Background: Staffing of inpatient medicine services with Advanced Practice Providers (APPs), including physician assistants and nurse practitioners, is becoming increasingly common at academic medical centers across the United States. The various roles filled by APPs have not been well-described in the literature. The purpose of this study is to better characterize how APPs are utilized and to summarize perceptions of APP contributions to inpatient general medicine teams at academic medical centers.

Methods: We performed a survey of hospital medicine programs at academic medical centers in the United States affiliated with the Hospital Medicine Reengineering Network (HOMERuN), a hospital medicine research collaborative. Questions regarding different APP roles were multiple choice. Questions that rated APP contributions were on a 1-5 Likert scale. Surveys were distributed via email to chiefs and/or senior leaders of unique hospitalist groups between January and August 2019. Responses to questions are reported as numbers and proportions or means as appropriate.

Results: We received responses from representatives of 43 hospital medicine groups from 86 invitees (50%). Thirty-four (79.1%) programs employ APPs. Respondents stated APPs perform a wide range of roles (Figure 1) and practice independently for at least some patients in 15 of these programs (44.1%). Most programs (18, 52.9%) reported hiring APPs who did not receive training at a hospital-specific training program. Respondents reported that APPs are involved with clinical operations/administration at 29 (85.3%) and teaching at 15 (44.1%) programs; they are eligible for faculty positions at 11 (32.4%) medical centers. The following were rated of highest importance in deciding to hire APPs: to allow physicians to focus on “higher level” activities (mean=4.2), increase efficiency (mean=4.4), and decrease physician burnout (mean=4.1). APPs were considered beneficial for the quality of patient care (mean=3.8), quantity of patients that could be seen (mean=3.9), and physician retention (mean=3.7) (Figure 2). Challenges to having APPs were rated of only moderate importance, with training requirements and support for new hires (mean=3.4) and less flexibility in number of hours (mean=3.2) having the highest ratings.

Conclusions: In this survey of hospitalist groups at academic medical centers across the U.S., we found that the majority employed APPs. APPs performed a variety of roles, though there was significant heterogeneity across sites. The presence of APPs was generally considered beneficial to hospitalist groups. As APPs become increasingly integrated into inpatient medicine teams, hospitalist groups may consider which roles for APPs are of greatest benefit. There may be a role for standardized training programs in hospital medicine for APPs. Additional research is needed to better elucidate the contribution of APPs to clinical outcomes, cost, physician and patient satisfaction.

IMAGE 1: Figure 1: Rolls/Tasks Performed by APPs

IMAGE 2: Figure 2: Rating of benefit to having APPs on hospitalist teams