Many people – this writer included – are on a first-name basis with their health care provider. She has prescribed everything from an ointment for a rash to valsartan for high blood pressure. Ashley’s a physician assistant (PA) whom I’ve thought of as my primary care provider for more than 15 years. I’ve never met the physician she works with.
A lot of people have an Ashley in their lives. She’s what’s known as an advanced practice provider, or APP as they’re called in the medical world. Besides physician assistants, APPs include (alphabet soup alert):
- Nurse practitioners (NP).
- Nurse anesthetists (CRNA).
- Clinical pharmacist practitioner (CPP).
- Certified nurse midwives (CNM).
Some of these professionals work only in hospital or urgent care settings, but many of them work in your primary care or specialists’ office. It’s also one of the reasons you hear the word “provider” in health care so much – not everyone who cares for you is a doctor.
These are medical providers who can diagnose, treat and manage the care of patients. They order tests, prescribe medications and perform or assist in surgical procedures, often in collaboration with physicians and surgeons. Today, APP training programs confer a master’s degree or higher.
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APPs have become more prevalent in recent decades. And their presence has helped dispel the myth that physicians have to be on-site for an APP to see patients. North Carolina does not require on-site supervision.
One more thing to keep in mind: APPs are critical to enhancing access to care, especially in rural and underserved settings.
Many APPs work collaboratively with one or more physicians. But physician assistants and nurse practitioners – especially those in primary care settings – often have their own patient population they see – and a doctor often isn’t, and doesn’t need to be, part of the equation.
Isaac Rowner is a physician assistant at Novant Health Southern Piedmont Primary Care in Monroe, North Carolina. He’s one of six APPs in an office that also has seven doctors. “I may collaborate with any of the doctors,” he said, “but I have my own patient panel. If my patient has a problem, they call me for a visit. If there's something that requires a higher level of care, more often than not, a referral to a specialist is appropriate.”
Rowner has been practicing for nearly four years and has developed a level of expertise along with his own patient population. “Maybe a couple years ago, I might have more questions for a collaborating physician in my practice,” he said. “But for somebody like me, who has been doing this for a few years, oftentimes I can go weeks or months without needing to seek the help of my supervising doctor. APPs see all levels of complaints and complexity. We see everything.”
Some physician assistants specialize. Emily Epling, for instance, works in oncology at Novant Health Cancer Institute - Forsyth but in the Mount Airy location. The 27-year veteran has worked with cancer patients in both inpatient and outpatient scenarios.
“A cancer patient might come in for a new patient visit, which is generally with a physician,” said Epling. “They’ll get their chemo plan, and then during the course of chemo, the physician and I may alternate seeing that patient. A lot of times the APPs are seeing patients prior to their chemotherapy appointments to assess for toxicity: Is it safe to treat them that day? Are they having symptoms that need to be managed? Are their blood counts too low? We may have to make some adjustment on the dose, or we may have to just hold the chemotherapy (that day) entirely.”
That’s a determination Epling can make on her own – without consulting a physician.
Physician assistants don’t typically aspire to become physicians.
“Some people don’t necessarily understand the different paths of training,” Rowner said. “I’ve had some patients say, ‘You’re so good. Are you going to go become a doctor?’ And the answer is no. You go to nursing school to become a nurse practitioner. You go to PA school to become a PA. You go to med school to become a doctor.”
To be clear, doctors have more education and more intensive licensing requirements, but each profession provides significant value to the patient care continuum.
Whether you’re under the care of a physician or an APP – or both – you’re getting the same high-quality care. They’re all part of the same team.
“We’re well-trained, well-equipped, for the work that we do,” said Epling. “For us in oncology, it really is a team sport. It's not just the physician. It's not just the APP. It takes the nurses, the dietitians, the navigators, the therapists – it’s a whole team of people. I really love the way we practice. We put the patient at the center. Our physicians take time with their patients.
“Life's tough in general, but when you have an illness that can be life-threatening, it takes on a whole new perspective,” she continued. “And so, we want to surround them, let them know that they have a deep bench and that we're all on their side and pulling for them. We're privileged to be a part of that team and be able to be there for our patients.”
Top photo: Isaac Rowner, PA-C.
Know your APP
When it comes to your personal care team, it’s not just made up of doctors and nurses. That’s why you hear the term “providers” used a lot. There are different types of health care team members known as advanced practice providers (APP) who can see you in the clinic, in the ER, in the specialist office, as well as in the hospital.
Nurse practitioners are registered nurses with a master’s degree and approach care through a holistic lens, helping patients meet wellness goals and preventing disease in addition to treating disease.
Physician assistants are trained in medical schools or with a medical school curriculum and approach care through a medical lens, helping patients recover from illness and injury. They also focus on wellness and prevention.
Certified nurse-midwives (CNMs) and certified midwives (CMs) encompass a full range of primary health care services for women, from adolescence to prenatal care and delivery to menopause and beyond. Midwives provide initial and ongoing comprehensive assessment, diagnosis and treatment.
Clinical pharmacist practitioners (CPP) are licensed pharmacists approved to provide drug therapy management, including controlled substances, under the direction of, or under the supervision of a licensed physician.
Certified registered nurse anesthetists (CRNA) practice both autonomously and in collaboration with a variety of health providers to deliver high-quality, holistic, evidence-based anesthesia and pain care services. The CRNA cares for patients at all acuity levels across the lifespan in a variety of settings for procedures, including, but not limited to, surgical, obstetrical, diagnostic, therapeutic and pain management.