicians in medical school, most do not incorporate a residency program as physicians do. I believe this is because most are anticipating practicing alongside physicians who are available for consultation and guidance in patient care. This has worked very well at Orange City Area Health System. The doubling of medical knowledge was 3.5 years in 2010 – and by 2020 it is expected to be 0.2 years (73 days).** No one can know it all. And I have been blessed to practice at OCAHS where I have colleagues I can call on in their areas of expertise. Working together as a team, we provide far better care than any of us could individually. So let me return to my earlier quandary about what to call this group of professionals. There is no single term that captures what this group does and is capable of doing. Perhaps one day, someone will coin the correct term. But for now, I am blessed to call each and every one of them a colleague. And even better than that, I get to call them a friend. And that is part of what makes Orange City Area Health System a great place to work.