JAAPA | Optimizing NP and PA Roles to Improve Care Access

Need actionable strategies for increasing patient access to services while also managing costs?

Turn to your NP and PA workforce! We’ve got the latest research and insights as published in the Journal of the American Academy of Physician Assistants.

It’s no secret that patients are struggling to gain access to care when they need it. In fact, a recent Harris poll found that the average wait time to get an appointment is 3.9 weeks.

How can we fix this? By opunlocking the full potential of nurse practitioners and physician assistants and optimizing their roles. SullivanCotter’s Amy Noecker, Zachary Hartsell, Jaime Lough and Lacey Buckler recently contributed to an important case study in the Journal of the American Academy of Physician Associates (JAAPA) about improving patient access in an academic medical center. This includes a study of three specialty areas – Cardiology, Hospital Medicine, and Oncology – and outlines how the organization was able to expand patient access while also increasing revenue through a more holistic care model design.

Now’s the time to rethink workforce models and empower APPs to work at the top of their license!

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Abstract: The healthcare industry is in the midst of unprecedented change as hospitals and health systems nationwide balance the need to increase patient access to services with managing costs. Nurse practitioners and physician associates are well-positioned, and often overlooked, members of the healthcare team who can serve as resources for organizations to improve care access. Using an intentional and data-driven process, one academic medical center both improved patient access and increased revenue through a holistic care model redesign in three specialty areas, as described in this organizational case report.

Authors: Chris Ferron, MBA, PA-C; Wendy Franklin, MSN, ANP-BC, CCRN; Hope Sellars, MSN, RN, ANP-BC, AACC; James Shamiyeh, MD, MDA, MSPH; Sandy Leake, DNP, RN, NEA-BC; Lacey Buckler, DNP, ACNP; Jaime Lough, RN; Amy Noecker, MEd; Zachary Hartsell, DHA, PA-C

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As the U.S. healthcare system continues to recover from the pandemic, patient access challenges remain critical, with widespread dissatisfaction and long wait times. A recent Harris Poll shows that only 10% of U.S. adults rate the system an “A,” while 60% give it a “C” or worse. Key barriers include long wait times, confusing care navigation, and a lack of providers. This is exacerbated by a projected physician shortage of up to 86,000 by 2036.

To address this, healthcare organizations are increasingly turning to advanced practice providers (APPs) like nurse practitioners (NPs) and physician associates (PAs), though their roles remain underutilized. Surveys reveal growing demand for APPs, parity in compensation across roles, and comparable productivity. Strategic deployment of NPs and PAs can enhance access and deliver financial benefits, as evidenced by their expanding role in Medicare billing.

Organization Background

Amid rapid APP workforce growth, a Southeast academic medical center identified critical gaps in structure, utilization, and productivity, prompting a comprehensive internal analysis.

• Workforce Underutilization: Despite employing nearly 360 APPs, many felt underused—55% considered leaving due to unclear roles and lack of recognition, especially in cardiology, oncology, and hospital medicine.

• Productivity Lag: APPs performed fewer independent tasks than national peers, with 10 specialties below median productivity and five below the 25th percentile in wRVUs.

• Missed Financial Opportunity: Bridging the productivity gap to national medians could generate $1.1–$3.6 million in additional annual revenue, yet the organization lacked a strategic plan for APP deployment.

Methods

To improve patient access, the organization launched a structured initiative focused on optimizing PA and NP utilization across key clinical departments.

• Strategic Planning & Department Selection: A steering committee, in partnership with SullivanCotter, identified cardiology, oncology, and hospital medicine as high-opportunity departments based on readiness for change and potential access gains.

• Collaborative Workgroups: Multidisciplinary teams—including physicians, APPs, nurses, and support staff—met to define ideal roles, determine patient management structures, and identify infrastructure and staffing changes to support new care models.

• Implementation Oversight: Recommendations were presented to the steering committee, which met monthly to approve plans and monitor progress as departments moved forward with care model redesigns and execution.

Results

Through a structured redesign effort, three clinical specialties implemented workflow and care model changes to improve NP and PA utilization, patient access, and productivity.

1. Specialty-Specific Changes:

   • Cardiology standardized scheduling, reduced NP/PA-to-MA ratios, and added rapid access appointments.

   • Inpatient cardiology piloted APP-led rounding models and developed a low-risk chest pain observation service.

   • Hospital medicine restructured cross-cover roles and trained staff to differentiate urgent vs. routine calls.

   • Oncology aligned scheduling and patient-facing time but faced delays in implementation due to leadership turnover.

2. Data-Driven SMART Goals: Each specialty established measurable targets—such as increasing patient volumes, reducing no-show rates, and tracking APP encounters—to guide performance improvements and access gains.

3. Early Outcome Highlights:

   • NP/PA outpatient cardiology encounters rose 7.5%; telehealth visits surged by 93%.

   • Inpatient cardiology encounters increased from <100 to 500–700 monthly.

   • Hospital medicine saw a 50% boost in cross-cover census and over 300 additional critical care visits.

4. Improved Engagement and Retention: NP/PA turnover dropped by 13% across participating specialties, with increased satisfaction leading other departments to request involvement in the redesign process.