Prioritizing Patient Care

Projections from the California Future Health Workforce Commission show a shortfall of approximately 4,100 primary care physicians statewide by 2030, impacting access to health care. This includes the greater Bay Area, where the shortfall could lead to longer wait times to get an appointment and increased reliance on emergency rooms for non-emergency care.

To address the shortage, hospitals and health systems are turning to Advanced Practice Providers (APPs) to help physicians manage patient panels and provide more efficient care. Washington Health Medical Group (WHMG) Chief of Quality and Physician Leadership and Interim Chief Medical Officer, Elizabeth Kurkjian, MD, FACOG, explained that APPs are health care professionals who provide medical care under the supervision of a physician. They are trained to diagnose, treat, and manage various medical conditions, and can also prescribe medication. The state of California recognizes five different APPs. Nurse Practitioners (NPs) and Physician Associates (PAs) can work within the hospital but usually work in clinics and physician offices. Certified Nurse Midwives (CNMs), Certified Registered Nurse Anesthetists (CRNAs) and Clinical Nurse Specialists (CNSs) usually work within the hospital.

Washington Health (WH) and WHMG have been proactive in dealing with the looming primary care provider shortage, bringing NPs and PAs to collaborate with physicians to provide comprehensive, quality care for patients.

Providing Care

Dr. Kurkjian works with both the WH/WHMG medical staff and APP staff. She said Washington Health NPs and PAs offer similar types of care and both are required to have completed programs leading to a master’s degree. Each are different in training, specialty focus, certifications and licenses.

“Originally in our organization, APPs were pretty heavily concentrated in the surgical specialties, working to help care for patients primarily around the surgical aspect of their care,” she said, “doing pre-op and post-op visits and conducting follow-up visits. We’ve had specialty APPs for some time, working in Women’s Health, for example. Bringing APPs into our primary care practices is changing the landscape for Washington Health and our community.”

NPs are licensed through the California Board of Nursing and are trained using a nursing model, focusing on caring for patients with steps defined in the nursing process: assessment, diagnosis, plan, implementation and evaluation. This process focuses on caring for the whole person: physical, emotional and mental. NPs often specialize in acute care, primary care, and women’s health settings and in specialty care offices. While 27 states allow NPs to practice independently, California requires NPs to work with a supervising physician.

PAs are licensed by the California Physician Assistant Board and are trained using the medical model, the same training method that physicians are trained under. The focus on the medical model is understanding diseases and their effect on the human body with an emphasis on pathology, biology, assessment, diagnosis and treatment. PAs are typically generalists that offer care for many fields in healthcare, including within the hospital and specialty care. In California, PAs must be supervised by a physician. Their scope of practice is determined by a practice agreement with their supervising physician, but they can generally perform many of the same services as physicians, including prescribing medications, ordering and interpreting diagnostic tests, performing procedures, assisting in surgeries, and making diagnoses and creating treatment plans.

Health Care Team

Research shows increased access to primary care is associated with lower mortality rates from cardiovascular, cancer, and respiratory diseases along with increased life expectancy. Solid relationships with primary care providers also yield higher patient satisfaction and better patient outcomes. At Washington Health, APPs play a large part in translating the abstract research into actual care. Dr. Kurkjian explained APPs enhance patient care, from improving access to care to providing additional services specific to their backgrounds to being able to spend more time with patients.

“Our APPs broaden our access and come to patient care with a bit of a different lens,” Dr. Kurkjian noted. “They are able to focus on treatment and health maintenance at the same time, bringing more education to our patients as our physicians may be more focused on managing the more complex medical issues. Our APPs can be health care partners with our patients, bringing a true holistic approach to care.”

“It can be challenging for physicians to carve out time for longer patient visits,” she continued. “Our APPs can take that time as they work to the top of the scope of practice and licensure and free up our physicians to see the more complex patients. This tandem approach means you get the best care guided by your doctor’s expertise and understanding of your health. And as our APPs collaborate with our physicians, it’s the best-case scenario for Washington Health patients.”

To learn more about Washington Health Medical Group, visit mywtmf.com.