APP Optimization & Implementation: Matt Bowles

<p>hello everyone this is Cole from the American Journal of healthc care strategy I'm joined today by a physician assistant who does some very special work in implementation and execution Matt Bulls Matt please introduce yourself okay hello everyone my name is Matt BS I'm a physician assistant I've been practicing for 20 years um over the past five years I've really become interested in AP implementation and utilization to the top of ap's [Music] license thank you so much for coming on we know that there is a growing number of advanced practice uh practitioners out there there's many of them right now you have Pas and nurse practitioners and there's a growing number because there's a physician shortage too at the same time time and so it's an area that we and our audience are are really needing to learn about I I first want to ask you know 20 years a along time to be practicing what first got you into this why did you decide to become a PA you kind of got into it before it was really popularized right right yeah so Cole I started my career after I graduated from undergrad with a biology and chemistry degree and was also involved in Emergency Medical Services I knew I wanted to do something in medicine and further my career so physician assistant kind of came across my path I was able to Shadow several physician assistance where I grew up and that kind of took off from there and I knew that was exactly what I wanted to do nice that's excellent and and what about the the shadowing kind of experiences and and what you saw interested you why did you actually want to be in healthc care at all what what Drew you to it yeah so Healthcare was always strong interest of mine um even growing up but the physician assistant profession really showed me that you didn't have to go to medical school to basically practice medicine and provide care and really you could be utilized in some underserved communities to kind of meet the needs of those you know patients excellent yeah and and it's a huge issue right now right the rural I mean medicine is that an area that you work in now I think we were talking about that earlier that you do some Cardiology work in those rural areas right right yeah so in Southwest Virginia I work in Salem which is a pretty populated area but our community spreads out even into the rural like less populated farming communities and you know really a rural practice wow and so is there a shortage of physicians in your area currently um there definitely is um we have trouble recruiting really in all Specialties I work for HCA which is a large multip specialty um practice and hospital system in Southwest Virginia um called Lewis Gale and we do have trouble recruiting in certain Specialties as well as primary care and it's really created a lot of opportunities for physician assistants and nurse practitioners to kind of take up in those areas and provide the care that is needed to those patients because hiring I think A cardiology PA right now right um we just hired one Cardiology pa um we have several other openings for Pas and nurse practitioners ranging from neurosurgery to general surgery to Primary Care to bariatric surgery your PA then you got to start looking in in the Virginia area with HCA that's awesome um very interesting and so you I guess I want to know how did you get into this area of imp mentation and also if you could just tell us what that means and then how you identify that as an area that you wanted to be involved with absolutely so probably going back seven or eight years ago the American Academy of physician assistant had kind of a subgroup that specialized in getting Pas involved in leadership actually up in the administrative level but still keeping their clinical responsibilities as well um so I really became interested in that and a couple couple other Pas and nurse practitioners that I was working with at the time um helped us kind of develop a leadership structure within our organization and we really took that and developed our own onboarding process and our own AP advisory Council that works with our Administration within Lewis Gale and it just kind of Grew From there um we found kind of a a blueprint that we developed that really became successful for creating onboarding programs for different specialty APS and it's just really proven to be good for Recruitment and Retention our job satisfaction is very high um so I just became very passionate about it at that point what did the difference look like before and after so what was the original onboarding program and then how did that differ from what you put into place yeah so traditionally 20 years ago um you would come in you'd get hired you'd have your traditional orientation to the health system or the practice depending on what size health system or practice you're working for you learn your computer system or your charting system and then really you get a day of shadowing or two days of shadowing in the practice and then they pretty much cut you loose and you started seeing patients with supervision and collaboration with the physician that you know as a PA you were working with with but you know in these days really we've developed a program where it's almost like a mini fellowship and it's become very successful to you know bring these APS in whether they be new graduates or have experience and it's kind of formed to fit them um what their situation is what specialty they work in um they get assigned an AP mentor and they basically learn the system of the practice and the health system and they develop their own kind of practice within that and they become comfortable and ramp up quicker