Norfolk, Va.-based Sentara Health is doubling the number of advanced practice providers in its primary care facilities, anticipating a 70% increase in care capacity for each APP added to physician-led teams.
Currently, Sentara has 132 APPs working in family medicine and internal medicine practices. The new initiative aims to double that number to 264, Steven Pearman, MD, vice president of Sentara Medical Group, told Becker's.
"My daughter is a physician assistant, so I've seen firsthand the challenges and benefits of this career path," Dr. Pearman said. "APPs are crucial to expanding primary care access and meeting the growing demand for healthcare services. It's vital to integrate them thoughtfully into the care team, leveraging their skills to improve outcomes and reduce burdens on physicians. A collaborative, team-based approach is the future of primary care."
Sentara is transitioning to a team-based care model in primary care.
"Instead of a 1-to-1 provider-to-patient relationship, patients will interact with a care team led by a physician and an APP," Dr. Pearman said. "Our extended care teams will include APPs, registered nurses, pharmacists, counselors, educators and care managers, all using Epic as a shared medical record."
The team-based approach will allow care teams to manage lower-complexity needs and provide bridging care for new patients awaiting their first primary care provider appointment. The model enables both physicians and APPs to practice at the top of their license in both primary and specialty care.
"Specialists often have to provide primary care-like services, which reduces their availability for acute or complex cases," Dr. Pearman said. "By shifting care to the ambulatory setting, we can manage a larger population with fewer inpatient services, ensuring our high-cost assets remain appropriately utilized."
APPs in primary care will manage about 1,100 patients annually, compared to 1,500 patients for physicians.
Most Sentara physicians have embraced the increased capacity and access APPs provide, though initial concerns were raised regarding legal exposure, training, compensation and a perceived loss of control over patient care.
"It's a cultural shift to recognize that delegating care responsibilities is essential for reducing burnout and improving outcomes," Dr. Pearman said. "APPs are viewed as colleagues, not 'helpers,' which fosters a professional environment."
To address these concerns, Sentara has enhanced its APP onboarding and mentorship programs and is transitioning to a compensation model in 2025 that balances base salary, quality metrics and productivity bonuses.
The system is also easing administrative burdens through centralized support for MyChart in-basket management, centralized medication renewals, ambient listening tools for documentation and streamlined form management.
"These changes have reduced administrative burdens and allowed physicians and APPs to focus on direct patient care," Dr. Pearman said. "Physicians in the pilot practices report feeling less overwhelmed and are able to leave work on time, which is a significant improvement."
Sentara has already begun hiring APPs, with a dedicated recruiting team in place. The health system offers competitive compensation and bonuses, flexibility and opportunities for APPs to practice at the top of their license.
To support its growing APP workforce, Sentara appointed Todd Roark, RN, as vice president of advanced practice professionals, along with two directors of advanced practice provider development.
Dr. Pearman shared six pieces of advice for systems looking to expand APP care:
- Create a culture: Educate stakeholders on the value of APPs and recognize them as professional colleagues.
- Define roles: Align APPs with organizational goals and clarify their scope of practice.
- Be flexible: Offer hybrid schedules and accommodate personal needs to attract and retain talent.
- Invest in training: Provide onboarding, mentorship and continuing education to support APPs' growth.
- Foster inclusion: Involve APPs in decision-making, governance and leadership opportunities.
- Utilize partnerships: Collaborate with academic institutions and training programs to develop a pipeline of skilled APPs.