The ever-changing environment of healthcare leads many practices to consider how they will control the cost of overhead, give access to their patients, and maintain or increase practice income. The solution may be to add a midlevel provider (MLP)–a Physician Assistant (PA) or Nurse Practitioner (NP)–to the staff. Both of these specialties train to see patients independently. The difference between a PA and an NP is the type of training and level of supervision required. The addition of an MLP can address many of the impending changes in healthcare, while increasing the quality and profitability of the practice. This article outlines the initial steps to take when adding an MLP to your practice.