Solve the primary care crisis by integrating advanced practice providers (APPs)

The primary care physician (PCP) shortage is in a crisis proportion and is expected to continue to be an industry-wide focus as more than one-third of currently active physicians may retire within the next decade. As new doctors enter the field and experienced doctors leave, practice faces increasing challenges to provide high-quality care to patients in a timely manner.

Senior Practice Providers (APPs), such as Physician Assistant (PAS) and Advanced Practice Registered Nurse (APRNS), provide an opportunity to increase the number of clinicians who can support patient care by playing a key role in improving practice efficiency and quality of care. They can also be powerful “power multipliers”.

Because practices tend to build greater flexibility in the application’s timeline, they can effectively expand patient care opportunities while allowing physicians to focus on more complex patients. It is no surprise to find that the app offers a higher percentage of primary care percentages over the next 10-20 years. Indeed, the next generation may get most of the primary care from the app.

However, ideally, the application should work closely with the doctor in practice. Exercises must ensure that the application is supported and supervised enough to optimize training for each clinician and keep everyone working on the top of the license.

Three key application integration strategies

Identifying the best role of applications in primary care practice requires understanding and appreciation of the different skills and training brought by various clinicians. For example, here are some examples of different types of graduate training:

• Physicians usually spend 4 years in medical school, plus 3-4 years of residence
• ARNP usually takes 2-4 years to earn a master's degree or doctorate in nursing
• PA often spends 2-3 years to get a PA master's degree

Overall, doctors receive more postgraduate clinical education, but the application may require years of nursing or other patient care training. All these factors should be considered in practice. To optimize the strengths of each clinician, practice should consider three application integration strategies starting with physician guidance.

Strategy 1: Encourage doctors to guide the app

For those who need to keep up with the fast medical speed of Lightning, learning and guidance never stops. All clinicians are students.

Although we tend to downplay the value of collective learning environments in medicine, practice must find healthy ways to encourage clinicians to learn and challenge each other’s clinical thinking. Just as experienced doctors often share knowledge between new doctors, doctors and applications, there are opportunities for guidance and development. Doctors who spend time sharing their hands-on experience and insights can improve their clinical knowledge and abilities over time. Similarly, apps should share their expertise with colleagues, including apps and doctors.

The tendency to develop a truly collaborative learning environment often penetrates healthier practice dynamics and better patient relationships.

Strategy 2: Provide clinical guidance and decision support

The key to successful application integration is to use their skills in a way that best meets the needs of the patient population, including increasing their access to care. Although it will vary from practice to practice, many primary care practices succeed by leveraging applications to achieve relatively simple patient concerns, which often constitutes a considerable patient visit. As the application makes it easier for patients to get more routine care, doctors have time to spend on more complex cases requiring their expertise.

Regardless of the efficiency that produces efficiency, practice should ensure that its applications have access to the same clinical guidance and decision support tools as physician colleagues. Educational opportunities should also be consistent. For example, workshops that improve clinical documentation are as beneficial as doctors.

Strategy 3: Implement monitoring plans to ensure quality care

Continuous guidance is important. It is crucial for physicians to conduct a consistent sampling review of their app’s notes to ensure that they agree to the clinical thinking of any app that works under license. It provides opportunities for providing clinical guidance and strengthening documentation, which can affect patient care and practice reimbursement.

Additionally, doctors should live with a mantra: “You can’t manage your own measures.” Some practices use reports to evaluate the extent to which their applications meet certain performance metrics, such as HEDIS measures or medication adherence.

Granted, when an app works under a doctor's license, metrics can be confused as it is difficult to determine if the app or the care provided by the doctor. Still, some complex practices have begun compiling specific performance reports for applications, allowing them to see which applications are closing the quality of care gap and which require additional training.

Such reports enable practices to identify high-performance applications and provide them with the tools to become the application champions in the group. These advocates can then use reports to develop peer-to-peer coaching and other ongoing performance improvement efforts to make Strategy 1: Mentoring competence.

The future of primary care

Integrating applications into primary care practices is critical to addressing the reality of physician shortages. However, successful doing so requires strategic support and oversight of the application. Practices must understand all the advantages and limitations of their training and enhance their capabilities through collaborative learning and development, clinical support, and quality improvement insights. Help apps work on top of their licenses promise not only to improve patient care and improve practice efficiency, but also ensure a healthcare future for everyone.

Photo: Stock View, Getty Image

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