Neurology APPs Have Officially Arrived: Should You Consider Adding One to Your Practice?

Just weeks ago at the 2018 meeting of the American Academy of Neurology (AAN) a new group officially emerged onto the neurology landscape: Advanced Practice Providers (APP). Largely due to the country-wide shortages of neurologists, APPs have been joining neurology practices in increasing numbers. At this year’s AAN meeting, the new thousand-member strong Consortium of Neurology Advanced Practice Providers held its inaugural section meeting.

In his Presidential Address, current AAN leader Ralph Sacco, MD, MS, FAHA, FAAN, said of APPs: “They are the fastest growing membership category in the AAN. We believe greatly that for us to meet the demands for neurologic care, APPs have to be important members in our association.”

What is an APP?

Calli Cook MSN, FNP-C, chair of the Consortium of Neurology Advanced Practice Providers for the AAN, says that APPs primarily include nurse practitioners (NP), clinical nurse specialists (CNS), and physician assistants (PA). But she says, “I think some folks do broaden that definition to include other advanced practitioners like physical therapists or pharmacists who are on their team.”

How are APPs utilized in neurology practice?

How you choose to integrate an APP into your practice will largely depend on the scope of practice laws in your state. These laws vary on issues like prescribing and APP autonomy. You can search for your state laws in the Kaiser Family Foundation’s directories for Physician Assistants and Nurse Practitioners.

According to Cook, “There are several different models of care, but a lot of practices rely on the follow-up model. It’s been very successful in neurology. It’s where the physician sees the patient and establishes a diagnosis (and that may take a few visits), but after the diagnosis is established, then the APP continues to follow-up with that patient, and the patient may see the physician just once a year.”

Whichever model you consider, Cook says you’ll get the most out of an APP if you utilize a team-based approach. “Most of the neurologists that I work with value the impact that team-based care has on patients.” Neurological issues can be complex and are often multifactorial. “There are several layers that go into the care of each individual neurologic patient, as well as the care of their family and caregivers. Every member of the team has to collaborate to create the best outcome for the patient.”

How can you find a good APP?

Finding the right people to help you deliver your best care is critically important to the success of your practice, and it isn’t always easy. When looking for an APP to add to your practice, Cook’s best recommendation is to align yourself with nursing and PA schools. These schools usually have a clinical liaison who can arrange internships with you at your practice. “Become a preceptor,” says Cook, “because when you’re able to connect with students who are interested in neurology, you can see how they interact during their clinical time with you and decide if they’re a good cultural fit for your clinic or not.”

How do you decide if bringing in an APP is right for your practice?

According to The American College of Physicians, adding an APP, like a NP or PA, to your practice can increase practice revenue by far more than the cost to hire one. Whether you are looking to improve your bottom line or to reap the benefits of team-based care, a thorough review of your practice needs will help you decide if an APP is right for you.

Ask yourself, “What is the problem you’re trying to solve by hiring an additional team member?” says Cook. “Do you have an access issue? Do you need someone to see these folks to improve satisfaction scores by getting people in and decreasing wait times? If it’s one of those types of problems, then an APP could be an important team member to address that problem.”