Norfolk, Va.-based Sentara Health is implementing a new primary care model that it expects will significantly expand access to care.
The team-based, physician-led model pairs one physician with two advanced practice providers and offloads administrative tasks to other supportive roles, such as medical assistants and clinical pharmacists. Each APP added to the team is estimated to expand primary care capacity by 70%.
That estimate comes from a simple calculation: Primary care physicians at the health system typically care for around 1,500 unique patients, while APPs manage about 1,100. Adding the two equals 2,600, marking a 70% increase, Steven Pearman, MD, vice president and chief medical officer of primary care at Sentara, told Becker's.
"There will always be a need for physicians, but we know there's a scarcity of candidates in primary care particularly," he said. "Instead of depending solely on primary care physicians, we want to augment them with APPs — both nurse practitioners and physician assistants."
The shift comes as patients face extended wait times to begin receiving care. Earlier this year, ECG Management Consultants published a report that found the average wait time for the third next available appointment — a common metric used to gauge patient access — across 11 medical specialties in the U.S. is 38 days.
Within the Sentara network, primary care access for new patients remains limited, which the new care model aims to solve, Dr. Pearman said. To support the shift, Sentara Medical Group plans to double its APP workforce over the next three years and is ramping up hiring. Currently, the group employs around 270 advanced practice providers in primary care, telehealth, urgent care and walk-in.
Nationally, health systems are increasingly expanding their APP workforces to meet growing demands for care. Data from AMN Healthcare shows job searches for nurse practitioners and physician assistants now surpass those for primary care physicians. In 2020, APPs accounted for upward of 60% of providers who entered the healthcare workforce. This shift is increasingly manifesting in primary care settings, according to Kaufman Hall.
"It can take anywhere from six to 12 months to see a primary care provider," Stephanie Zeiber, a physician assistant and one of two newly appointed directors of APP development at Sentara, said in an October news release. "Opening more positions for advanced practice providers should reduce wait times and give patients the care they deserve."
Under the model, clinicians will share a group of patients, allowing them more time with each patient. Patients will have a designated provider within the team, though the entire team collaborates on care. Freeing up physicians' and APPs' time to focus on direct patient care as much as possible is a major component of the model, with supportive roles taking handling more administrative tasks, such as prescription refills and form management.
The model's development began with an analysis of time-consuming tasks that occur outside patient encounters: documentation, chart review and MyChart in-basket management.
"We're trying to address all of those things at the same time" with the care model shift, Dr. Pearman said. During pilot stages, some physicians reported they had time to see a few more patients each day.
"What drags them down is all of the extra work that goes on outside of the office … but if all of that is unburdened from them, most of them will actually prefer to see a few more patients a day — and we've seen that anecdotally," Dr. Pearman said. "It's refreshing."
In addition to office settings, Sentara is integrating more APPs into virtual care functions. The system does a portion of transitions out of the hospital virtually, and has leveraged advanced practice providers to lead virtual visits in the first several days after patients have been discharged. If a primary care physician leaves, APPs also fill in gaps during the transition period until a new physician is onboarded, Dr. Pearman said.