If you have visited an Intermountain Healthcare facility lately, you’ve probably met an advance practice clinician or APC. These professionals are non-physician healthcare providers who have advanced training at the graduate level and have passed a national board examination to practice as a non-physician healthcare provider in their state. APCs are being utilized in most healthcare facilities such as hospitals, clinics, emergency rooms, InstaCare clinics, homecare services, hospice programs, and specialty clinics.
APC professions emerged in the 1950s. Initially, doctors started training nurses and expanding the scope of their practice to perform increasingly sophisticated services. In 1965, federal legislation launched the Medicare and Medicaid programs, which helped more aged, poor, and disabled Americans to afford and access physician services. Almost overnight, this new demand for health care created a doctor shortage. In addition, Medicare and Medicaid policies were also calling for an increase in specialist physicians, which directed medical school graduates to residencies in specialties instead of in primary care disciplines. This further fueled the primary care doctor shortage. At that time there were simply not enough medical school programs to produce the number of physicians necessary to meet the rising healthcare demands. This need lead to establishment of the first official advanced practice registered nurses (APRN) and physician assistants (PA) training programs in 1965. The first APRN training program was established by Henry Silver and Loretta Ford. Duke University launched the first PA professional program. Since then, there have been more than 350 APRN and 150 PA programs established across the country.
Education and training for APRNs and PAs both include anatomy, physiology, pharmacology, pathophysiology, as well as genetic and other mechanisms of disease. The clinical portion of PA training is comprised of both inpatient and outpatient settings in a variety of areas including emergency medicine, family medicine, general surgery, pediatrics, orthopedic surgery, obstetrics and gynecology, the internal medicine specialties, and many other disciplines. For APRNs the clinical portion covers a wide spectrum of primary care similar to the PA. In addition, the APRN specializes in one area of clinical expertise.
The Healthcare Provider Shortage
Our nation continues to be at the forefront of a shortage of healthcare providers due to an aging population, the implementation of the Affordable Care Act, and the continued shortage of physicians. APCs are filling the gaps in the physician shortage around the nation. This is evidenced by the fact that the number of visits performed by APCs in the outpatient setting increased by five percent between 2001 and 2009.
In the state of Utah there are approximately 1,445 APRNs and 1,900 PAs in practice. More than 106,000 APRNs practice in the United States, as well as 93,000 PAs. APCs are also filing the gaps by providing care to populations that are currently under-served such as rural communities and uninsured populations.
APCs are crucial today to give patients access to quality health care at a reasonable cost. Current studies show that APCs are spending more time with the patients than physicians, and they are doing this with excellent patient satisfaction scores. So, the next time you visit an Intermountain Healthcare facility, consider scheduling your appointment with an APC.
Advance Practice Registered Nurse’s education follows the nursing process, which includes a systematic method that directs the nurse and patient as they work together to provide holistic, patient-centered care. APRNs are registered nurses who have practiced in the field of nursing prior to entering a graduate training program. To be eligible to apply for an APRN program, the nurse must complete a bachelor’s degree and have specialty nursing experience in the field of the degree they are seeking. Most APRN programs are a minimum of three years resulting in a master’s degree, doctoral degree or a PhD. APRNs must also pass a national board exam for certification and licensure. Once licensed, APRNs must complete additional continuing education courses in their field of study to maintain an active license.
A Physician Assistant generally has a bachelor’s degree before starting their training as well as a number of years of medical experience in various fields. There are some PA programs that offer an integrated undergraduate degree within the PA program. All PA programs award their graduates with master’s degrees. The PA education follows the example of formal medical school training. The total time of the PA training is about 27 months of continuous study with over 2,000 hours spent in clinical training mentioned above. Once licensed, a physician assistant must complete 100 hours of continuing medical education every two years. They must also pass the board examination after graduation from their training and repeat the test every ten years.
APCs work in a variety of clinic and hospital settings. Physicians who employ and use APCs in their clinics can devote more time to complicated, high-risk patients. They can also accept more patient referrals and increase the availability of appointments. APCs help by conducting physical exams, ordering and interpreting tests, diagnosing and treating illnesses, counseling patients on preventative health care, assisting with surgery, and writing and refilling prescriptions. In the hospital, APCs perform many of the same duties as they do in the outpatient clinic. They work with physicians to provide updated assessments and evaluations of the patient’s condition. They also review and evaluate the recent laboratory and other diagnostic tests performed.
APCs update the physician on the patient status and any problems that were discovered. They can also write appropriate orders regarding the patient’s care and perform skilled procedures during the hospitalization either independently or with the assistance of the physician. APCs provide education to patients and their families regarding their diagnosis, plan of care, treatment options, medications and diagnostic testing. In surgery, the APC works alongside the physician during the surgical procedure. They also provide the patient and family with pre- and post-op education, and they write post-hospital prescriptions. All APCs have a collaborative physician who is responsible to be available for consult and patient referral as needed. APCs are able to provide care independently without the need to consult a physician at every patient encounter. Each APC has a practice agreement contract with their employer. This document identifies when consultation between a physician and an APC should occur such as with high-risk patients or when complicated problems arise.