MEDICAL SPOTLIGHT: At Health First, Physician Assistants and Nurse Practitioners Extend Physicians’ Practices

physician shortage has helped spur the growth of Advanced Practice Providers

Americans Are Making Appointments Amid a Doctor Shortage, Advanced Practice Providers Are Answering the Calls

A physician shortage across the nation has helped spur the growth of Advanced Practice Providers (APPs) – healthcare clinicians with advanced degrees who often serve as the hub for a patient’s healthcare journey.

BREVARD COUNTY, FLORIDA – Many Americans are living longer lives than their parents, and regular doctor’s visits deserve much of the credit – but not all of these are staffed by doctors.

“I will never say I know as much as a doctor,” says longtime Health First Provider Evan Cataldo, an Advanced Practice Registered Nurse (APRN). “We are an extender of a physician’s services.”

In his practice, Cataldo may see new and existing, pre- and post-op patients – many of these are elderly people, but some are kids.

When Cataldo saw Chase DeMarco’s little girl, she had broken her arm in two places.

“They ended up putting a cast on, and you know, they managed to make it kind of fun. She got to pick out a color,” he remembers. “We just had a follow up with Evan where they removed the cast, and that could’ve been scary with the saw, but he made her feel comfortable.”

“I would go out of my way to see him again.”

MEDICINE IS INCREASINGLY SPECIALIZED

Cataldo won’t hesitate to arrange for his patients to follow up with a physician, especially if the patient is presenting complex comorbidities such as diabetes or osteoporosis. But these are “a significant minority” of cases.

“Some patients think, ‘I have to see a doctor,’ and that’s fine. If we can’t figure out what’s going on, and I can’t help you, I’ll be happy to send you to a specialist,” he says. “I say, ‘Let me help you with your issue first, and if it’s something we can’t agree upon, or that’s confounding, we’ll see a specialist,’ but 99 out of 100 times, they didn’t need to see a doctor. What it’s really about is trust – and almost every time, they leave shaking my hand.”

Health First Medical Group’s Jayde George, DO, who maintains a Family Medicine practice offering both in-office and Virtual Visits, says that, from alleviating scheduling pressures to getting necessary tests ordered, Advanced Practice Providers extend a physician’s practice.

“Getting tests ordered, getting the results, following up face to face to review results – patient wellness is an ongoing learning experience from the Provider side, and APPs carry much of that load,” she said.

What’s more, the training many APPs go through include bedside medicine on critical care floors of hospitals, or high-variability Emergency Departments, such that “by the time they’re working with us, they’re so sharp, and they have experience that a lot of physicians don’t have.”

“Having as many people involved in your care is one way to ensure a quality outcome for you.”

Medicine has become incredibly specialized, and “physicians are unbelievably good at what they do,” says Elizabeth “Betsy” Ambrose, APRN, an Internal Medicine Provider at Health First Medical Group-Gateway, whose collaborating physician is Dr. Mario Ruberte. The medical community’s own success has strained availability.

According to one survey, the average “soonest physician appointment” has gone from 20 days to 26 days over the last two decades.

NURSING’S CORE MODEL

“I think that’s the biggest difference – we do very frequently get a bit more time,” says Wendy Fiumano, a Cardiology Nurse Practitioner. “We can dig deep. And patients can always call us. We’ve available.”

Availability is critical, as Ryan Wilson sees it. Wilson is Chief Physician Assistant (PA) for the Orthopedic Trauma Group, Trauma Surgery and Acute Care Surgery teams at Health First’s Holmes Regional Medical Center. He’s also Health First Medical Group’s Director of Advanced Practice Providers, which includes PAs and Nurse Practitioners.

While a surgeon is at the hospital operating, “I can see today if your knee pain is something that requires surgery,” and begin to make plans, he says. Healthcare on hold is no care at all.

Meanwhile, doctors spend their careers examining disease courses at the cellular level, but the core model of nursing is “holistic, whole-body,” says Ambrose, which often is the proper scope on a first visit.

“It’s never just one thing – it’s always a combination of factors,” she says, “That’s what I like about Health First Medical Group. It’s a large multispecialty group with different resources we can tap into.”

BIXBY AND SMITH’S TWO-STEP

The story of Health First Medical Group’s Stephanie Bixby, APRN, and her patient Sheena Smith is a vivid illustration of this patient investment – of deeper listening, then tapping into healthcare’s kaleidoscope of specialty care and services.

Years ago, Smith was seeing a doctor who was sure the headwaters of all her ailments was the extra weight she carried.

“No, really, he said, ‘You’re fat,’” she recalls.

Seeking a new Primary Care Provider, she balked at making an appointment with Bixby at HFMG’s Internal Medicine practice in Malabar. “I don’t want to see an APRN,” she thought.

But she did it.

“That first appointment, I cried,” she says. “I cried because she listened. She asked what was wrong, and she listened to all of it. Then she started talking about how we were going to come up with a plan to address my health.”

Smith eventually did pursue a surgical weight-loss solution, and lost 100 pounds, but it turns out, she also suffers from postural orthostatic tachycardia syndrome (POTS) unrelated to her weight. At Bixby’s direction, she now gets comprehensive cardiac care from Health First Cardiologist Enrique Polanco, MD, and Cardiologic Electrophysiologist Vishal Patel, MD.

Later, Smith watched another mystery unravel when she received an auto-immune disorder diagnosis from Health First Rheumatologist Sheetal Patel, MD.

“I think I’ve sent 25 friends and clients to Stephanie, maybe more,” Smith says. “Every time I have a breakthrough, I commend her, and thank her for all of her service to me, listening, never giving up on me. Not thinking I’m crazy.”

“She’s a Rolodex of specialists and industry information. She literally is the epitome of what healthcare should be.”

“I know people like their doctors, but she saved my life.”

Need to schedule an appointment? Visit HF.org/findadoc. To see more news coverage of Health First, visit HF.org/news.

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