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Sentara Increasing Reliance on APPs in the Primary Care Setting

Analysis  |  By Christopher Cheney  
   October 23, 2024

Sentara Medical Group is planning to double the number of its APPs over the next three years, according to this CMO.

Advanced practice providers (APPs) are a critical part of the healthcare workforce since nurse practitioners and physician assistants can carry out responsibilities similar to physicians, including conducting physical exams, prescribing medications, and making referrals.

In the next decade, nurse practitioners and physician assistants will be among the top 10 fastest growing occupations in the country, according to the U.S. Bureau of Labor Statistics.

In part due to a need to increase care access, Sentara Medical Group is planning to double the number of its APPs over the next three years. Sentara Medical Group is the physician group of Sentara Health.

There are three reasons why Sentara Medical Group is seeking to double its number of APPs, says Steven Pearman, MD, vice president and CMO for primary care at the physician group.

"The primary driver of doubling the number of APPs is to increase access to care," Pearman says. "Another driver of increasing the number of our APPs is growth. We do pretty well with established-patient access, but getting new patients in is where the access challenge comes into play."

Finally, Sentara Medical Group is planning to utilize APPs to address a shortage of primary care physicians.

"There is high demand for primary care physicians but a decreasing supply," Pearman says. "We do pretty well in hiring, but it takes a lot of physicians to meet the increasing demand for care, and we can augment the ability of physicians to care for more patients by hiring APPs."

Relying on APPs in the primary care setting is a necessity, according to Pearman.

"In general, there is going to be an increased supply of APPs and there is going to be a declining supply of primary care physicians," Pearman says. "So, relying on APPs is a necessary step if we are going to provide care to the thousands of people who need primary care but do not have access."

Most of the new APPs will be deployed in primary care, where they will have their own patient panels, Pearman explains.

"One of the calculations is that if a primary care physician can take care of 1,500 unique patients, an APP can take care of 1,100 unique patients and two APPs can take care of 2,200 unique patients," Pearman says. "We can leverage APPs to increase our capacity."

Currently, about 50% of Sentara Medical Group's primary care providers are APPs, so there is about a 1-to-1 ratio of APPs to physicians. Pearman says the goal is to get to a 2-to-1 ratio.

Team-based primary care model

Sentara Medical Group is embracing a team-based model for primary care.

One of the goals of the team-based model is to take some duties away from physicians and APPs so they can spend more time on patient care delivery, according to Pearman. For example, the physician group is increasing staffing of a nurse advice line, and medical assistants and registered nurses will be fielding most electronic in-basket messages from patients.

"They want to see patients, but they are burdened by documentation, chart reviews, patient messages, and medication refills and renewals," Pearman says. "If we address those things, we can give physicians and APPs the cognitive capacity and time to take care of more patients."

Under the team-based model, primary care physicians and APPs have a collaborative relationship with defined expectations, Pearman explains.

"Early on in a relationship, even if the APP is experienced, there is close collaboration including physician chart reviews for about six months," Pearman says. "After that, there are select chart reviews."

Physicians serve as "sounding boards" for APPs, according to Pearman.

"We onboard APPs and educate APPs to manage complex issues," Pearman says. "If there is something they have not seen before or something they are unsure about, there is an open-door policy for APPs to go to their collaborating physician."

Another option for an APP is to refer a patient to specialty care, according to Pearman.

"We are rolling out electronic consults, which will provide APPs with an opportunity to ask questions before they refer a patient to specialty care," Pearman says. "APPs usually function as an autonomous primary care physician, with the backup of a physician if needed."

Christopher Cheney is the CMO editor at HealthLeaders.


KEY TAKEAWAYS

Nurse practitioners and physician assistants will be among the top 10 fastest growing occupations in the country over the next decade.

Currently, about 50% of Sentara Medical Group's primary care providers are APPs, so there is about a 1-to-1 ratio of APPs to physicians. The goal is to get to a 2-to-1 ratio.

In Sentara's primary care practices, APPs and physicians have a collaborative relationship rather than physicians providing direct supervision of APPs.


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