Medical groups turn to advanced practice provider roles amid staffing struggles

The staffing struggles in medical practices in recent years have prompted many organizations to seek new solutions to ensure patients receive high-quality care while also achieving operational efficiencies and financial sustainability. One of those solutions has been integrating new advanced practice providers (APPs) and optimizing their roles.

A June 18, 2024, MGMA Stat poll found that more than six in 10 (63%) medical groups plan to add new APP roles in 2024, while 37% did not. The poll had 428 applicable responses.

These results point to continued interest in expanding use of APPs in medical group practices compared to an April 11, 2023, poll in which 65% of medical group leaders said they planned to add new APP roles last year.

APP job growth is expected to be higher than the average for employment gains across all occupations:

• Federal labor data suggest that employment of nurse anesthetists (CRNAs), nurse midwives (CNMs) and nurse practitioners (NPs) is projected to grow by 38% from 2022 to 2032, with about 29,2000 openings each year on average.
• Additionally, the Occupational Outlook Handbook projects 27% growth in physician assistant (PA) employment in that same period, with about 12,200 openings each year on average.
• Much of the growth for APP roles was seen as being tied to the recent surge in retail clinics, in which APPs play key roles; however, several major companies that entered the retail clinic space have since revised their growth plans or otherwise halted their efforts, such as the recent decision by Walmart Health to close all 51 of its health centers.

In general, many of the medical group leaders from organizations planning to add new APP roles in 2024 noted that they continue to see a surge in patient demand; this aligns with MGMA polling earlier this year that found that more than three-quarters (77%) of groups are seeing the same or higher visit volumes in 2024 compared to the same time last year. “Patient volume is driving this,” according to one practice leader who has added PA and NP roles this year.

Several respondents to this latest MGMA poll who noted they are not adding new APP roles pointed to no specific need for new APPs in their staffing model now, or that they already have success in recruiting students who then rotate through with more experienced APPs.

At the same time, many medical groups responding to this week’s poll noted that their areas do have several recent-grad APP candidates but often very few applicants for open roles who have a higher level of experience, thus requiring more on-the-job learning in addition to onboarding efforts.

• Other practice leaders noted they plan to add an APP supervisor to standardize onboarding, education tracks and connect with the team for feedback and ensure they are adhering to protocols.
• Some respondents signaled they plan to subspecialty-train APPs to help in areas where physician time-to-fill is significant.

Trends in APP utilization

APPs play an increasingly important role in healthcare organizations by expanding access to care and alleviating the burden on physicians. APPs are highly trained and possess advanced clinical skills and knowledge, allowing them to diagnose, treat and manage a wide range of medical conditions. The increasing physician shortages have put renewed focus on state-by-state scope of practice rules for APPs as their roles evolve and expand.

• Click here for state-by-state information on NP practice authority.
• Click here for state-by-state information on PA practice authority.

Several trends and developments in healthcare have allowed APPs to participate in patient care more:

Telehealth and remote care

APPs can deliver virtual consultations, remote monitoring and follow-up care, making healthcare more accessible and convenient for patients. Following the flexibilities granted amid the COVID-19 pandemic, the industry has seen a surge in NPs delivering care through telehealth platforms.

Value-based care models

The continued focus on value-based care, which emphasizes quality and outcomes over volume, aligns well with the strengths of APPs. Their focus on preventative care, chronic disease management and patient education supports the goals of value-based care models.

Integrating APPs into value-based care will be important for healthcare and requires collaboration and coordination among healthcare teams, including physicians, nurses, APPs and other providers.

Interdisciplinary collaboration

Care delivery relies on collaboration and good communication. APPs often have several responsibilities across direct and indirect patient care, as well as in the administrative realm. For example, APPs in gastroenterology may be spread across new patient and follow-up visits, telemedicine visits, ancillary procedures, patient messages and phone calls and more.

Medical groups may consider developing a standard of practice guideline/document to set clear roles and expectations for how physicians and APPs should work in a team-based care environment.

• For more insights on APPs and incident-to and split/shared E/M services, read this recent article from VMG Health.

Education and training

As demand for APPs grows, there will be more demand for advanced training. It will be important to expand educational opportunities and clinical training to APPs that want to do more in healthcare.

Additional resources

• Advanced Practice Provider Compensation Model Contract Outline (Member tool)
• Provider Pay and the Dawn of a New Era of Productivity (Provider Compensation data report)
• “Key considerations for your next anesthesia arrangement” (Insight article)
• “Making sense of evolving models for advanced practice provider compensation” (MGMA Stat)
• “General and Unique Communication Skills Challenges for Advanced Practice Providers: A Mixed-Methods Study” (J Adv Pract Oncol)
• “Optimal Use of Advanced Practice Providers at an Academic Medical Center: A First-Year Retrospective Review” (Cureus)