Health Care’s Emergent Workforce: Advanced Practice CliniciansMay 17, 2019 For many years, prescribing, diagnosing and treating patients was a job for physicians only. Recently, that has begun to change.
Thanks to growing demand and the increasing practice of team-based medicine, the health care industry has begun to rely on more advanced practice clinicians (APCs) alongside doctors. In Oregon and in many other states, these clinicians can provide medical care as part of a team or practice independently.
My prescription: let’s take a look into the growing role of APCs in health care. Some potential side effects include uncomfortable acronyms and confusing terminology – but with a little time and effort, I’m confident we can clear up your understanding of the changes in the health care workforce.
Confusing Titles Obscure Critical Roles
“APC” is an umbrella term that includes nurse practitioners (NPs) and physician assistants (PAs), although the roles differ. Both occupations require a Master’s Degree or more, work in many different types of medicine with strong representation in primary care settings, and have a decision-making role in patient diagnosis and treatment similar to doctors.
For people who don’t work in the medical field, or even some who do, the terminology can be confusing. Nurse practitioners differ from registered nurses, who don’t prescribe or diagnose (for more on NPs, see this recent QualityInfo.org article). Physician assistants are not “medical assistants,” who require non-degree training after high school and focus on a wide range of administrative and clinical tasks.
The Growing APC Role in Health Care
Health care employment is growing rapidly, but advanced practice clinicians stand out even in this high-growth industry. The supply of physicians has grown relatively slowly compared with the demand for health care services. In some instances, APCs fill the gap.
Because the training period is shorter than medical school and residency, and because more health care organizations use team-based models of care, where APCs, doctors, and other health professionals collaborate on a panel of patients, APCs are taking on a larger role, especially in primary care settings.
NPs and PAs are among the fastest growing jobs nationally and in Oregon. More than 10,000 physicians were employed in Oregon in 2017, compared with around 3,500 APCs. The Employment Department projects APC roles to grow 35 percent from 2017 to 2027, double the 17 percent growth in physician roles and triple the 12 percent average for all occupations.
Wages for APCs are generally high, and can be higher in particular specialties and work environments. The median nurse anesthetist, for example, earns nearly 90 dollars an hour, though they require additional post-Masters training and work in high-risk environments.
A Day in the Life of an APC
To get a better feel for what an APC career looks like, I spoke with Sara Degler, a physician assistant at PeaceHealth Sacred Heart Medical Center-University District in Eugene. She’s worked there since 2018, after graduating with a Master of Clinical Health Services from the University of Washington MEDEX program.
A graduate of South Eugene High School, Degler worked as a paramedic on an ambulance for 14 years before going back to school to become a PA. That experience taught her critical skills and convinced her that direct patient care was the right fit.
“Learning how to look at a patient and determine whether they are truly ill in a matter of seconds, how to converse with patients, and take a good medical history – all of those are learned skills,” she says, that helped prepare her for her role as a PA.
When we think about medical careers, we often focus on the patient diagnosis or in-depth laboratory work we see on TV medical dramas, but the day-to-day reality involves a wide range of tasks and skills.
Degler loves working through the “puzzle” of diagnosis, which keeps the job fresh by forcing her to think critically about what the “specific constellation of symptoms could indicate.”
Social skills are also vital for APCs. Degler enjoys meeting and building trust with her patients. “Without trust,” she says, “they are not going to follow my instructions,” no matter how brilliant her diagnosis.
Degler estimates she spends about half of her time with patients, and the other half charting (writing medical notes in a patient’s record), ordering and following up on lab tests, answering calls and emails, or other administrative tasks.
Although she enjoys her career, the amount of time and energy an APC spends on paperwork is less exciting. While she recognizes that some paperwork is necessary, it can be frustrating to spend a large (and in her view, increasing) amount of time completing forms and documentation that could be spent with patients.
Education and Training
If an APC career interests you, you’ll need to lay the groundwork professionally as well as academically.
A Master’s degree is required for NPs and PAs. There are a number of training options, including a growing number of online schools, although every program requires in-person clinical training to graduate. There are four schools located in Oregon, all in the Portland metro area, with a fifth opening in 2021.
Anyone hoping to enter the career will need a solid foundation in natural sciences. With the growth in the profession, admission is highly competitive, and grades and academic preparation can make a big difference on your application.
Developing good study skills will serve potential APCs well, not only through school but also in their career. Degler finds her study habits helpful to this day, as much of her day-to-day work involves looking up new information and updated medical guidelines.
Because APCs spend less time studying medicine than doctors, both NP and PA schools prefer that applicants have health care experience. The most straightforward path to becoming a nurse practitioner is earning a bachelor’s degree in nursing and working as a registered nurse first, although there are some schools that train students to earn a bachelors in nursing on the path to becoming an NP.
There are established pathways into APC careers from particular health care roles, such as certified nursing assistants or emergency medical technicians. The MEDEX program, from which Degler graduated, started as a program for military paramedics to translate their field experience to advanced practice. It’s one of many programs with an especially strong focus on health care experience – medical assistants, paramedics, or physical therapy workers with more than 200 patient contact hours can apply.
Not every applicant will have more than a decade of health care experience before going to school, but Degler argues it’s vital to get at least some hands-on experience. She suggests doing some job shadowing before considering the programs. Understanding the possibilities and limitations as well as what specialties you might want to focus on is important before you jump into the role.
What’s My APC Role?
While NPs and PAs have similar roles, there are a few differences.
PAs always operate within a team-based model, and every state has guidelines for how collaborative or supervisory their relationship with a physician needs to be. NPs can be independent practitioners, but their “scope of practice,” or the procedures they can perform, varies widely by state. Oregon is one of 22 states with “full practice authority,” meaning NPs here have the highest degree of independence.
Differences in training philosophies affect APC practice on the ground. PAs train as generalists and in collaboration with a physician can practice in nearly any field, such as surgery or dermatology. NPs train in primary or acute care and further focus on specific populations and may require additional training to switch their patient focus.
Regardless of which is a better fit, there are many reasons for someone with the right skills and interests to look into an APC career. Advanced practice clinicians boast high wages, in-demand jobs, and a variety of opportunities to do meaningful work. To get there, you’ll need a lot of education and career preparation.
Most APCs get into the career because they are passionate about helping people. If you’re intrigued by the possibility, it’s a sure thing that there are APCs in your area who would be willing to help you find out if it’s the right choice for you.