The rise of the “extenders”—but who are they?

“By the end of 2014, more than half of states were weighing expanding the clinical duties of nurses, physician assistants, pharmacists and others. Scopes of practice for these so-called ‘extenders’ will expand as the US healthcare system absorbs millions of newly insured consumers under the Affordable Care Act and stretches to care for a cresting wave of aging baby boomers.”

The excerpt above is from an article published in January 2015 by the PricewaterhouseCoopers Health Research Institute (PwC HRI). The engaging article captured the institute’s predicted top health industry trends for 2015. PwC’s eighth ranked trend was “Physician extenders see an expanded role in patient care.” This expansion is no doubt driven by the perfect storm of physician shortages combined with the intense wave of baby boomers who are entering the healthcare funnel. However, I wonder if we have clearly defined which professional roles fall under the extender umbrella.

Who are the extenders?

The quote above defines physician extenders as “nurses, physician assistants (PAs), pharmacists and ‘others.’” The term others seems nebulous to me.

In April 2013, we posted 2 blogs that described the expansion of the role of healthcare extender even further to include, “certified health education specialists, nurse-practitioners, registered dietitians, certified diabetes educators, nurses, pharmacists, patient educators, public health professionals, community health workers, and social workers, among many others.” Again—we see the term, others.

Do we need to formally define the extender role and its competencies?

The PwC HRI asserts that extenders are growing in numbers and roles are expanding. In a recent HRI survey report, we learn that:

  • Three-quarters of consumers supported this shift and stated that they would be comfortable seeing an extender
  • One-third of doctors believed that half of their clinical encounters could be managed by extenders

According to the HRI, physicians feel that extenders allow them to “spend more time with patients, better coordinate care and enjoy more work-life balance.”

However, this shift has not come without detractors. In the same HRI survey, some physicians said that they “remain reluctant to cede patient care to other clinicians.” The core barrier for these doctors seems to be “turf battles over who should treat patients—and where.” In fact, the American Medical Association contends that nurse-practitioners and other clinicians lack the needed medical training to fully diagnose patients.

Am I a healthcare extender?

I have worked in the healthcare industry for 25 years in multiple roles and settings. In the early part of my career, I worked directly with patients/families, and my titles included, “psychiatric technician,” “activities therapist,” “child life counselor,” “group home coordinator,” “director of education,” and “special care center manager.” Was I a healthcare extender during this time”? I believe that I was because my work supported and extended the treatment plan developed by the healthcare provider. I assisted with personal care and therapeutic activities that improved the physical and psychosocial well-being of the patient and his or her family caregivers. If I didn’t do my job well, the health of both the patient and family caregivers’ would suffer.

In the second half of my career, I shifted to health education and instructional design. I don’t currently work directly with patients, so am I still considered a healthcare extender?

Are you a healthcare extender?

I hope that this blog contributes to the important, provocative dialogue related to the role of the extender. Please join this dialogue by adding your title, a brief description of your role, and your opinion on whether you identify with the healthcare extender role. To connect with more than 6000 healthcare extenders, please visit our online extender social network community at Membership is free, and you can benefit from discussions, articles, blogs, and resources that improve outcomes for all.


NP Core Competencies Content Work Group. National Organization of Nurse Practitioner Facilities. Core Competencies Content. 2014. Accessed February 2, 2015.

Greene, J. HealthEd Blog. 7 reasons you need to get closer to healthcare extenders. 2013. Accessed January 31, 2015.

Centers for Disease Control and Prevention. Indicators Spotlight: Health Care Extenders. (2013). Accessed January 31, 2015.

PricewaterhouseCoopers Health Research Institute. Top health industry issues of 2015. Accessed  January 31, 2015.

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