Blog Posts


The Emerging Role of Advanced Practice Providers Requires Comprehensive Training

Posted on Mon, Oct 10, 2016
The Emerging Role of Advanced Practice Providers Requires Comprehensive Training

As the population ages and consumer demands grow, the need for physicians is increasing faster than the supply. Simultaneously, the industry is experiencing profound changes in major healthcare reimbursement methods.

There’s no simple solution, but adjustments to how we approach healthcare delivery are being made at practice sites across the country - each with a mission of supporting quality, value and both fiscal and clinical accountability.

One change that seems to be highly effective at helping alleviate the impact of reductions in reimbursement and overtaxed physician resources is the use of advanced practice providers (APPs).

APPs are advanced, certified or registered professional caregivers, including nurse practitioners (NPs) and physician assistants (PAs), who are licensed to evaluate and treat patients under the general (if not immediate) supervision of an onsite physician. PAs, NPs or advanced registered nurse practitioners (ARNPs) have advanced medical training to conduct examinations and diagnose and treat patients under the general direction of a physician. APPs are largely seen as analytical, efficient problem-solvers who are detail-oriented and patient-focused.

According to the American Association of Nurse Practitioners, more than 205,000 nurse practitioners (NPs) are licensed in the U.S., with 44.8 percent holding hospital privileges. The National Commission on Certification of Physician Assistants reports more than 95,000 physician assistants in the U.S. All signs point to increasing demand and growth in job creation in these fields.

Licensure requirements, which often determine the level and scope at which APPs may practice, can vary significantly state to state. More importantly, there exists a great deal of variability in education, clinical training and experience among APPs, which impacts both the roles they can serve and the degree of acceptance they may receive by physicians and other healthcare workers.1

APP Academy Provides Training Continuity

Training and experience is crucial, and unfortunately for most APPs, this can only occur on the job as part of their clinical practice. To reduce variability among providers and improve overall training and clinical expertise, EmCare developed an innovative APP Training Academy. Developed by Andy Mulvey, MD, FACEP, and Richele Wright, MSN, FNP, the academy began training APPs at Community Hospital South in Indianapolis. More than 25 providers have completed the academy.

The program has prepared participants for improved interactions with patients and staff, including emergency physicians and medical staff. Documentation improvements along with more efficient patient flow have been additional benefits of the program. And, perhaps most importantly, patient satisfaction scores have improved.

Lead APPs from EmCare’s North Division have participated in monthly calls to share best practices, disseminate organizational updates, learn from guest speakers and get updates on recruiting, enrollment, human resources issues and quality. By nurturing the APPs and APP leaders, both patients and the healthcare industry are benefitting from well-equipped practitioners who are helping to close the gaps in access to care and the physician shortage.

“This has been such a rewarding experience for everyone involved,” explained Wright. “The additional training allows both the APPs and physicians to practice at the full extent of their licenses and education. Word is spreading about our approach to emergency medicine, and we now have a waiting list for the academy.”

Implications for Emergency Medicine and Hospital Medicine

While there are still barriers and resistance in some areas, APPs are forging ahead with new roles and responsibilities in the fields of emergency medicine as well as hospital medicine.

APPs in the emergency medicine field help physicians achieve goals for providing efficient, quality patient care. These highly trained professionals conduct an evaluation, order tests, diagnose and provide urgent treatments for minor to support improved access to care.

Some of the benefits that APPs can provide in the E.D. include:

  • Fast evaluation and treatment of acute conditions
  • Communication to patients and families about diagnoses and treatment
  • Communication with patients’ other physicians
  • Stabilization and monitoring of acute conditions

In hospital medicine, APPs become an important part of the hospital team through:
  • Careful ongoing monitoring of the patient condition, progress and treatment through rounding
  • Coordinating the services patients need within and outside of the hospital
  • Answering questions presented by patients and families
  • Providing ongoing communication with patients’ other physicians
  • Timely discharge and planning to ensure continued treatment after discharge
  • Sending records to patient’s other physician

The roles and responsibilities of advanced practice providers are likely to grow as the healthcare industry evolves to support consumer demands and better manage costs. Finding ways to help provide quality patient care will be essential to building a better healthcare system.

For more information about APP jobs at EmCare, visit our Clinical Careers page.

