Gastroenterology practices are hiring more advanced practice providers to cover the growing physician shortage, but many can’t keep them, according to a report from the American College of Gastroenterology’s Workforce of the Future Task Force.
The report was published Sept. 22 in a supplement to The American Journal of Gastroenterology. It found that practices often have no leadership structure, no GI-specific training and no clear career path for nurse practitioners and physician assistants. As a result, many APPs leave for other specialties or for industry jobs.
Here are 10 things to know:
1. Each APP brings a medical practice about $500,000 a year in net revenue on average. Much of that comes from APPs taking over clinic visits, which frees physicians to spend more time in the endoscopy suite. According to the report, practices can move up to 75% of returning patients to APPs.
2. The number of GI practices employing APPs rose 14.2% from 2008 to 2016.
3. APP turnover runs 10% to 12% a year nationally. Each departure costs $85,000 to $120,000 in recruitment, onboarding and lost productivity.
4. Only 64% of health systems have a designated APP leader to oversee recruitment, onboarding and team management. Forty-one percent rely on human resources to recruit APPs, compared with 19% for physicians.
5. SullivanCotter data cited in the report ties a dedicated APP leader to a 2% drop in turnover. That works out to more than $200,000 in savings for every 10 APPs employed.
6. GI competes for APPs with emergency medicine, surgery, orthopedics and other procedure-heavy specialties that often pay more. Industry employers are also hiring GI-trained APPs as medical science liaisons and for commercial roles, offering higher salaries and better work-life balance.
7. APP roles in GI vary widely from practice to practice. Some APPs see eight to 10 patients a day and others are asked to see more than 20. Some work with one supervising physician and others support 10 or more. The report said this lack of consistency makes GI jobs less appealing to candidates.
8. Payers typically reimburse APP visits at 85% of the physician rate, even for the same services. The task force wants payment parity for APPs working within their scope of practice.
9. Early exposure to GI is limited. PA programs usually offer only a few weeks of GI instruction and don’t require a GI rotation. NP programs often cap clinical hours in specialty practices at 40 to 80 hours, or don’t allow them at all.
10. The task force’s recommendations include:
- Formal APP leadership roles with protected administrative time
- GI-specific APP fellowships, backed by federal or GME-style funding
- Salary benchmarking against fair market value every one to two years
- Flexible schedules, such as four 10-hour shifts or hybrid telehealth
- Reform of restrictive noncompete clauses
- Faster credentialing across systems and states
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