Becker's Clinical Quality & Infection Control

12 Executive Briefing Sponsored by: A dvanced practice nurses and physician assistants are playing increasingly important roles in patient care and organized leadership, stirring up a new set of challenges and opportunities for hospitals and health systems. A growing workforce of advanced practice professionals is countering physician shortages across the U.S., and more of these clinicians are stepping into medical staff leadership positions. The Bureau of Labor Statistics estimates the NP and PA workforce will increase 36 percent and 37 percent, respectively, by 2026, compared to just 13 percent growth in the physician workforce. With so much growth in the APP workforce, it's no wonder these clinicians are increasingly engaged in governance, management and leadership positions at hospitals and systems. "APPs are engaged in all clinical aspects of healthcare delivery and provide the opportunity for a well-rounded, collaborative medical staff leadership team," says Sally Pelletier, chief credentialing officer at The Greeley Company, a national healthcare consulting and professional services firm in the greater Boston area. The Greeley Company coined the term APP in 2008 after recognizing the industry's need to identify non-physician healthcare professionals who provide medical care and need to be privileged through the medical staff process, according to Ms. Pelletier. "At the time, there was a lot of confusion in the field due to the term 'allied health professional' being used to define both privileged and nonprivileged healthcare professionals," she says. Physician assistants and advanced practice nurses — including certified registered nurse anesthetists, certified nurse midwives, nurse practitioners and clinical nurse specialists — fall under the umbrella of APP, which is now a widely used term in healthcare credentialing. This article discusses the expanding role of APPs and identifies regulatory considerations and internal governance changes hospitals and health systems can implement to support these medical leaders as they step into leadership roles. Then and now: How and why the APP role is expanding APPs entered healthcare in the mid-1960s as a creative solution to fill care gaps and manage capacity issues created by physician shortages, particularly in the primary care area. University of Colorado in Denver launched the first nurse practitioner program in 1965. By 1980, there were more than 200 NP programs available for students in the U.S, according to American Association of Nurse Practitioners. The growth of APP positions throughout the past 50 years reflects the value hospitals and health systems see in deploying these individuals to support patient care. Yet because APPs first emerged to supplement the physician workforce, these clinicians initially lacked autonomy in healthcare settings, thus undercutting the benefits of their roles. "APPs' initial scope of practice within the hospital setting was often limited with strict rules for co-signatures and/or requirements for the physician to also round the same day — essentially negating the benefit of the NP or PA," says Ms. Pelletier. Fast forward four decades, and APPs are now gaining more autonomy and prominence than ever before, stepping into medical staff leadership roles traditionally held by physicians. These roles include medical staff officer and department chair positions, as well as chair or member positions on the hospital's credentials committee or medical executive committee with full voting rights. "We are seeing this change in increasing numbers across the country," says Ms. Pelletier. She identified four major trends driving this role change for APPs. 1. A national physician shortage. The Association of American Medical Colleges projects the U.S. will face a shortage of up to 120,000 physicians by 2030. This deficit is due in part to an aging physician workforce; about 43 percent of physicians in the U.S. are 55 years or older, meaning a retirement wave is looming, according to a 2017 report from Merritt Hawkins. The healthcare industry will rely on APPs to fill these absences in the healthcare setting. 2. Increasing demands on physicians. Today's physician workforce is stretched thin — and getting thinner. A 2016 survey of 17,000 physicians conducted by Merritt Hawkins found 81 percent of primary care physicians were at capacity or overextended, and only about 19 percent said they had time to see more patients. These demands not only contribute to physician burnout but also increase wait times and decrease patients' face time with their providers. Hospitals are realizing APPs in leadership roles: Key opportunities and considerations for hospitals

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