There is no questioning the importance of Advanced Practice Providers (APPs) in modern healthcare. The roles of Nurse practitioners (NPs) and physician assistants (PAs) came into existence in the 1960s as a way to mitigate the impact of the emerging primary care physician shortage. Today, these care providers are even more prevalent in healthcare. In fact, it’s a common occurrence for patients to be offered an appointment with an NP or PA as a way to get into the office sooner.

Considering the expanding role that APPs have in our primary care system, healthcare administrators are beginning to focus on their recruitment and retention in the same manner as physicians. Let’s look at some of the differences between APPs and primary care physicians in terms of education, training, and scope of practice, as well as how to increase access to care by recruiting these professionals as part of your staffing plan.

Education and Training Requirements

Interestingly, there is lack of consistency for the education, training, licensure, certification, and scope of practice for APPs.  Each of these areas varies significantly from one state to the next.  Nurse Practitioners generally achieve education and clinical training at the master’s or doctorate level, along with the completion of at least 1,000 hours of clinical practice in a focused area.  The specialized focus is typically in pediatrics, adult, or geriatric medicine.  Oversight for NPs is provided by the state nursing boards.  To demonstrate how NPs are treated differently between the states, nearly half have laws allowing NPs to practice independently without oversight.  All states allow NPs to have prescription writing authority, even for controlled substances.

Physician Assistants are typically trained alongside medical students, for two years before receiving their master’s degree.  Before graduating, PA students will have completed 2,000 hours of supervised practice.  While state nursing boards regulate NPs, the PAs come under the jurisdiction of the state medical board, and have to practice under a supervising physician.  As with NPs, prescribing authority is afforded to PAs; however, Kentucky is the lone state that doesn’t allow PAs to prescribe controlled substances.

Contrasting this training to a typical family physician illustrates one of the reasons why we have a primary care physician shortage.  A family practice physician completes 15,000 hours of clinical work through five years of additional training and residency.  In that same amount of time and cost, more than 3 NPs could be trained.

Scope of Practice

NPs and PAs have a significant overlap in scope of service when compared to their physician counterparts.  For example, in VA hospitals, nearly half of all inpatient services are performed by APPs.  Administrators within the VA system are relying heavily on NPs and PAs and recognize that there are only minor differences in a patient’s perception of care.  Another area where APPs are being relied upon are in rural and underserved communities.  A study published in 2015 by the National Institutes of Health cited NPs are more likely to deliver care in inner cities and rural settings than primary care physicians.  Additionally, the study concluded that an increase in the numbers of primary care NPs would serve to expand access to primary care for vulnerable populations.

Recruiting APPs

According to the Bureau of Labor Statistics, demand for NPs and PAs will not be slowing down anytime soon.  Both occupations are still listed in the top ten fastest-growing occupations and are expected to grow by up to 30% through 2028.  This demand is a sign that healthcare administrators need to treat the recruitment of APPs the same as they do physicians.  Here are a few ways that administrators can proactively attract APPs to their organizations.

• Work with local or regional university systems. You often hear of healthcare systems establishing relationships with medical schools to provide opportunities for student doctors.  This same approach should be developed for APPs.  Bringing advanced practice students into your clinical setting provides you with a perfect opportunity to evaluate how their skills and personality translates to your care team.  In the long run, if they are a good fit, you have an excellent opportunity to retain them upon graduation.
• Work with your state’s professional associations. The American Association of Nurse Practitioners (AANP) and the American Academy of Physician Assistants are two organizations that healthcare administrators should have an established relationship.  Most states have chapters that support graduating and experienced APPs in their job search.
• Have a social media strategy. While physicians tend to rely more on physician-specific job boards and websites like Doximity, APPs are more prone to utilize traditional social media sites.  Many APPs are very active on professional networking sites, such as LinkedIn.  Understanding this critical difference between how physicians and APPs use social media can help administrators more effectively tailor their recruitment strategy.
• Be creative with scheduling. Like physicians, APPs value work/life balance and are more attracted to positions that allow flexibility.  Healthcare administrators who are expanding their utilization of APPs, need to be creative in developing part-time positions, building in Telemedicine hours, and finding other ways to offer flexibility and variety into their APP schedules.
• Work with a recruitment partner. Finding a trusted recruitment partner has been an essential component of physician recruitment for healthcare administrators for years.  As demand for APPs continues to rise, it is becoming increasingly more important for healthcare organizations to expand their reach in finding qualified candidates.  Recruitment firms have access to candidates that administrators may not otherwise reach for their vacancy.  Finding a recruitment partner that has a nationwide candidate pool, plus the technology and means to cast a wider net, can be the answer to your hard-to-fill vacancies.

Jackson Physician Search can be the trusted recruitment partner that your organization needs.  Whether you are looking for physicians or advanced practice providers, our team of experienced healthcare recruiters can help you reach more qualified candidates.  Contact us today.

