At Summit Health, there are many members of the health care team. Physicians and registered nurses are the most familiar roles. But you have probably also heard about—and maybe even have scheduled an appointment with—one of our advanced practice providers (APPs). There are two types of APPs: physician assistants (PAs) and advanced practice nurses (APNs).

APPs are essential to the patient-centered care model at Summit Health. Approximately 130 PAs and APNs work in every specialty throughout the Summit Health system. As Summit Health has expanded, its leadership has continued to recognize the importance of PAs and APNs and support their growth as valued members of the health care team.

What does a physician assistant do?

“PAs are licensed clinicians trained to practice medicine in every specialty. They evaluate, diagnose, and treat patients,” explains Lauren Soroka, PA-C, Lead PA on the Orthopedics and Sports Medicine team. “PAs function alongside physicians in a team-based approach to health care. We do not replace the role of a physician but rather function to expand patient access to quality health care.”

The role of a PA can vary greatly depending on the specialty. For example, the PA may be the only clinician a patient needs to see for primary care or gynecology. By contrast, a PA and a surgeon would work together to co-manage patients in a surgical specialty like orthopedics.

“In my world of orthopedic surgery, I see patients independently in the office, but it is the physician who ultimately performs the surgery with a PA as the first assistant,” says Ms. Soroka. “In my specific role, I see new patients, assist in the operating room, am responsible for follow-up during the first 90 days after surgery, answer clinical questions, and administer shoulder and knee injections.”

What does an advanced practice nurse do?

APNs are licensed registered nurses trained to make diagnoses and manage and prescribe treatments for patients. Nurse practitioners (NPs) are classified as APNs, as are certified registered nurse anesthetists, certified nurse-midwives, and clinical nurse specialists.

Like PAs, APNs provide a wide range of health care services in collaboration with other members of the health care team. They can:

• Obtain patient histories and perform physical exams
• Diagnose and manage various acute and chronic conditions
• Order tests and interpret results
• Develop and implement treatment plans
• Prescribe medications
• Perform minor procedures
• Serve as primary care providers

In addition, APPs are responsible and accountable for health promotion, disease prevention, and health education to promote wellness.

Patients often view PAs and APNs interchangeably, but there are some differences in national board certification requirements and patient population focus.

“The educational focus between the two types of advanced care providers varies slightly,” Ms. Soroka explains. “APNs are often drawn to medical specialties like family practice while PAs gravitate heavily to surgery; however, both types of providers are equally capable in any role.”

Training and Education

PAs are trained in a similar medical model to physicians, but they are taught at a master’s degree level and can pursue a doctoral  degree. PA school is two to three years—half of that time is spent in the classroom and the other half in clinical rotations of various medical and surgical specialties.

Meanwhile, to become an APN, one must be a registered nurse and receive a graduate master’s or doctoral nursing degree from an accredited APN program. Depending on the graduate degree, APNs must have 650 to 1,000 clinical hours.

After graduation, PAs take the Physician Assistant National Certifying Exam (PANCE) to obtain certification and then obtain state licensure. PAs must have at least 2,000 hours of clinical training, and they continue to learn from physician mentors once they begin on-the-job training. Additionally, PAs continue to train throughout their careers, completing 100 hours of continuing medical education every two years and take a recertification exam every 10 years.

APNs must pass a national board certification exam after graduation and before obtaining a state license. APNs choose their patient population focus when they enter their graduate program, and their national board certification exam is specific to their selected population. In addition to the core knowledge and skills assessment all APN candidates prepare for, they choose to focus in:

• Adult-gerontology acute or primary care
• Family care
• Neonatal care
• Pediatric care
• Psychiatric mental health care
• Women’s health

Like physicians, both APNs and PAs must maintain continuing education and board certification.

Depending on their population focus, APNs pursue recertification every one to five years. They must also complete 100 hours of continuing education every one to five years per their national board certification requirement and the continuing education hours required by their state.

Ms. Soroka says the best thing about a PA education is that the training is generalized. Unlike physicians, PAs do not have to choose a medical discipline while in school. Instead, they gravitate toward a particular specialty once they start working.

“Throughout your career, you have the freedom to change and explore different fields,” she explains. “I started out in the emergency department because I liked the variety of patient encounters and ability to use my hands to do things such as suture or splint. Eventually, I realized my favorite part of work was the orthopedic patients, so I took a job in orthopedic surgery about four years ago.”

The Advantages of Having Advanced Practice Providers

Advanced practice providers are uniquely qualified members of a team committed to delivering comprehensive and coordinated care.

There are some distinct advantages to seeing a PA or APN. Generally, they expand access to care with more appointment availability and longer visit times in some cases. In addition to expanding and expediting care, PAs and APNs support team-based care by:

• Collaborating with physicians to deliver optimal, timely, high-quality care
• Coordinating care with other team members
• Completing health care management
• Connecting patients to other medical specialties and services
• Developing meaningful, lasting relationships over time

“I absolutely love my job,” says Ms. Soroka, who has been a PA for seven years. “I have a great relationship with the surgeon I work for. He has been my mentor, my colleague, and now my friend. I am challenged and rewarded every day seeing patients in the office and improving my technical skills in the operating room.”