The Medical Minute: Advanced practice providers play key role in health care

October 06, 2021

If you have ever seen a physician assistant or a nurse practitioner when you needed medical care, you are one of a growing number of patients who have come to rely on advanced practice providers.

It’s a category of medical professional that includes certified nurse anesthetists, clinical nurse specialists and certified nurse midwives.

These nonphysician providers first emerged in the 1960s in response to a shortage of primary care physicians. Their numbers continue to grow thanks in part to their ability to help physicians increase efficiency and improve patient satisfaction.

Although both physician assistants and nurse practitioners are educated at the master’s degree level, nationally certified and state licensed, their approach to care is different. Physician assistants practice with an emphasis on diagnosing, assessing and treating diseases. Nurse practitioners place focus on the health and well-being of the whole person.

“Nurse practitioners tend to look holistically at the patient, giving equal attention to emotional needs and physical problems,” said Dianne Mulreaney, a family nurse practitioner at Penn State Health Medical Group―Muhlenberg. “Nurses are natural caregivers. Their education comes from that perspective.”

One of the biggest hurdles advanced practice providers must overcome is helping patients understand they are qualified to perform physical exams, interpret lab results, provide treatment and prescribe medications. Marisa Kovach, a physician assistant with Penn State Neuroscience Institute, says the key to making the relationship between an advanced practice provider and a patient successful is to address the patient's concerns about education and certification at their first visit.

“I usually start by explaining that I have a bachelor’s and master’s degree and am certified to practice as a physician assistant. Sometimes I emphasize that during our master’s program, it is like medical school and clinical rotations shortened into two years instead of four,” she said. “Patients are fairly receptive when I say I am an extension of their physician’s practice. We reassure patients the attending physician still participates in their care and reviews everything we do in that visit.”

Although some states allow nurse practitioners to practice independently, in Pennsylvania, they too must have a collaborative physician.

“Throughout my career, I have had the pleasure of working with some very skilled physicians who mentored me and allowed me to glean a lot of knowledge from them,” Mulreaney said. “I also spent many years developing the experience and critical care thinking skills necessary to succeed as a nurse practitioner.”

This team-based approach to care is standard for Penn State Health advanced practice providers and essential to their development. For Kovach, who joined the health system as a new graduate four years ago, working closely with multiple physicians helped her to gain valuable skills similar to the way physicians learn in a residency program.

“I worked closely with the physician, watching how he saw patients. I started doing little steps. I took histories, did the physical exam and presented a differential diagnosis and ideas for treatment. I ran all this by the doctor, and we would present it to the patient,” she said. “Eventually, I learned his skills and how he does things and could be intuitive to what it was he would likely do. The longer I was with him, it was like a residency in itself.”

Now in her fifth year as a physician assistant, Kovach works with Dr. Sol De Jesus, who specializes in movement disorders.

“We’ve developed a good partnership and developed a good foundation for how we practice,” she said, explaining that with her on De Jesus’s team, they have doubled the number of follow-up appointments on her schedule. “This improves access. It helps us accommodate more people in appropriate time intervals.”

What about those patients who still prefer to see a doctor?

“We are happy to accommodate them,” said Kovach. “While it may mean they are seen less due to physician availability, the goal is always quality of care and ensuring the patient is happy.”

Advanced practice team members

Physician assistant (PA-C)

A licensed medical provider who works in collaboration with a physician and has the education and training to prescribe medications, perform physical exams, interpret lab results and provide treatment.

Certified registered nurse practitioner (CRNP)

A registered nurse with advanced education and training who prescribes and administers medications, performs physical exams, interprets lab results and provides treatment.

Certified nurse midwife (CNM)

A registered nurse with advanced education and training who specializes in women’s reproductive health and childbirth. A CNM prescribes and administers medications, performs physical exams, interprets lab results and provides treatment.

Certified nurse anesthetist (CRNA)

A registered nurse with advanced education and training in anesthesia who administers anesthesia services, anesthesia medication and care to patients, performs physical exams, interprets lab results and provides treatment.

Clinical nurse specialist (CNS)

A registered nurse with advanced education and certification who is an expert in a specialty area of nursing care. A CNS provides assessment, care planning and patient and family education while working with a health care team to improve patient outcomes.

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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Last Updated October 18, 2021