In tandem with our 20th anniversary, we at Clinical Advisor recognize the advances that have occurred in clinical practice over the past few decades and share the perspectives of members of our audience.

While electronic medical/health records (EMR/her) have streamlined the charting process and have made it easier to search for medical history information and diagnostic results, it has also left many providers feeling like we are spending more time on the computer in the exam room than actually examining the patient. To offset this disparity, I will turn the computer screen so the patient can see what I’m doing, and then ask them to verify the information I am entering and to add or correct anything. This involves the patient in the process, and they feel less like a fly on the wall. I think most patients appreciate this and leave feeling that they were really heard during the visit.—Pamela Porter, DNP, APRN, FNP-BC, CNS, PA-C, Davis, California

Practice is now more complex. We are caring more for patients with numerous medical diagnoses. Patients are more demanding. They use “Dr Google” and come to the office with their own diagnosis or diagnoses. It takes patience to listen and sort out their signs and symptoms. It is also a more litigious atmosphere than when I first became a nurse practitioner. I have had the blessing of being in a wonderful family practice setting with compliant patients for the last 18 years, but I do plan on retiring this year!—Melinda O’Neil, CANP, Albuquerque, New Mexico

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Whereas my early practice was definitely focused more on treating a disease state with medications, now I focus more on emphasizing lifestyle measures to improve health and well-being. It is a joy to see people make healthy choices that will benefit them for the rest of their lives.—Jeanne Chase, DNP, APRN, FNP-BC, Stanford, Kentucky

I started with an hourly wage and no benefits; 25 years later, partnerships in physician groups are not uncommon like they were all those years ago. Reimbursement is better, there is greater understanding of our role in the care team model, and there is more autonomy. More federal and state laws favor PA practice, as do labor groups and industries.  We now have hospice and palliative care capabilities. The biggest change I see is the acceptance by other providers—MDs and DOs—and the recognition that we are professionals and should be treated and reimbursed similarly; at least in my state of Washington that is the rule rather than the exception! Coupled with the quadrupling of my hourly pay, the provision of full benefits with short- and long-term disability, 2 weeks of CME and $3000 available for it, 6 weeks of vacation, and 20% of gross to retirement paid from the group practice like the other providers:  there have been a lot of positive changes over 25 years!—Kevin Lewis, Physician Associate, Seattle, Washington