Why We Need Advanced Practice Clinicians

A former primary care doctor who's now a health system CEO says physician leaders need to get comfortable with the industry's increasing reliance on APCs, such as PAs and NPs.

This article appears in the September/October 2018 edition of HealthLeaders magazine. It is a sidebar to the feature story "Direct Primary Care: A Segue to Direct-to-Employer?"

If you could start from scratch and build the U.S. healthcare delivery system in a vacuum, assigning tasks to team members with the goal of maximizing efficiency and effectiveness, would you have an orthopedic surgeon spend his or her entire day seeing patients with back pain that doesn't require surgery?

"It wouldn't make sense," says CHI Health CEO Cliff Robertson, MD, MBA.

The same is true for primary care practices, which is why physicians and physician leaders need to get comfortable with the industry's increasing reliance on advanced practice clinicians (APC), such as physician assistants and nurse practitioners, Robertson says.

"We have to be realistic that a primary care physician with a team of other clinical experts—other APCs, pharmacists, therapists—actually can work together to provide care for a larger population probably more efficiently than any of us can do on our own," he says.

While hospital-owned primary care practices with a higher ratio of nonphysician providers report greater expenses, they also report higher revenue after operating cost than their peers that have fewer nonphysician providers, regardless of specialty, according to MGMA's 2018 cost and revenue report.

"Think of it this way: We can't afford as a country, as an industry, … to have highly trained surgeons that spend their days not operating. That's an inefficient use of resources," says Robertson. "We can't afford to have medical specialists directly caring for patients that really could have been appropriately cared for by a primary care physician like me."

It's a simple principle, he says: "All clinicians must operate at the top of their license."

Actually delivering that type of practice model is the hard part.