The future of professional nursing: APP, MD, and machine-guided supervision

Across the United States, health systems are turning to advanced practice providers (APPs) to address an escalating crisis in access to specialty care. This is a necessary and logical solution. However, as a recent survey series Bloomberg For the record, this rapid expansion has exposed persistent gaps in training and supervision, leaving many to wonder whether we are setting this critical workforce up for success.

This isn't a training issue, it's a design issue. The real risk to patient care is not the APP model itself, but the outdated clinical architecture within which it is forced to operate. Health systems are asking APPs to expand capacity without fundamentally redesigning regulatory models to ensure their work is safe, effective and sustainable. Simply inserting new providers into workflows built for a different era is not a strategy but an improvisation that prioritizes coverage over clarity, thereby introducing risk and undermining trust.

As a practicing gastroenterologist and a leader with the American Gastroenterological Association, I see this challenge firsthand. The need is particularly acute in gastroenterology, where provider shortages and increasing complexity are putting pressure on traditional models. In my clinical and leadership roles, I have learned that the success of APP-led care does not depend on who delivers care, but on how care is structured, supported and overseen.

The scalable model is more than just plugging an application into a physician's location. True scalability requires redesigning systems around applications, not just plugging them into legacy workflows. These include:

• Clear common presentation protocols based on specific professional guidelines
• Live escalation path for out-of-scope cases
• Proactive rather than reactive ongoing supervision
• A structured peer-to-peer network in which applications can consult and collaborate
• Feedback loops for quality, safety and continuing clinical education

Oversight is often viewed as a compliance function or legal safeguards. But in fact, it is a core driver of quality of care. When integrated into daily workflow, it can accelerate clinical development, build trust and reduce variability.

The ideal model would be real-time supervision, where deviations from the protocol surface immediately and the supervising physician can step in if needed. In this mode, applications can confidently practice within the scope of their permissions because they know support is nearby. Such systems do more than just protect patients. It protects the integrity of providers, organizations, and overall care delivery.

In this mode, everyone is clear. Applications know their boundaries and upgrade paths. Doctors are free to focus where they are needed most. Patients experience systems that feel coordinated rather than cobbled together.

Regulation at scale: Where artificial intelligence actually comes into play

Much of the focus on AI in healthcare has been on tasks such as documentation, diagnosis, or patient engagement. But one of its most valuable and overlooked applications is in surveillance.

With the right design, AI can track compliance with protocols, surface edge cases, and flag inconsistencies in real time. It helps ensure that the supervising physician does not review every chart but instead focuses on where their judgment is most important. It supports applications by identifying patterns and deviations early, enabling faster feedback and better decision-making.

This is not just another layer of technology. It's a way to expand guidance and safety without slowing down. It strengthens the entire system by improving the quality of supervision without adding unnecessary complexity.

Due to differences in training, APP-led care is often considered narrower in scope than physician-led care. But the real risk lies not with the characters themselves, but with the systems around them. With the right structure (clear expectations, strong supervision and technology to enhance clinical judgement), APPs can manage a wider range of care safely and effectively. Technology-enabled platforms are helping to bridge historical gaps and expand possibilities.

Many of today’s systems were not built for speed, regulation, or scale, and they cannot support the level of intelligence or flexibility required for modern care delivery. The solution is not to abandon the application. Invest in models that make their work safe, effective, and scalable. We already know how to do this. In aviation, junior pilots don't fly alone. They are embedded in multi-personnel environments with defined escalation points and simulated training. In surgery, the attending staff does not disappear when the resident takes the lead. They monitor, report and improve.

Why should professional nursing be any different?

A smarter future is still possible

We are at the crossroads of gastroenterology and specialty care. Patient demand continues to rise. The doctor shortage isn't going to be solved anytime soon. Apps are here to stay, that's a given. They are a critical part of the solution, but the systems around them must continue to evolve.

Expanding health care doesn’t just start with technology. It begins with thoughtful, consistent structure and supervision, supported by tools that enhance, rather than replace, clinical judgment. This is how we build a smarter, safer and more sustainable future for professional care.

Photo: Panya Mingthaisong, Getty Images

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