Pandemic, Practice Authority and Pay Parity: AANP's Past President, Sophia Thomas, Looks Back on an Eventful 2-Year Term

New president April N. Kapu begins leading the nurse practitioners' national association today.

As April N. Kapu, DNP, APRN, ACNP- BC, FAANP, FCCM, FAAN, begins her two-year term as president of the American Association of Nurse Practitioners (AANP) today, her predecessor, Sophia Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, can look back on a term quite like no other.

The COVID-19 pandemic dominated most of her term, impacting healthcare at every level, but Thomas ably guided the association through substantial membership growth—it has 118,000 members today—and legislative successes, as nearly half the states now allow nurse practitioners (NPs) full practice authority.

Thomas talked with HealthLeaders on the last day of her term about the road ahead for NPs and what she considers her most important accomplishments.

This transcript has been edited for clarity and brevity.

HealthLeaders: AANP considers nurses "the future of healthcare." What does that mean?

Sophia Thomas: We're meeting the needs of healthcare patients living in areas where they really don't have access to care. And while the profession is experiencing double-digit growth, the number of primary care physicians continues to decline as physicians opt for more lucrative specialties.

It's important that we realize that by 2025, as the US faces a shortage of as many as 90,000 physicians, nurse practitioners are really growing and really working to meet the needs of the underserved communities. After COVID, it's an opportunity for us to look at the future of healthcare and redefine healthcare.

HL: COVID altered the course of NPs regarding full practice authority. How likely is it that American NPs eventually will be able to practice without physician oversight?

Thomas: In 24 states now, the District of Columbia, Indian Health Services, and the whole [Veterans Administration] healthcare system, nurse practitioners do practice with what we call a full practice authority. We practice many times in clinics and hospitals with physicians.

We don't believe that a nurse practitioner needs a written piece of paper, or agreement, to say we collaborate with Physician X, because we collaborate with healthcare providers of all specialties, including physicians, every day without written agreements. [Physician oversight] is an outdated practice model and more and more states are choosing to shift to allow nurse practitioners to practice to the top of their education and training without the regulatory restrictions.

HL: Along the same lines, how likely is it that Medicare will increase the NP reimbursement rate to 100% of the physician pay rate?

Thomas: It's important for us to look at clinical outcomes and certainly the data is there to suggest that nurse practitioners' clinical outcomes are equal to physicians' on many levels, and certainly more and more research is being done.

It's about equal pay for equal work. We're not paying healthcare providers based on how much they spent for their education, we're paying for a service. And there are specific guidelines for the service—how much time you spend with the patient or how complex the diagnoses are—and that's what's billed. So, it really should be about equal pay for equal service.

HL: More clinicians than ever before are choosing the nurse practitioner path. Why do you think that's happening?

Thomas: I can tell you that for me, when I became a nurse, I loved my contact with patients and making a difference in their lives. I was at a hospital, and certainly for me, it was a calling to provide more comprehensive care and to look into prevention because I was seeing patients in the ICU who had very preventable conditions.

It was a calling to get higher education, get my master's and doctorate degrees, get that national certification, and be able to practice with patients on the outpatient level to work on preventive strategies. More and more people are choosing it because they see the healthcare disparities in this country, and they want to be able to provide more care to patients and educate them to really improve the healthcare and the outcomes of our country.

HL: Your term has been quite unlike your predecessors', particularly with the challenges of COVID and all that came with it. What do you consider your most important accomplishment?

Thomas: I worked throughout my presidency to really connect with our members and educate them on all the changes with COVID and as the guidelines kept changing, we thought it was important to really shift our focus to provide our COVID resources to our members, as well as PPE. People were having a hard time getting access to PPE and so we provided PPE access to our members as well as COVID education. Then we realized very quickly that burnout was happening in the healthcare community, so we again quickly shifted to provide resources.

Most of all, [I've enjoyed] engaging the grassroots, providing them more educational opportunities from within our Continuing Education Center, listening to our members, and meeting their needs.

Certainly, I had some highlights, like getting to visit the White House and being a consultant for Operation Warp Speed [the public-private partnership to accelerate development and distribution of COVID-19 vaccines], but all of that is about elevating the role of the nurse practitioner to create more awareness.

NPs really stepped up to the plate. We now have 325,000 nurse practitioners in this country, which is amazing, and that's 325,000 solutions to healthcare as long as nurse practitioners are able to practice to the top of their education and training.