MAR 2016

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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24 Ophthalmology Business • March 2016 4 tips to add a PA to your practice 1. Start at the ground level. If there's a PA program near you, offer a rotation in your office, Ms. Davis suggested. "Having a PA student on rotation can function like a long-term job interview to see if there's a good fit," she said. It also exposes new PAs to aspects of eyecare they may otherwise not learn about. "The lack of exposure to the field in PA school along with the lack of postgraduate training opportunities probably causes many students to overlook ophthalmology as a potential career choice," Mr. Hanifin said. 2. Advertise via specialty organi- zations. In addition to the usual web- sites or hiring venues you might use, post an ad through the AAPA website or through your state or regional PA groups. You can ask colleagues in spe- cialties that commonly hire PAs about PA organizations in your area or if they know about PAs who may be job searching, Ms. Guilbault recommended. 3. Decide how you will bring new PA hires up to speed within oph- thalmology. At Minnesota Eye Consul- tants, when the first PA was hired, she spent 2 months following surgeons, observing surgery, helping design the workflow, charting, and billing system, and coordinating care with outside providers as needed. 4. Consider the logistics. Adding a PA will require rethinking workflow design, staffing, space considerations, and charting and billing set up, Ms. Simerson said. "You may also need approval to bill CPT codes to payers for their services," she added. OB Contact information Davis: ann@aapa.org Guilbault: maryr@nccpa.net Hanifin: Christopher.Hanifin@shu.edu Morton-Rias: maryr@nccpa.net Simerson: cssimerson@mneye.com Although ophthalmologists often feel "myopic" in their focus on the eyes, Ms. Guilbault sees a connec- tion with the work she does and the patient's overall health. "We all have to look at the big picture," she said, noting the large number of patients with conditions like diabetes or kidney problems who may have eye-related issues. With Ms. Guilbault's help, the practice has been able to cut down significantly on the time it takes to examine patients preoperatively and clear them for surgery. Another PA/ eyecare example At Minnesota Eye Consultants in the Minneapolis area, 2 PAs (and soon, a third PA) evaluate patients for the preop physicals, said Candace Simerson, president and COO, Minnesota Eye Consultants. Surgeons got frustrated when they would schedule eye surgery but pa- tients did not visit their primary care doctor within the necessary timeframe for the physical—or they didn't have a primary care doctor to see, Ms. Sim- erson said. That prompted the practice to hire the PAs and add them to their mix of 14 ophthalmologists and 13 optometrists who work among 4 sur- gery centers. The PAs also see the 250 staff members at Minnesota Eye Consul- tants for urgent care concerns. "We are self-insured, so this limits the need for our staff to go to urgent care and take time off from work," Ms. Simerson said. As in other typical eyecare prac- tices, the surgeons handle evaluations and consultative care, while optom- etrists handle internal postop visits, routine eyecare, follow-up visits, and on call. "If a practice did not have a robust optometry team, the PA could also do urgent care and postop visits with proper training. The PAs could handle on call if needed," Ms. Sim- erson said. lab tests and imaging, and prescribe medication. "In broad terms, PAs can generally do anything that their collaborating physician delegates to them," Mr. Han- ifin said. PAs enjoy their ability to move among different specialties and subspe- cialties, Ms. Davis said. Fitting a PA into eyecare: One example Martha Jane Guilbault, PA-C, Wake For- est Baptist Medical Center, Winston-Sa- lem, North Carolina, was a PA in family medicine and other specialties before entering ophthalmology, where she has worked with eye surgeons for 7 years. Her practice has 12 MDs. At her practice, once a patient is slated for surgery, she will evaluate the patient preoperatively, and she will explain the surgery in layman's terms. She ultimately medically clears most of the patients for surgery; otherwise they are cleared for surgery by the anesthe- tist if getting general anesthesia. She finds herself collaborating frequently with the corneal and retinal specialists, anesthesiologists, and the scheduling people. She also finds herself serving as an objective sounding board for pa- tients who may be reluctant to follow a doctor's orders—be it from their prima- ry care doctor or a specialist. Ms. Guilbault also can perform an ultrasound of the eye to determine if something may need further evalua- tion by the ophthalmologist. continued from page 23 Nurse practitioners on the rise, too The number of nurse practitioners is growing as well. The American Academy of Nurse Practitioners (AANP) predicts that the number of NPs will increase by 2025 to 224,000. There were 205,000 licensed NPs in the U.S. in 2014. The majority work in primary care settings.

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