Bridging the Gap: Physician Extenders to Close the Ranks of Emerging Healthcare Shortages

     Who will close the gap in healthcare shortages as doctors / physicians become overwhelmed with an aging and ever growing population of patients?  Nurse practitioners, physician assistants, clinical nurse specialists, nurse anesthetists, nurse midwives, and additional physician extenders may be just the answer. 


Dr. Neeta Kohli-Dang and Kari Kingsley, CRNP

                    Legs slightly crossed, with my back posture as stiff as that of a military cadet, I nervously clear my throat as my interview for what I consider to be the cremdelacreme of nurse practitioner positions begins.  Sitting across from the impeccably dressed and perspicacious otolaryngologist, I silently pray she won’t notice the bead of sweat forming on my upper lip or the faint quiver in my voice as I try to answer her straightforward questions in the most astute way my nervous 29-year-old brain could formulate.  Luckily, she missed my dry heaves in the ornate Viburnum bushes landscaping her charming office parking lot, after the interview concluded.

           Thinking back on that moment, a smile inches across my face.  My nerves got the best of me.  At the time, I would have bet the entire Powerball Lottery I wouldn’t be getting the job offer.  I’d never been so happy to be wrong.  I now consider my collaborative physician to be not only my mentor, but one of my dearest friends and confidants.  I jokingly embellish the retelling of my interview story by adding that I made sure to find out Dr. Neeta Kohli-Dang’s dress style and shoe size before we agreed on terms so that I could take full advantage of her flawless taste in clothes and accessories AND her generous heart when it comes to lending me outfits for special occasions.

          I count my blessings daily for the working relationship I have with my boss.  I have nurse practitioner and physician assistant friends at all ends of the spectrum in terms of job satisfaction and fulfillment.  They range from highly salaried slave labor positions in which they work grueling hours, rarely seeing their families all the way to those seeing 5 patients a day, begging for more work.  I’m happy to fall in the middle.  We run a state of the art ENT practice performing cutting-edge in office surgeries using low radiation CT imaging, complete with in office neck and thyroid ultrasounds, a speech pathology department, and audiologic testing.  Likewise, Dr. Dang recognizes in me a very hardworking, OCD, type-A nurse practitioner that loves to solve the puzzles human anatomy and physiology can pose. While exemplary patient care is always our top priority, we still find a few minutes here and there to laugh and sip lattes.

          As our aging population continues to grow and as we continue to make astonishing advancements in medicine, raising the cost of healthcare, the American medical paradigm is shifting into uncharted waters.  As our Baby-Boomers retire, the growing demand for healthcare abuts our government’s dwindling reimbursement deterring many young medical school graduates from a career in primary care… or a career in medicine altogether. Reduced reimbursement also lays a heavy burden on specialists requiring heavier patient loads with less time to spend on one-on-one care.  Dawn C. Joy, Accredited Practitioner and Nursing Instructor at Gannon University has said, “I feel that the healthcare system is an upside-down pyramid; we have the personnel with the most education and knowledge farthest away from the patient because of administrative and regulatory requirements.”


          So, what’s the solution when you need to connect two separate forces and bring the patients at the top of the pyramid to meet physicians at the bottom?  To put it simply: You build a bridge.  Physician extenders such as nurse practitioners, physician assistants, and nurse midwives are specially trained individuals, licensed to perform certain tasks and procedures that might otherwise be performed by physicians themselves.  They work under the direction of a supervising or collaborating physician to bridge the gap.  Physician extenders are not meant to replace physicians, simply to extend highly-skilled, quality medical care such as determining differential diagnoses, implementing protocols of care, using critical thinking skills to interpret laboratory tests and medical imaging, and performing patient education regarding various treatment modalities. Physician extenders alone will not solve the tough healthcare reform changes America has to face. But they do provide a valuable solution to an accelerating need by providing competent medical care.  Metaphorically (and possibly literally), nurse practitioners and physician assistants will be the bridge on which we will carry our patients from the top of Dawn Joy’s pyramid to the bottom.  Bariatric physician extenders are reaching for their back braces as they read this.

               When I put ink to paper and list the top characteristics my “Dream Job” would entail, my position with Dr. Neeta Kohli-Dang at Huntsville Ear, Nose, and Throat fulfills them all.  She and I have formed an enthusiastic working relationship with a strong passion to provide exemplary care to our patients, which enriches both our lives.  These strong interpersonal relationships between physician and physician extender are vital to support our efforts to bridge care to patients.   And it doesn’t hurt that I get to borrow Dr. Dang’s Jimmy Choo’s.


Kari and Dr. Dang photo for IM
Kari Kingsley and Dr. Neeta Kohli-Dang

Kari Kingsley, MSN, CRNP works as an otolaryngology nurse practitioner in collaboration with Dr. Neeta Kohli-Dang. Together they share nearly forty years of ENT experience. They treat dizziness, ear infections, hearing loss, nasal congestion, sinus infections, thyroid nodules, tonsillitis, neck masses, hoarseness, trouble swallowing, and a multitude of other ear nose and throat conditions. Please call 256-882-0165 to schedule an appointment with Dr. Neeta Kohli-Dang and Kari Kingsley or visit Huntsville ENT.

                                   Written for and published by Inside Medicine.


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