With increasing pressure to see more patients in a more cost-effective manner, physicians are exploring new staffing variations, including the use of ancillary clinical personnel, physician extenders.

The term "physician extender" can be used to describe nurse practitioners (NPs), physician assistants, telephone triage programs and a variety of other mid-level providers. The growing demand for use of physician extenders in direct patient care settings is well-timed, given the supply of NPs has increased sharply in recent years. The National Association of Pediatric Nurse Associates and Practitioners (NAP-NAP) estimates there are 10,000 PNPs in the United States, and NAPNAP membership has increased by 50 percent over the last five years. According to the American College of Nurse Practitioners an NP is "a registered nurse with advanced academic and clinical experience, which enables him or her to diagnose and manage most common and many chronic illnesses, either independently or as part of a health care team."

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