Where's the Doctor? The Often Misunderstood Role of the Advanced Practice Provider

Guest Author: Stacey Wendling, MSN, RN, FNP-C
Nurse Practitioner, Covenant HealthCare Cardiology

The use of advanced practice providers (APPs) such as nurse practitioners (NPs) and physician assistants (PAs) is a growing theme in America in response to the national physician shortage. The American Nursing Association reports that shortages in primary care providers affects one in five Americans._¹

According to the Michigan Academy of Physician Assistants, in January 2016, an estimated 108,000 PAs were in clinical practice and in 2022, more than 355,000 NPs were licensed in the U.S., with both professions expecting faster growth potential. Roughly 45.6% of NPs are licensed, or privileged, to provide care in a hospital setting._³

As the population ages and more people gain access to health insurance from the Affordable Care Act, the nation will increasingly depend upon APPs to meet the healthcare needs of the nation and fill provider gaps within many healthcare teams across the medical spectrum.¹ With service areas including primary and preventive care, mental health, birthing, anesthesia and an emerging number of specialty practices,¹ APPs are becoming the face of healthcare services, particularly as many physicians approach retirement age.⁵

Often tasked with daily inpatient rounds, the hospital-based NP or PA is commonly the face that patients see and know is not the doctor, prompting the frequent-heard comment and perception of “never seeing a doctor.”

What Does an APP Do?

The roles and functions of APPs are often widely misunderstood by patients and the greater community. APPs undergo extensive medical education, training and credentialing processes. These caregivers adhere to the same high-quality standards of care as doctors.

Although APPs have the capacity and licensing to formulate recommendations for patient care, their care plans most often resemble that of the supervising physician's clinical interpretation of the situation and resulting recommendations. The employment of APPs has been proven to increase access to health care and yield positive patient outcomes.²

In general, NP and PA roles are different, though not separate, from the supervising physician. APPs deliver care that has been proven not only to increase patient satisfaction but also enhance access to care, as well as positively impact chronic disease management and cost-effectiveness for patients.⁶

The role of the APP is to diagnose health conditions, order tests, and prescribe medications. The American Association of Nurse Practitioners notes that an NP’s scope of work varies depending on their specialization area, the population they serve, and the state where they practice. Most often, patients will have a similar experience during encounters with APPs compared to physician encounters.

The Provider is Here

Though APPs are indeed not doctors, they are quite capable of providing outstanding and timely patient care. Based on a strong collaborative relationship, the work of the highly trained APP directly aligns with that of the supervising physician and is not meant to replace, but effectively supplement and extend the reach of patient care provided by physicians.

With a better understanding of the role of the APP, patients will experience greater satisfaction in care. This is especially true when waiting on a physician to provide care would extend the time to assessment, testing, and hospital length of stay—all of which are known to negatively impact patient satisfaction.

Rest assured, when in the hospital, a highly qualified provider is closely managing your care, even though you may not see “the doctor” at every visit.

References

1. American Nurses Association (ANA) (n.d.). Advanced Practice Registered Nurse (APRN).
   https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/
2. Michigan Academy of Physician Assistants (MAPA) (n.d.). What is a PA?.
   https://www.michiganpa.org/page/34
3. American Association of Nurse Practitioners (AANP) (11, 2022). NP Fact sheet.
   https://www.aanp.org/about/all-about-nps/np-fact-sheet
4. American Medical Association (AMA) (4, 2022). Doctor shortages are here—and they’ll get worse if we don’t act fast.
   https://www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act
5. International Journal of Nursing Studies Advances (Htay & Whitehead, Nov, 2021).
   The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. https://www.sciencedirect.com/science/article/pii/S2666142X21000163