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Understanding Advanced Practice Clinicians

 
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Let’s follow the story of Henry, a typical 65-year-old man, from his first chest pains through heart surgery--all the way to his full recovery at home.
 

iStock 000017967353XSmallIf you're like many Americans, you have seen a Physician Assistant ("PA"), like me, or a Nurse Practitioner ("NP") at some point for medical care, yet perhaps you're not exactly sure what we're all about. You may have heard of us collectively called midlevel providers, non-physician providers, or physician extenders. For our purposes in this article, we'll refer to PAs and NPs together as "Advanced Practice Clinicians," or "APCs."

APCs are people who have a high level of medical training and who practice alongside physicians (and sometimes independently) to provide healthcare services. APCs represent an important resource in our rapidly evolving healthcare landscape because, as you may be aware, there is a dire shortage of primary care physicians in our country – a dilemma that is only forecast to worsen into the future. APCs are able to ease that gap, providing high-quality medical care for our patients. In fact, the American Association of Nurse Practitioners cites that Americans make over 600 million visits to NPs every year and the American Association of Physician Assistants tells us there are more than 95,000 PAs currently practicing in the U.S.

Physician Assistants (“PAs”) are trained in the medical model, much like doctors. Often, PAs are people who have worked in the healthcare field and decided to go back to school to for an advanced degree. To become a PA, we take a master’s level program with both didactic (classroom) training and real-world rotations through various specialties like family practice, surgery, obstetrics, and more.

Nurse Practitioners (“NPs”) most often practice first as registered nurses (sometimes for many years) and then return to school for their NP certifications. They also go through a master’s or doctorate level program that includes didactic and clinical courses.

iStock 000004415847XSmall“To be a good NP,” says Beth Weidner, who recently joined our practice at IPC/Senior Care of Colorado, “you have to rely on a wealth of nursing experience and good assessment skills to make decisions about patients who might have multiple medical conditions and be on many medications. And we often have to do that quickly in the long term care setting. You also have to have good critical thinking skills (which often means thinking outside the box), be really organized, and be able to communicate well with patients, their family members, and colleagues.”

Following our education, both PAs and NPs practice day-to-day medicine in very similar ways. During a visit we take a history, examine the patient, order diagnostics, make a diagnosis, form a treatment plan, then follow up with the patient. While in some settings APCs practice independently, in our practice at IPC/Senior Care of Colorado we use an effective team approach that pairs a physician with an APC. This way, every patient has at least two providers who know them and their history. We typically alternate visits so the patient sees the physician once for every two times they see the APC. The idea is that there are two sets of eyes looking through the chart and examining the patient. I always think two heads are better than one, especially when they come from different perspectives and viewpoints.  One of us might catch something the other has missed, or understand something differently. I think it results in great patient care.

It’s true that some people who are not well-informed about APCs say they would rather see a physician. And that is sometimes necessary and appropriate. However, most patients who have a couple of visits with an APC understand that we practice very much like doctors; we are able to build great relationships and the patients really like working with us. Often, we will have more time to spend with patients than physicians do. In our practice we are able to schedule 20-30 minute visits while the doctors typically schedule 15-20 minute visits. So we have a greater opportunity to get to know you personally—to learn about your family, your hobbies, what you do for fun, and when you’re going through hard times, how we can help.  We can also spend time talking about things like advance directives or doing specialty service such as foot care. Another advantage is that, while some physicians are booked out for months, you can usually get an appointment with an APC the same day you call, or at least the next day. That can be important when you’re really not feeling well.

We know that our patients are much more savvy healthcare consumers with different expectations today than in iStock 000010084325Smalltimes past. You or your family members may have done research on the Internet or talked to friends, and arrive at our office with plenty of questions and ideas. I think it’s important to empower my patients to make decisions about their own healthcare. I use a straightforward approach of laying out the risks and benefits of treatment options—the relevant science and information--and letting people make educated decisions for themselves. This is pretty different from the days when a doctor in a white lab coat dictated what you needed and you followed orders, no questions asked.

So, the next time you have the choice between a physician or an APC, give one of us a try! You’ll be seeing a lot more of us in the coming years as our dynamic healthcare system continues to change.

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