Advanced Practice Providers (APPs) occupy some of the fastest growing roles in health care. The Bureau of Labor Statistics predicts 37% and 31% growth over the next 10 years for physician assistants and nurse practitioners respectively, while nurses and physician roles are expected to grow only 15% and 13%. Yet, there’s a lot of value left on the table. In fact, the Advisory Board’s Medical Group Strategy Council estimates that 20% of APPs expect to change jobs within the next year – and a vacant nurse practitioner position costs around $1,500 per day. HR leaders need to work with their physician executive peers to carve out a clear identity for APPs.

We spoke to leaders from Cooper University Health Care to learn how they successfully carved out an organizational identity for their 280 APPs. Cooper uses APPs all over their organization: from the acute care space, to behavioral health, to independent family practices. They’ve exponentially increased their use of APPs, and used them in a way that not only extracts more value but has increased APP engagement. Recent results show an increase in APPs who are engaged or content, and a decrease in those who are disengaged or ambivalent. And to make this happen, Cooper has relied on a strong relationship between HR and APP leadership. Read on to learn Cooper’s three keys to successfully deploy APPs and extend the reach of the care team.

Elevate a dedicated APP lead for the system

Too often, APPs are force-fit into the existing governance structure of an organization – usually into the physician or nursing enterprise. This can leave APPs feeling like they have no clear place in the organization. Cooper University Health Care recognized this issue manifesting among their APPs. Their solution? Hire an Associate Vice President to sit over all of the APPs in the organization. In 2016, Cooper hired an Advanced Practice Registered Nurse to serve in this role, who has a dotted line reporting structure to all of the APPs in the organization. Being an APRN gives her the expertise and professional experience to understand and advise APP scope and practice. This AVP reports through the CNO, and serves as a partner with the CMO for many initiatives in the organization. Giving APPs a clear leader, who shares a similar background, sends a strong message to the organization about the value of APPs and ensures APPs perspectives are heard at the highest levels of the organization. Additionally, having one point person for APPs makes it easier for HR to know who to partner with on APP people strategy.

Key takeaway: An APP-specific senior leadership position will help enable input in strategy development and boost engagement among APPs in your organization. This also makes it easier for HR to partner on developing a system-wide people strategy for APPs rather than taking a more disjointed approach for different pockets of the organization.

Find opportunities to bolster APP identity as providers

APPs tend to find themselves in a middle ground between providers and employees. More often than not, we’ve found that organizations who are successful at deploying APPs are fully embracing them as providers. Over the past few years, Cooper has made some key changes to bolster APPs professional identity as providers including:

• Surveying APPs as part of the provider engagement survey
• Incorporating APPs in with provider orientation
• Inviting APPs to provider leadership meetings
• Giving APPs dedicated time for continuing education
• Inviting APPs to write for the provider blog
• Posting APP headshots and biographies on the website as providers

And the distinction is more than just a ceremonial one – as of January 1st, 2019, APPs are considered to be full members of Cooper’s medical staff, stating loud and clear that Cooper values APPs as providers. The AVP for APPs is a voting member of the Medical Executive Committee.

Cooper also recognized that the nuance between providers and employees goes even deeper – they had to strike the balance between APPs being part of the provider group, while also making space for them to have their own professional identity as APPs. To do this, they created an APP leadership council comprised of each lead APP (supervising APP at the practice-level) and the AVP of Advanced Practice Providers. This committee owns APP engagement, educational opportunities, scope of practice issues, professional development and mentorship, and networking events. Cooper’s leadership also decided to remove APPs from the Provider of the Month Award and create a specific APP of the Month Award, because it became clear that the cohort was large enough to warrant its own recognition. Compensation is also handled differently for APPs. Cooper ensures they are maintaining competitive salaries by revisiting APP compensation every six months.

Key takeaway: Show APPs that you recognize their unique stature in your organization by treating them as providers, but also looking for opportunities to acknowledge them as a unique subset of your provider group. For example, include APPs in with physicians for activities like onboarding, your engagement survey, and ongoing provider leadership meetings. This not only tells APPs that you see them as providers, but reduces the time spent running separate programs. Then, determine where it might make sense for you to carve out opportunities for APPs exclusively like recognition programs, or system-wide leadership councils.

Formalize support for APP career development and advancement

Creating a unique career path for APPs and supporting them to develop into new roles are key steps toward building an identity. Cooper’s take was to create a lead APP position, who would be in charge of onboarding and sit on the APP leadership council. There are 22 leader APPs across the organization in primary care, specialty care, critical care, and hospital medicine. APP leaders spend 80% of their time in clinical practice, and the other 20% with recruiting, onboarding, and leadership responsibilities. Cooper likens this role to that of a supervisor. This is a way to make sure that APPs at individual practices are getting the ongoing development support they need.

Key takeaway: There are a myriad of ways to create development opportunities for APPs. Consider creating a career ladder, where each new level involves increased amounts of project and administrative work. You may also assign an APP mentor to each new APP to help them navigate their new role. Another option is to assess where skill gaps exist in your cohort, and create a preceptorship program to train APPs on these specific competencies. For example, if you find that your cohort has room for improvement in leadership skills, you may tap another APP to lead a training around that competency.

Assess where you stand with APP deployment and find levers to pull to improve those areas.