The Role of the Advanced Practice Provider in a Subspecialty Practice: Satisfaction and Professionalism, Including COVID-19 Impacts

Abstract

The advanced practice provider collaborates with other clinicians and works to educate, advocate, and increase access for patients in the clinical setting. Research has shown that advanced practice providers working collaboratively with physicians yield improved quality of care and outcomes; however, the current level of understanding of this role in gastroenterology has not been explored in detail. Across two academic institutions, we conducted 16 semi-structured interviews to examine how the environment of the gastroenterology department aligns with the professional satisfaction of its advanced practice providers. Thematic saturation was achieved, revealing four themes: (1) productivity of the working relationship; (2) inconsistent understandings of the advanced practice provider role in clinical care; (3) mixed advanced practice provider experience relating to colleague support; and (4) autonomy impacts satisfaction. These themes highlight not only a reasonable degree of advanced practice provider satisfaction, but also the need to engage with colleagues regarding the advanced practice provider role in care to allow for better integration into the overall gastroenterology healthcare team. The results from different institutions suggest the need to interview gastroenterology advanced practice providers in different settings to better understand whether similar themes exist.

Figure 1.. APP level of professional work satisfaction.

APPs expressed varying levels of satisfaction with their professional work environment. A majority of APPs noted that collaborating with colleagues to provide exceptional patient care brought them the most satisfaction. APPs also highlighted the potential room for improvement with respect to varying levels of an understanding within the department of the scope of the APP practice, which may lead to challenges in the work environment. These codes suggest there is an opportunity for education and standardization of the role of the APP in a subspecialty practice.

Figure 2.. APP professional relationships with supervisors.

APPs reported a wide range of experiences with the support they receive in their relationship with a supervisor, whether it is a physician or APP leader. Some APPs reported a close, supportive working relationship with their supervising physician or APP leader, while others highlighted areas for improvement with respect to supervisors addressing APP concerns. Few APPs noted they are not always recognized as a provider with an advanced scope of practice, suggesting this impedes the APP’s ability to participate equal to supervisors as a member of the patient care team.

Figure 3.. The impact of COVID-19 on the role of the APP.

APPs reported that the COVID-19 pandemic impacted multiple aspects of their roles as providers in a subspecialty, both positively and negatively. A majority of APPs noted that the shift to telehealth changed the way they practiced with respect to both workflow and patient care. APPs highlighted the existing room for improvement with respect to a lack of support in the shift to either telehealth or inpatient work during the pandemic, which impacted the way they practiced patient-centered care. The transition to inpatient work did, however, bring more satisfaction to some APPs as they shifted to patient care in an acute setting. This impact emphasizes the essential role APPs have played during the pandemic and the challenges they have faced as they continued to adhere to the APP model of care.

Figure 4.. The APP’s level of autonomy and its role in the APP model of care.

A majority of APPs reported that their level of autonomy as a part of the patient’s care team was satisfactory and allowed them to practice under the APP model of care they defined for themselves. APPs noted positively that their level of autonomy in this practice does not hinder their potential as an APP. They find physician collaborators to be a productive form of support. Autonomy does, however, depend on the provider the APP collaborates with, according to some APPs.

Figure 5.. Suggestions for implementing change and establishing standardization within an institution utilizing APPs.

Three actionable items arose from interview analyses regarding area for improvement in APP satisfaction and operation. With the willingness and desire to improve these weaker areas that lie at the base of interprofessional work, institutions can implement the 3 suggestions outlines here in a cyclical manner in order to reach the goal of maximum interprofessional collaboration and efficacy for the benefit of the patient.