Tag Archive for: advanced care providers opioid crisis


Patients seeking pain relief from PPOA are just as likely to see a Physician Assistant (PA) or Advanced Practice Registered Nurse (APRN) as they are a physician.

Both of these advanced care providers have advanced training and are able to write prescriptions, including those for controlled substances, without direct physician supervision. They can administer opioid antidotes  and also adjust medicine dosages autonomously.

This is significant as the opioid crisis continues to rage nationwide. Bound by a combination of policy and principle, Physician Partners of America continues to focus on interventional treatment modalities; we favor minimally invasive and laser spine procedures that treat pain at its origin instead of masking it with opioid medication.

The onus is often on the PAs and APRNs to manage medication and taper patients down.

“Advanced care providers get to be the enforcers of the number of medicines – pain pills – that can be taken at a time,” says Abraham Rivera, M.D., Chief Medical Officer of Physician Partners of America. “They get to police what to do with the results of an abnormal urine drug test. They get to educate the patients about drug interactions. They get to enforce those reductions when they are part of a treatment plan.”

The physicians design treatment plans, and work hand in hand with Physician Assistants and APRNs to ensure that these plans are followed.

“Say I’m going to design a patient’s taper-down treatment plan for opiates because the doses are too high,” Dr. Rivera says. “Over the next three months, I’m going to scale them down in a certain fashion; but it is my advanced care provider who might be seeing that patient in those three months. They will have to endure the difficult task to make sure the patient sticks to that scale-down plan. That creates some very difficult interactions. “

Eric Shelton is a Physician Assistant in PPOA’s busy Habana Avenue, Tampa, Fla. practice. He says tapering down opioids is a challenging part of his job.

“We’re the target of frustration from changes in politics to changes in protocols, and definitely tapering opioids is very, very difficult,” he says. “Patients are hurting. You reduce their opioids, they see that as a threat and therefore that’s offensive and you’re the one doing that to them.

“I can educate patients all day long on why it’s a good thing and why using interventional pain management methods instead of opioids are going to be better in the long run,” Shelton continues, “but the truth is that instant gratification in any field of medicine is the most desired, and that’s what opioids provide. And when you start to reduce that, it’s not welcomed at all.”

To be successful in the pain management field, advanced care professionals must get to know their established patients. He or she must be highly observant for such red flags as patients coming up short in their medication supply, requesting refills sooner than expected, or coming into the clinic with an “off” demeanor.

“Knowing these things contributes to a patient’s quality of care,” Shelton says, “and you’ve got to be able to pick that out and be a detective in the amount of time that you’re given. You use the tools at hand to do the job to the best of your abilities.”

In all, it takes a strong and well-educated professional to help patients in their journey out of pain, but advanced care practitioners see it as a very rewarding challenge.

“Advanced care providers need to have spring in step and happiness in heart,” says Dr. Rivera. “They have to have peace that they are doing the right thing for patients and endure the fact that we won’t please every patient. They have to be secure in the knowledge that what they are doing is the right thing.”

At Physician Partners of America, we are in the business of caring for people. Our goal is to transform the doctor-patient experience with our patient-centric model. We are a diverse and extended family of professionals bringing innovation and wide-ranging talents that to our healthcare mission.