Invisible Prescribers: What You Do and Don't Know About NPs and PAs - Pharmaceutical Executive


Invisible Prescribers: What You Do and Don't Know About NPs and PAs
How many prescriptions are written each year by nurse practitioners and physician assistants? It could be 200 million. Not that anyone is counting.

Pharmaceutical Executive

The earliest academic programs in both disciplines graduated their first classes in 1965. Since then, tremendous changes within the industry, practice patterns, and models of care have enabled nurse practitioners and physician assistants to expand their roles as professional healthcare providers and bring increasing value to medical practices across the country.

Today, many of these clinicians attain additional credentials through post-collegiate study, CME, CE, and practice certifications in a variety of specialty disciplines.

In some areas of medicine, they are increasingly recognized as key opinion leaders, credible authors, expert reviewers, researchers, or partners.

The available data on prescribing patterns of physician assistants and nurse practitioners are often buried within various reporting structures. Such information is difficult to access in the first place, and is also hard to evaluate, especially if a manufacturer wants to attribute prescribed pharmacologic therapies to clinicians. Multiple state boards complicate uniformity and reciprocity, making sales subject to rules and regulations that vary from state to state.

Perhaps most importantly, the roles of nurse practitioners and physician assistants vary dramatically from one place to the next.

In some areas, they function independently in solo practices. In others, they work collaboratively as members of a larger healthcare team. In all settings, however, they are recognized as highly qualified healthcare providers.

Inconsistencies in the way physician assistants and nurse practitioners practice have also kept them under manufacturers' radar when it comes to provider-targeted education. However, that has slowly begun to change.

For one thing, pharma sales managers have labeled increasing numbers of physicians "Do Not See." So sales reps are being forced, in some cases, to turn their attention to nurse practitioners and physician assistants if they want to train all office prescribers in best practices of counseling, medication, or other aspects of patient care.

But even as pharma's motive to call on this influential group of practitioners grows stronger, there is still too little data. Last year, in an attempt to shed light on prescribing and practice behaviors, MEBN, a continuing medical education provider, conducted a survey among nurse practitioners (n=697) and physician assistants (n=172) in order to better understand the unique profile of these clinicians.

The survey obtained current data regarding patient visits, length of time seeing patients, and other important practice facts. Statistics such as these, including prescribing by nurse practitioners and physician assistants, should prompt pharmaceutical manufacturers to take notice of this virtually untapped source of prescribers.

Fully 95 percent of responding nurse practitioners spend 11 minutes or more with their patients during routine office visits. They have time to discuss medication usage, compliance, comorbidities, and behavioral elements of care. Almost half of the respondents (48 percent) indicated that much of their time is spent in medication education.

More than a third (36 percent) report spending large amounts of time conducting physical exams, while 38 percent provide comorbidity counseling as well as primary-disease lifestyle and dietary education. Primary care physicians, on the other hand, report spending an average two to five minutes with patients.

If nurse practitioners see an average of 50 patients per week, the 100,000 nurse practitioners in the United States would have a quarter billion patient visits if they all worked 50 weeks a year. In fact, the number of patients seen in a year could easily be higher. One in four nurse practitioners sees more than 75 patients a week.

Once again, assuming 100,000 nurse practitioners working 50 weeks a year, nurse practitioners would write 125 million prescriptions per year, if they all wrote just 25 prescriptions per week. That number could also be higher; more than a third of all nurse practitioners write more than 50 prescriptions a week.

The AAnurse practitioner, in their 2003 member survey, reports that nurse practitioners write prescriptions in very specific categories, often by brand name, in a wide variety of settings. (

Like nurse practitioners, physician assistants spend a great deal of productive time with patients during routine visits.

Two of five physician assistants indicated they spent more than 30 percent of their patient time conducting physical exams. One in three spends as much time on primary-disease and comorbidity education (including diet and lifestyle).

Almost one in four physician assistants spent 30 percent of all patient time on medication education, while another 45 percent spent at least one hour in six advising patients about medications.


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