The first thing most healthcare administrators think about when considering the current physician shortage is, “How are we going to recruit to fill vacancies?”  That is certainly a valid question, but it is one that needs to be asked in tandem with, “How are we going to retain the physicians we already have?”  According to Gallup research, workplace culture is one of the leading drivers of physician retention, and healthcare organizations that ignore that fact are setting themselves up for a steady stream of physician vacancies.

Over the past several decades, physicians graduating from medical school are increasingly diverse and come from a wide range of ethnicities, religions, and world views.  This level of diversity in our healthcare system is an achievement.  But a diverse workplace doesn’t necessarily mean an inclusive one, and that is an important distinction.  An inclusive environment is supported by a workplace culture where the collective group of employees all feel welcomed, valued, and included.  With the role that culture plays in retention, let’s review some strategies that will contribute to a more inclusive work environment.

Instill a top-down approach.

In healthcare organizations where the executives and other higher-level administrators are too far removed from what is happening in the trenches, there is no way of gaining a full appreciation of the actual workplace culture that exists.  A prime example of this was illustrated in the results of a study conducted by Jackson Physician Search, where significant differences were found in how executives and physicians rated their workplace culture.  For example, in response to a statement about physicians always being treated with respect, only 48% of physicians agreed versus 78% of the executives.  Administrators and other leaders have to be personally invested in fostering a culture of inclusion and engagement in their organization.

It’s more than a one-hour sensitivity training.

Healthcare organizations that do not conduct periodic sensitivity, diversity, or other bias-related training sessions are less likely to have an inclusive workplace environment.  But these types of training sessions are only part of the solution.  Utilizing a one-hour training class to check a box is not getting it done.  As alluded to with our top-down approach, sensitivity, and other training sessions have to be used to develop proactive, actionable items that can be implemented throughout the organization.  The classes are a tool to help educate leadership and staff at all levels about behaviors that are inappropriate.  A proactive result from the training might include a mechanism for reporting bias or a strategy for how to deal with employees who exhibit harmful behavior.  Another way a healthcare organization can demonstrate a true commitment to inclusion would be in the formation of an employee-driven inclusion committee. Most likely, your organization has a celebrations committee, forming one that is dedicated to driving a more inclusive workplace is a strong first step.

Give everyone a voice.

If you don’t have a clear picture of what type of culture exists in your workplace, it is important to find out before it is too late.  A Mayo Clinic study on physician burnout and well-being cited workplace culture as a major factor in physicians leaving to find a better opportunity.  Creating an environment where all staff is encouraged to respond to workplace surveys or participate in focus groups is the only true way to understand workplace culture.  It is critical for healthcare administrators to think about the type of culture that will keep staff engaged, drive them to better performance, and support the organizational brand. A few keys for managing this include:

• Conduct a full audit or assessment to gain a data-driven measure of the environment.
• Identify gaps regarding inclusiveness and bias.
• Collect, measure, and report on the data.
• Develop strategies and set goals, and publish them.
• Communicate why you want an inclusive culture and how it impacts the bottom line.

Celebrate Your Diversity.

We have already suggested the formation of an inclusion committee, but even if you aren’t prepared to take that step, you can still celebrate the diversity within your workplace.  It is important to remember that it is as much about celebrating and recognizing diversity as it is about removing bias.  From creating breast pumping rooms to having meditation or prayer rooms, employing physicians and other staff from such diverse backgrounds means that unique solutions are needed.  Another strategy to combat unintentional bias is with a more creative pot luck program. Let’s face it, your hospital or health system has regular pot luck luncheons, we all do.  These informal gatherings provide the perfect opportunity to center them around a different ethnic or cultural background.  Encourage your teams to discover new recipes and post fun cultural facts that will help everyone to appreciate and gain a better understanding of varying cultures.

Encourage Gratitude.

Most healthcare organizations have some form of gratitude program.  Is it effective?  How many of your physicians make an effort to formally recognize others?  A well-constructed and properly intentioned gratitude program is one that encourages anyone to recognize anyone else at any time. Whether it is a patient recognizing their doctor or nurse, a doctor recognizing maintenance staff, or a nurse highlighting a security guard, gratitude should always be more than a “program.”  Having a culture that fosters the expression of gratitude can be a powerful part of a healthy workplace environment.  It is also a means to understand and eliminate unconscious bias that may exist by learning who is being recognized and how often.  Wouldn’t it be helpful to learn which departments are engaged with the recognition program and which aren’t?  Or if physicians were being recognized by staff, but they weren’t reciprocating that appreciation in return.  Using these tools to identify gaps and taking actions to address them is a valuable exercise in developing a healthier workplace.

If you need help finding ways to recruit and retain physicians for your vacancies, partner with a firm that was founded on decades of healthcare industry success. Contact the professionals at Jackson Physician Search today.