Between 2012 and 2016, visits to nurse practitioners (NPs) and physician assistants (PAs) increased 129 percent. That’s according to a 2018 insurance claims review of primary care office visits, which also reported an 18 percent drop in PCP visits in that same time frame. Along with this trend have come some tensions and some sense of competition between Advanced Practice Providers (APPs) and physicians. It has also prompted calls of concern like this nursing industry article that urges providers to put egos aside and patients first.

Does this mean the same thing is going to happen in neurology, now that APPs are increasingly entering the field?

The American Academy of Neurology (AAN) doesn’t seem to think so. The AAN has made a concerted effort to bring APPs into their group. This is largely because of the shortage of neurologists (which is slated to worsen over the next decade) as well as their high level of burnout. In other words, neurologists can use all the help they can get.

According to this AAN position statement:

Incorporating APPs into neurologic practice… may alleviate some of the stress and burden associated with the care of chronically ill neurology patients, thereby reducing the recently reported high ‘burnout’ rate of neurologists.”

The AAN’s new section, the Consortium of Neurology Advanced Practice Providers, met and had offerings for the second year in a row at the 2019 annual meeting. “We had a few networking events as well as our consortium meeting, and all were very well attended,” says Calli Cook DNP, FNP-C, chair of the group. They also had several sessions dedicated to the incorporation of APPs into clinical neurology practice.

Cook says the AAN offers a very collaborative environment. They promote a team approach in practice, which, “works really well to reduce burnout for all parties, not just the physicians, not just the APPs, not just the nurses, but everybody.”

Senior female doctor taking notes of patients ct scan while consulting with young colleague

Key to this is utilizing APPs to their fullest potential. “The team-based approach in delivery of care, with everyone working to the top of their scope of practice, is really best for the patient. It allows improved access, improved patient satisfaction, and improved quality.”

So, what does it mean for an APP to work at the top of their scope of practice?

This can vary widely among APPs and largely depends on their training and the limitations of their professional license in each state. However, Cook says, “PAs and Nurse Practitioners can really do any type of procedure that they’re trained to do in the office. In my clinical practice, I do multiple different nerve blocks. I do lumbar punctures. I do Botox.” In her state (Georgia) she is limited to procedures done by the physicians in her office.

Allowing APPs to take on a leadership role in the more straightforward cases will allow neurologists more time to dedicate to the treatment of complex or difficult cases. But that is not all that APPs bring to the table.

“I don’t think APPs want to be little miniature neurologists. They want to be advanced practice providers,” says Cook. For her, that means bringing a different perspective and approach.

I’m trained in the nursing model. I like coaching patients, I like talking with patients about lifestyle modifications, including diet and exercise and sleep, and I think the value that I bring to that side of the equation is very collaborative to what the physician does. You’re getting the best of both worlds, and when you create that team-based dynamic, you’re really setting your patients up for success.”