How to Use Mid-Level Providers to Grow Your Practice

Hiring or partnering with a mid-level provider such as a nurse practitioner or physician assistant can be a cost-effective way to improve practice efficiency. It is even possible to expand the scope of your chiropractic practice to a multispecialty health care facility providing primary care services and walk-in medical care, in addition to chiropractic care, if you partner with a physician and mid-level providers. Mid-levels can typically spend more time with your patients, provide personalized, unhurried attention to a patient who needs it, and handle less complicated cases.

Comprehensive Care

You can best serve the interests of your patients when the scope of your practice is dynamic and you are in a position to deliver safe, best-practice patient care and eschew needless duplication of services. With the help of mid-levels, you can manage the process of examination, diagnosis and health assessment more comprehensively.

Mid-levels can even support your practice in terms of referrals to other specialists and physicians for consultation, as well as the prescription of various procedures and tests such as lab tests, diagnostic imaging, and home-testing equipment for glucose monitoring or blood pressure.

Patient education is also an important part of your chiropractic practice, of course. This role can be carried out effectively by mid-levels, who can educate and encourage patients to make vital lifestyle choices and changes, as well as guide them on various disease prevention practices.

More Integrative Practice

An ACA News survey designed to find out how far chiropractors take integration in their practices revealed 76 percent of doctors of chiropractic agree with the idea that collaborating with other providers leads to enhanced patient care.

As a result of their efforts at building an integrative practice, as many as 51 percent of the 1,242 DCs surveyed said they have experienced more patient referrals and 38 percent said they have noticed practice growth. Five percent said they have seen other benefits, such as increased awareness about chiropractic among allopathic providers, better patient compliance, and increased knowledge, skills and viewpoints themselves.

Some experts are of the opinion that partnering with primary-care-service and mid-level providers may present a greater opportunity for DCs because the allopathic medical community's interest in that position on the decline. Primary care is no longer a particularly attractive proposition because MDs increasingly desire to pursue specialty areas. This leaves the field of primary care open for mid-level providers, including physician assistants and nurse practitioners.

As a chiropractor, you can foster relationships with other providers by way of referring patients to them, informing them that their patients are receiving chiropractic care, writing letters of introduction to the patients' providers, becoming a part of local professional networking groups, organizing educational seminars in the community, volunteering for social causes with other physicians, and engaging via social media and online networking groups.

How to Find a Mid-Level Provider: Key Resources

Consider the following resources for hiring a mid-level provider for your chiropractic practice:

• The American Academy of Physician Assistants (AAPA.org) has a membership of more than 33,500 mid-level providers across all practice settings.
• The American Academy of Nurse Practitioners (AANP.org) represents over 80,000 mid-level providers across all practice settings.
• Several medical schools have training programs for mid-level providers. Get in touch with the program director or their placement office for information on program graduates.

How to Recruit / Integrate

Take note of the following tips to ensure smooth integration of the new mid-level provider into your practice:

• As a first step, research your state regulations with regard to recruiting a mid-level provider and the rules of reimbursement.
• Check whether your state allows mid-level providers with prescribing authority or authority to order tests.
• While evaluating candidates, look for someone who may have previous experience working in a chiropractic setting.
• Determine the gaps within your practice to outline a well-defined role and function for mid-level providers. Do not expect them to know what needs to be done. Articulate roles and responsibilities clearly.
• Invest adequate time in orienting and training the mid-level provider.
• Introduce them to patients and colleagues, and foster collaborative relationships from the very beginning.
• Monitor the mid-level provider's performance periodically and provide constructive feedback.

Step Up Your Marketing

It is important to coordinate the expansion of your chiropractic practice with mid-levels by pursuing renewed efforts at marketing. This will create an opportunity to increase the number of patients in your practice. For instance, if you bring in a mid-level nurse practitioner who has an interest in diabetes, you may consider providing an open house on diabetes. You may also be in a position to offer Saturdays or evening hours to attract more patients, if you do not already do so.

Looking at the wide-ranging possibilities, consider the idea of bringing in non-physician providers, as well as partnering with physicians, as an effective way to grow and expand your chiropractic practice.

Editor's Note: The author thanks Vikas Vij, who assisted in the writing of this article.