1 Kleinpell, R., Scanlon, A., Hibbert, D., Ganz, F., East, L., Fraser, D., Wong, F., Beauchesne, M., (May 31, 2014) "Addressing Issues Impacting Advanced Nursing Practice Worldwide" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 5.


Studer Spotlight: Patient Communication that Builds Trust in Advance Practice Providers

Posted on Wed, Apr 13, 2016
Studer Spotlight: Patient Communication that Builds Trust in Advance Practice Providers

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on Each month, one of Studer Group's insightful articles will be made available to blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit

By Josh Kosowsky, M.D., FACEP

Over the past two decades, advance practice providers (APPs) have been growing both in sheer number of jobs and in their importance to the delivery of healthcare. U.S. labor statistics estimate that more than 90,000 physician assistants and 122,000 nurse practitioners are practicing today with growth rate estimates ranging from 33 percent to more than 50 percent over the next decade.i

Healthcare reform continues to drive demand for APPs, not just in primary care, but across all inpatient and outpatient specialties as organizations respond to the convergence of physician shortages, cost reductions and increased demand for services.

While healthcare organizations are expanding the roles of APPs, patients' understandings of these roles has not evolved as quickly. As leaders, we can't afford to wait for public perception to catch up. It's up to us to manage patient expectations, and in turn the patient experience, by leveraging proven communication techniques.

Nowhere is this more true than for APPs practicing in the emergency department (ED) setting. While the scope of practice for a nurse practitioner or physician assistant will vary depending on the ED, APPs play an increasingly significant role in emergency departments big and small, rural and urban, academic and community-based. Whether performing advanced triage, providing fast-track coverage, overseeing an observation/clinical-decision unit, or seeing patients alongside physicians in the main treatment area, APPs have become ubiquitous to the point where at some EDs the average patient is more likely to have contact with an APP than with a physician.

Because they often tend to see lower acuity patients, APPs have an outsized impact on the perceptions of patients who end up being discharged from the ED. And it is those discharged patients who will receive the Emergency Department Patient Experiences of Care (EDPEC) survey. Because survey questions place an emphasis on the quality of communication with providers, we need be sure that our APPs are well versed in tools and techniques such as AIDET® (Acknowledge, Introduce, Duration, Explanation, Thank You).

How can APPs make patients feel confident they are in good hands?

For a lot of patients, there is confusion and apprehension around the role of APPs within the ED care team. The AIDET® framework is proven to reduce patient anxiety and build trust with patients. In particular, AIDET® is important for APPs when it comes to "I" - Introduction.

A     Acknowledge      Provider smiles and greets the patient and family members/friends in the room.

"Good evening, Ms. Jones. Who is here with you today?"
I Introduce

"My name is John Smith. I've been a physician assistant - or PA -in this Emergency Department since 2012. I'll be the provider taking care of you today."

If working alongside a medical doctor, either directly or indirectly, the PA would continue: "I'm working with a fabulous team, including Dr. Meltzer, the attending physician on duty today."

D Duration "Dr. Meltzer will be in to see you after we have your x-ray results. Typically, that takes about 45 minutes."
E Explanation "I want to be sure we're not missing anything, so I'm going to review your case with Dr. Meltzer and ask him to come take a look at that rash".
T Thank You "Thank you for trusting us to care for you."

In a less careful introduction, a patient might hear "nurse practitioner" and think "nurse," or, in the case of a physician assistant, they might hear "physician". In either instance, this confusion can impact the patient's perception of care of their entire visit. For example, it is not unusual to read survey comments from EDs that utilize APPs, where patients complain "I was never seen by a doctor" or "there were different doctors coming in and out of the room, but I couldn't tell who was in charge." These anxieties can influence a patient's overall perception of care even when their experience has been excellent in every other area.

With the increasing prevalence and expanding roles of APPs in ED settings, their impact on patients' perceptions of care will continue to grow. Focusing on key words for APPs, particularly around how they are introduced, is something you can start doing today to make a difference for your ED and for your patients.

Josh Kowosky

Dr. Josh Kosowsky is coach on Studer Group's Emergency Department Services team. He is Vice Chair and Clinical Director of Emergency Medicine at Brigham & Women's Hospital in Boston and holds an appointment as Assistant Professor of Emergency Medicine at Harvard Medical School.

iBureau of Labor Statistics and