and become more confident and efficient providers wow so it's actually faster than the old onboarding you may be seeing less patience but you become more productive in the same or shorter amount of time wow and then at the same time you're saying that the the staff retention has been increased yeah so we've proven and this is Across the Nation in you know small practices and even large health systems that if those APS are happy and they believe that the health system has you know invested in them or the practice has invested in them to help them become productive and confident providers then they'll stay with that practice for a long time and really the retention rates have been great so that's probably saving them money as well right because they don't have to maybe attract them with such humongous salaries or you know huge bonuses to keep them they could just you know maybe have a more reasonable salary and then also recruitment is really expensive right yeah exactly so um you know in that same note you know not only are they not having to offer huge sign on bonuses necessarily but their retention we know we all know that when you know a provider turns over it can cost hundreds of thousands of dollars in loss Revenue as well as recruitment efforts and just downtime in the practice of you know not being able to get patients in and get them seen um so it definitely you know is a benefit to the practice or the health system to keep those APS and retain them so after you implemented this at HCA right that were your one the one Clinic you know part that you were part of how did you said you've done this hundreds you know over around a hundred times since how did it start getting to that level we're a very large practice um so we've implemented it you know hundreds of times across our area in Southwest Virginia um I've also advised practices outside of our health system um to kind of guide them and help them Implement a very similar model dep depending on you know it can be molded to any practice size so whether you want to employ one a or you want to employ 50 APS depending on your size we can help you you know mold that to really be successful in your practice what are some of the challenges that a lot of these practices are seeing that you've helped them to overcome is it you know dealing with upper you know leadership or Administration is it you know getting the financial approval yeah so I think uh for first it's you know a lot of times it's recruitment so knowing how to recruit appropriately and you know developing some strategic plans to recruit APS you know do you know what you need do you want to hire new APS do you have the ability to train them and on board them appropriately or do you need to you know hire experienced APS would that be a better fit for your practice um so I think it really depends on the situation and so if a practice had not ever had APS before let's say it was you know three Physicians or four physics at a family practice that had been you know kind of just doing the the Motions for you know 5 10 years and then now they want to expand they want to increase their patient volume or you know whatnot take some load off the doctors how would that situation work introducing the new PA would you want to go more of the experienced route not necessarily um so that's that's a prime situation to bring an AP into the practice and you know utilize them appropriately what I found is that a lot of times Physicians are just not sure or they're afraid to kind of take that jump you know to hire an AP and they don't really know what they need until we actually discuss it why why are they afraid to to do that is there a question of how much uh AP can do there is and you know there's certainly regulation that go along with that and you want to make sure that you're kind of following all the steps that need to be put into place you know to make sure that you're meeting all the individual state regulations and scope of practice and practice guidelines so sometimes there's definitely a lot of questions out there um that need to be answered and you know make things flow smoothly so you're involved with the Virginia Academy of physician assistant right you recently got elected to the board there yes so I did recently get elected for the next two years as a director at large for the Virginia Academy of physician assistant so I think that will even help get a larger scope you know into the Pas in Virginia and with that knowledge that you have right because you're involved with these regulations and the legislation that's going on are you seeing situations where the aps that this Clinic has had right let's say you have a clinic they've been using APS for a while are they sometimes underutilized definitely yeah so we've been able to really increase the utilization of some APS Within These clinics you know sometimes they're not seeing the optimal amount of or patients in the clinic or they're you know being utilized incorrectly for after hours Hall um so you can kind of fine-tune their scope and really help be more productive but also help take more load off of some of the other providers like the Physicians and other APS in the practice so are we seeing good pretty good Financial returns off of that what is do you have any idea on what the savings are or the increase in revenue is usually from implementing these individuals definitely so with proper utiliz I mean you could see you know Revenue in the $100,000 range you know if you've got an AP that's not being utilized properly or being underutilized um and they're only seeing five or six patients a day um and then you kind of optimize that implementation or utilization um you can