Mid-Level Providers Followed Their Hearts to Fill Vital Role in Healthcare System

“I think a common misconception people have of physician assistants is that people go to PA school because they don’t have the chops or grades to make it into medical school,” said Phillips, a member of the Trauma Services team at Utah Valley Hospital. “I specifically chose the path of being a physician assistant. It wasn’t a default or fall back option.”

Physician assistants and other mid-level healthcare providers like nurse practitioners (NPs) play a critical role at the hospital. They often don’t receive as much attention as physicians, but PAs and NPs share many of the same responsibilities as doctors.

Utah Valley has 163 mid-level providers on its medical staff. Mid-level professionals include nurse practitioners, physician assistants, certified registered nurse anesthetists, certified nurse midwives and advanced practice registered nurses. Nurse practitioners and PAs make up the largest portion of that group with a total of 85 NPs and 51 PAs. 

Phillips joined the hospital’s Trauma Services in 2003. He graduated from Brigham Young University in human biology and then attended George Washington University to receive his master’s. After completing his education, he worked on an inpatient cardiology team in Baltimore and then in Salt Lake City doing cardiothoracic surgery.

Since beginning his career at Utah Valley, Phillips has worked with Craig Cook, MD, the hospital’s Trauma Medical Director. Dr. Cook has been a surgeon at the hospital for almost 14 years and relies on Phillips as his right hand man.

“He’s my eyes, ears, and hands when I can’t do everything. Outside of final say on care issues, administrative care issues, and the primary operation, Adam can do anything I can do,” said Dr. Cook. 

Steve Minton, MD, a neonatologist at the hospital, has similar thoughts on working with nurse practitioners. Dr. Minton is the Newborn Intensive Care Unit Medical Director and Chief of Neonatology and Newborn Services of Intermountain Healthcare’s South Region.

“We see the neonatal nurse practitioner as our colleagues and we work together. It’s not a preceptorship; it’s colleagues working together and caring for the patients. Our nurse practitioners are not just colleagues in clinical care, but they’re colleagues in improving the quality of what we do here and how we treat patients,” said Dr. Minton. “We work together seeing patients, we work separately seeing patients, we both do procedures on babies together. We’re interchangeable in doing procedural things.”

Dr. Minton works closely with 17 nurse practitioners in the Newborn ICU, including Allison Showalter. She’s been at Utah Valley her entire 20-year career. Showalter began as a bedside nurse but decided to pursue more education so she went back to school and received her doctorate of nursing practice.

Nurse practitioners study a specific area they’re interested in and all their time goes to that niche. Throughout Showalter’s training, she focused on taking care of infants who stay in the Newborn ICU. In addition to more education, training and experience, NPs receive independent licenses and DEA licenses to prescribe medication.

“Sometimes people ask, ‘What can a doctor do that a nurse practitioner can’t?’ and truly I do everything that a doctor can do. There isn’t any restriction on my ability to practice as their partner. I do procedures, I write for medications, feeding orders; we work as a team to take care of the whole unit,” said Showalter.

Both NPs and PAs are sometimes perceived differently than doctors. But in many healthcare settings, patients see a mid-level provider more often than a physician because physicians can’t be at the hospital or clinic all the time.

“A good PA, in my estimation, knows with certainty the things that they know and are capable of, and with just as much certainty knows when they need the help and back-up of their physician partner. A good PA is a good team member who knows his/her role on the team. I have excellent relationships with the physicians I work with day in and day out,” said Phillips.

Although patients don’t see the day-to-day interaction between NPs and PAs, they both speak with their doctors when they need to consult. Showalter said they all have the ability to contact a colleague who is a physician, but otherwise they’ve been trained very well.

“We’re interchangeable with the doctors. Patients should feel good and safe in knowing that they can trust those nurse practitioners they see throughout their lifetime. They’re very qualified, they can trust them and they have good skills and knowledge that they worked really hard to obtain,” said Showalter.