Live From AMGA Conference: Operating a Primary Care Practice With One Doctor and APPs

The physician-advanced practice provider primary care model can help address the doctor shortage.

Operating a primary care practice with one doctor and a handful of advanced practice providers was the focus of a session at the AMGA Annual Conference.

There is a shortage of primary care physicians nationwide, and the aging of the U.S. population is likely to make this shortage more acute in the years to come. Pairing primary care physicians with advanced practice providers such as physician assistants is one strategy to address this challenge.

"We have developed a successful interdependent team model consisting of one physician and multiple advanced practice providers (APPs), each with their own patient panel delivering high-quality and safe patient care," said Gretchen Velazquez, MD, a regional medical director at Atrium Wake Forest Baptist Health Network. She leads a primary care practice in collaboration with four physician assistants.

Valezquez said the model of her primary care practice is an effective strategy to address the physician shortage.

"There's a challenge—healthcare organizations do not have enough doctors," she said. "We need to have physicians practice at the top of their licenses while supervising and guiding advance practice providers in a way that we deliver safe and high-quality medical care."

Physicians must have qualities to be apt to successfully work with and supervise advanced practice providers, Valezquez said.

• A doctor who supervises advanced practice providers should be experienced. In the first two or three years of being a primary care doctor, a physician is starting to grow their patient panel and learning how to navigate relationships with nurses and medical assistants. A more experienced physician can be a leader.
   
• You want a physician who can be a team player. You want someone who is respected and able to bring a team together. You want someone who is available for consultation. You want someone who is available and willing to teach. There is a lot of mentoring with advanced practice providers.
   
• You want a good communicator—someone who will tell it like it is when the time comes. When there is an issue with an APP, you want a physician who is not going to put people down and is not going to belittle people. You want the physician to be supportive. You want to have a physician who creates a relationship with APPs, so they feel comfortable coming to the physician.

There are many benefits from the physician-APP model, Valezquez said.

"You have greater access for your patients—that is really the bottomline. We must take care of a growing elderly population," she said "There is greater access for acute-care visits for patients. You have doctors working at the top of their license—you can have physician assistants handle the simpler cases such as urinary tract infections. This model is a leadership opportunity for physicians. At my practice, I am the captain of the ship. If the APPs run into a situation where they need me, they can call me any time and there is another doctor who has a similar model of practice who cross-covers for me and I cross-cover for her."

Another benefit of the physician-APP model is coverage of in-basket messages from patients, Velazquez said. "If I am out on vacation, the APPs can monitor my in-basket and respond patients."

For this model to be successful, the physician must be involved in the hiring of APPs, she said. "You can't have a physician who is disengaged. They must look through the resumes and sit down with the practice administrator to review candidates. If I cannot see a patient, I can tell the patient that it is OK to see one of the physician assistants because I hand-picked them. So, there is a level of trust there."