really see that come out and you know triple fold in Revenue why would why would they only be seeing five or six patient a day what would be causing that um there there's different things sometimes there's just kind of mismanagement um sometimes like I said earlier they weren't onboarded correctly so they just need to kind of be reoriented and you know set some realistic goals and expectations within the practice and you know really develop their scope of practice and try to get them to the top of their license well and so I want to talk about that too and Virginia right where I go to a family practice and I see a PA how how much can they do on their own and how much you know what does that look like because a lot of people do not understand or know what the top of the license means yeah so APS uh physician assistants and nurse practitioners alike um can treat you in your primary care office um The Physician oversight is really just a collaboration you know if needed you know typically APS that operate at the top of their license um use that is like a backup so if they feel like they're you know above their head or there's an illness going on that needs to be managed better then they can always ask questions of their collaborating physician in the state of Virginia now um nurse practitioners can actually become independent so after three years of full-time practice practice they can become independent in their field um there's other states that nurse practitioners when they graduate they're fully independent so once they pass their boards um physician assistants right now still require collaboration with a physician um but really it is a situation where the aps can treat those patients and really be utilized you know in a way to meet the patient needs how many collaborators can a physician have attached to their license so let's say I was you know in my family practice I'm getting into my late 50s right and I you know or late 60s and I or early 60s and I can't handle as much you know as I used to how many Pas or and you know nurse practitioners can I bring on to collaborate with me yeah it really varies State tostate Cole um some break it down on how many nurse practitioners can you have you know collaborating how many physician assistants some lump them together you know but in most States I would say it would average between four and six and how about Virginia uh Virginia is six okay so I could essentially six times my my volume right if or or and it would really lessen the work off of me a lot if I'm if I have a family practice Yeah and typically you can definitely increase your volume I would maybe maybe not say times six you know yourself but there A lot of times we like for the aps to spend a little more time with the patients and you know really have time to you know sit down and talk to the patient and spend that extra time to make that connection so you'll find that in a lot of practices you know if the physician is on like a 15minute time slot schedule per patient the AP is may be more like 20 or 30 minutes per patient so it's increasing the quality of care a lot of ways too them absolutely so not only are you're increasing your volume but you're increasing your quality of care and really that's you know benefit to the patient and the practice and is that because it's more affordable is that why we're able to do that 30 minute yeah absolutely you know ap's salaries are not what physician salaries are and they shouldn't be you know I mean Physicians go to school for a really long time and have specialized education um so AP are typically more cost effective and provide care more efficiently wow that's very interesting and so how does that differ in in the specialty World versus Primary Care is it still 30 minutes usually in the Specialties or is there even longer appointments and Specialties no I think it really depends on which specialty you go to um so some Specialties like hand surgery you may be seeing a large volume of just posttop care um so patients that are coming in after surgery that may only be like a 10-minute visit because you're just in there real quick checking the incision making sure the patient not have any problems and that everything healed up okay um if you're doing women's health or any type of you know really Specialized Care you may actually be spending 45 minutes or an hour with each patient and so it really requires a customized approach and that's part of what you do right is you go into these clinics you talk with them and you formulate this unique plan absolutely yeah so really depending on the specialty you know from primary care all the way to bariatric surgery neurosurgery hand surgery um Women's Health we really can mold a program to fit you know that specialty and that particular practice that is really cool I I appreciate you coming on and sharing this with us it's a very interesting kind of world of AP implementation and I hope that we kind of continue to do this it sounds like it's it's going to make care more accessible but also cheaper so that's awesome yeah it really has been great and it's really been a passion of mine to really get into the world of a on boarding and implementation and utilization and I think you'll see that you know over the next coming years it's going to continue to grow and grow so we're gonna you know link you down below we're going to have you of course on the LinkedIn page here we encourage people to reach out to you or to use the link to look for the services and uh get some advice as well hopefully uh you know lots of people will be interested and we'll be able to increase the amount of APS and the efficiency of the clinics I look forward to it</p>