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| In the 2005 AANS Physician Extender Survey, respondents who currently employ physician
extenders were asked how they are using PEs, and those not currently employing PEs were asked how their practices would like to use them. Because respondents could check any option that applied, results do not sum to 100 percent. |
“The growth of America’s population and the increasing longevity of its citizens are being met with a decreasing number of neurosurgeons to provide care for them,” said AANS President Fremont P. Wirth, MD. “Recently, there has been significant discussion regarding the use of physician extenders in neurosurgery, and how they could be used to alleviate the current strain.”
Physician extenders, a collective term for nurse practitioners and physician assistants, also have become increasingly important to training programs in order to help compensate for lost resident time related to work hour restrictions. Similarly, physician extenders appear to be playing an increasingly important role in the practice of neurosurgery by helping to facilitate the efficient use of neurosurgeons’ time. In fall 2005 the AANS surveyed members in the Active and Active Provisional categories, specifically addressing:
- how members use or would like to use, physician extenders in their practices;
- which neurosurgical procedures physician extenders should be trained to perform;
- how physician extenders currently are trained in neurosurgical procedures and how members would like them to be trained in the future; and
- which educational resources the AANS currently offers that might meet physician extender needs, and what should be developed in the future.
Charles J. Hodge Jr., MD, the AANS vice president during fiscal 2005 and the head of the Physician Extenders Task Force, led the survey project, which ultimately was administered by a contracted research firm. The online survey garnered 524 responses and a robust sample size of 380 or more for most questions. Therefore, researchers are 95 percent confident that results presented in the survey report have accuracy of plus-or-minus 5 percent or better, which essentially means that if the survey was implemented one hundred times, the results would be the same 95 times.
The survey results are being used by the AANS Long Range Planning Committee and the AANS Physician Extenders Task Force in their planning. The first of the resulting initiatives will be launched during the 2006 AANS Annual Meeting in San Francisco.
Respondent Profile
About half of the respondents were from private practices. Another 28 percent were full-time academicians. Forty percent of respondents indicated that their practice settings were small (two-to-five neurosurgeons), and 24 percent selected medium (six-to-20 neurosurgeons and neurosurgical groups). These figures are consistent with the AANS Member Needs survey taken in 2004, and demonstrate a representative sample of membership.
Use of Physician Extenders
Seventy-four percent of respondents indicated that they employ physician extenders. Of these, just over half have been using physician extenders for more than five years. Another 40 percent have been using them for two-to-five years. When physicians in university settings were asked with whom extenders primarily work, 76 percent responded “attendings,” and 18 percent, “residents.”
The AANS also asked members if they felt their practices were in need of physician extenders (regardless of whether they currently employ them). A slight majority of respondents, 53 percent, said that their practices are in need of physician extender assistance compared with 47 percent who did not.
Survey respondents who currently employ physician extenders were asked how they are using PEs, and those not currently employing PEs were asked how their practices would like to use them. Respondents could check any option that applied (multiple options).
Most respondents identified “hospital based patient evaluation and management” (74 percent) and “office patient evaluation and management” (73 percent) as among the duties for physician extenders. The selection “phone call returns/administrative duties (letters of appeals)” generated 70 percent of responses, and 64 percent selected “first assist in the operating room.” When asked specifically about which invasive procedures they would like physician extenders to perform, top choices were suturing (58 percent) and lumbar punctures (36 percent).
The pie chart illustrates reasons for employing physician extenders. As shown, most respondents selected to “increase patient volume in the office”(74 percent) and to “assist in the operating room” (70 percent).
Neurosurgical Training for Physician Extenders The majority of respondents, 81 percent, indicated that “on the job training” best describes the method of physician extenders’ neurosurgical training. Sixteen percent reported that extenders were trained in a formal training program. Only 2 percent indicated they were trained in the military. The majority of respondents (60 percent) also indicated that their physician extenders received training at a university hospital.
When asked how long the neurosurgical training period was, the majority of respondents, 57 percent, indicated that their physician extenders received training for six months or less and 21 percent indicated one year.
More than 77 percent of respondents reported that the establishment of formal training programs for physician extenders in neurosurgery would be useful. When asked how long this training period should be to gain competence in the tasks that neurosurgeons expect a physician extender to accomplish, over half, 52 percent, selected six months of neurosurgical training. Thirty-seven percent selected one year. The participants were equally divided on who should be paying for the training: 40 percent said the physician extender, and 40 percent said the future or current employer. About 57 percent indicated that they expect the physician extender to receive a salary while attending an extended training program in neurosurgery.
Working With the AANS
When asked: “which of the following AANS offerings would best help meet the educational needs of physician extenders,” 62 percent selected “AANS annual meeting practical clinics or breakfast seminars.” Fifty-three percent of respondents selected “AANS instructional DVDs, publications or online offerings,” and 36 percent selected the “AANS Master Series courses taught in educational/ research facilities offering lab work using cadaver material.” (Multiple selections were allowed.)
“Survey participants also identified many topics and types of educational experiences they would like extenders to receive from the AANS,” said Dr. Hodge. “Leadership reviewed a summary of write-in recommendations.”
Moving Forward
With survey results in hand as well as input from the task force, the Long Range Planning Committee began to address the issue of using of physician extenders as one of many solutions to workforce shortages.
“Initially, training courses for physician extenders will be offered during the 2006 AANS Annual Meeting in San Francisco,” said Dr. Hodge. “Short-range plans focus on identifying funding for additional physician extender neurosurgical training and expanding AANS offerings for physician extenders. Long range plans under consideration include developing a physician extender curriculum for competency in neurosurgery, developing advanced curriculum for continued education, and investigating Web-based modules for a formal training program.”
Addressing workforce issues has been a priority for Dr. Wirth during his presidential year.
“It is clear that there is tremendous potential for physician extenders to help alleviate neurosurgical workforce shortages,” said Dr. Wirth. “We are considering all the recommendations of the task force and are working closely with nurse practitioner and physician assistant organizations to investigate which avenues will result in optimal benefit to our patients.”
Kathleen T. Craig is AANS director of marketing.