Abstracts

Rationale:
Advanced Practice Providers (APPs) are potential solutions to providing quality health care access in the United States. AAN and Epilepsy Currents have published consensus statements about potential APP use, but both recognized that there is a knowledge gap about the current scope and function of APPs in neurology practices. Due to this, we analyzed our APP group at Children’s Hospital Colorado (CHCO) to provide insight that could help optimize APPs

14 years ago, the neurology practice at CHCO included 100% staffing outpatient clinic model, no APPs performed procedures and no APP’s were incorporated into the inpatient (IP) neurology consult service. Subsequently practices expanded to have independent clinics, APP’s are credentialed to perform independent procedures and APP’s now provide 7 day per week IP coverage. This model is effective in terms of APP satisfaction outcomes, patient satisfaction, RVU productivity, scope and independence




Methods: A 26-question survey was administered to neurology APPs. The patient family experience department provided satisfaction metrics and the medical staff contributed information on credentialing. The neurology business manager provided information on FTE, faculty and RVU’s.


Results: We have 22 neurology APP’s ( 6 PA’s and 16 NPs).  There are 35 child neurologists for a ratio of 1.6:1 . The average APP years of experience is 11. Our APP’s average 11 years as APP’s and on average, 8 (72%) of those years have been in their current position.

The mean RVU expectation for neurologists in our section is 3689 and the mean achieved RVU is 2838, which is 30% short of goal. The average RVU expectation for APPs in our section is 1675. The mean clinical RVU achieved is 1776, - 6% above goal.

Ten MD’s (28%) and six (27%) carry leadership roles

Of APPs surveyed, 100% reported outpatient clinic independence. 90% of respondents reported >50% of patients seen inpatient are done entirely independently. 47% reported co-authoring journal articles and 47% report giving didactic lectures to physician learners.

Outpatient clinic patient satisfaction data published for 2023 at CHCO showed scores of 88.2% for child neurologists and 91.7% for APPs.

27% of child neurologists and 14% of APP’s are credentialed for lumbar punctures. 19% of both APP’s and child neurologists are credentialed for botox. 13% of child neurologists and 28% of APP’s are credentialed for Trigger point.

Survey results:

I expect if I am practicing in three years, it will be this institution: yes MD: 63%, yes APP: 81%

I have adequate input into decisions that affect how I practice: yes MD: 45%, yes APP 62.5%

I would stay here if offered similar job elsewhere: yes MD 50%, yes APP: 75%


Conclusions: APPs in child neurology at CHCO now have a broad scope that includes procedures, clinic and inpatient independence. APPs at CHCO also engage in resident teaching, scholarly work, research and leadership positions. Credentialing numbers and patient satisfaction scores are similar between APPs and MDs. APPs are slightly exceeding RVU goal while MDs are on average not meeting their goal. APPs outperform in job satisfaction scores compared to child neurology peers


Funding: none