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In 2003 there will be over 45,000 Physician Assistants (PAs) and 90,000 Nurse Practitioners (NPs) in practice throughout the United States. Both professions can practice in all 50 states and they have been accepted by the VA, U.S. Public Health Service and the armed services. It is estimated that NPs are growing by 9,000 graduates and PAs by 4,000 graduates annually. These clinicians, although not physicians, routinely evaluate, diagnose, treat and prescribe, as only physicians have traditionally been able do so in the past. 
Generally, most NPs and PAs work in practices with their physician colleagues. Frequently, both professions can be found operating satellite offices and in rural areas, operating offices with minimal or no physician contact. All PAs must be associated with a physician while in some states nurse practitioners can practice independently. 

While both professions predominate in the primary care specialties, they can be found practicing in almost every specialty. With the upcoming cutback in resident house staff hours they will also see more positions open up in-house filling slots that once were filled by house officers and residents. 

Nurse practitioners can prescribe in 48 states and physician assistants in 47 states without any physician countersignature needed. The average PA writes between 18-20 prescriptions daily while the average NP writes 16-18. 

Much of the time, even when an NP or PA writes a prescription, the patient leaves the pharmacy with a bottle that has a doctor's name as the prescriber and not the name of the PA or NP who wrote it. When the name of a person who did not prescribe a medication appears on the bottle as the prescriber, there is the potential for confusion. It easily can give the patient the message that the person who treated them was not really able to write their prescription. 

There have been episodes of patients seeing PAs or NPs and coming back to the group or clinic for a recheck a few days later and telling the receptionist that they saw the doctor whose name was on the prescription bottle and being sent to the wrong clinician for a recheck. Furthermore, the person dispensing the medication may say your "doctor" prescribed product "X." Again a mixed message. 

Lastly, even when the pharmacy labels the PA's or NP's name as the prescriber and puts it on the bottle, the label usually has a pre-printed "Dr." before the name. Never before in our country's medical care system have non-physicians been able to prescribe. The system is certainly geared to the "doctor" but not to place the proper name on the bottle or give credit to the right prescriber for the prescription is at best poor communication; at its worst it could be malpractice. 

An Opportunity
NPs and PAs will be increasingly interacting on many different levels with pharmacists. They want and need your expertise and information. They want a better relationship with pharmacists and their staffs. There is an opportunity for pharmacists to recognize that there are many different prescribers. A call to your local NP or PA state organization for a speaker who can review the training and prescriptive practice legislation of their profession to your local or state pharmacy group  would be welcome and would go a long way to make your pharmacies more "PA and NP friendly." 

  A PA Asks Pharmacists:
Place Prescriber's Name on the Label

When first reviewing a new prescription, pharmacists should look at who wrote the prescription. If it is a PA or NP please place his or her name on the bottle. If you practice in a state where the NP's or PA's name must appear with the physician's name, place both on the bottle. 

                                                                         --David Mittman, RPA-C