Member Spotlight: Growing TEAM MEDICINE: A Program for Nurturing Advanced Practice Providers at Vancouver Clinic

Known for compassionate, skilled care with a strong focus on patient-provider communication, Advanced Practice Providers (APPs) are vital members of many modern healthcare organizations. 

As the need for patient-centered healthcare continues to grow, smart healthcare organizations are snapping up newly minted APPs to meet growing demand.
Healthcare organizations that understand how to attract and support APPs will be poised to better serve their communities, says Mark Mantei, CEO of Vancouver Clinic, where around a third of the staff (currently numbering around 350) are APPs. “In the last five years, the number of APPs we employ has grown by around 30 percent,” Mantei says. “We now have about 120—around a third of our providers. This includes audiologists, physical therapists, nurse practitioners, physician assistants, and midwives.”

Mantei stresses that building a robust roster of APPs didn’t happen by accident. “We’ve been very deliberate about attracting more APPs,” he says. A vital component of this effort was the launch of Team Medicine, Vancouver Clinic’s two-year development program that provides supervision and professional-development opportunities for APPs while gradually increasing autonomy. The program’s goal is to help APPs grow in a supported clinical environment as they build their own practices and panels of patients. 

In this interview, Mantei describes the program’s background, design, and results in greater depth.

How does Vancouver Clinic support strong engagement between APPs, administrators, and board members?
As the clinic hired more APPs, we recognized that they wanted a stronger voice in our group. Together with our chief medical officer, I met with as many APPs as I could. We encouraged them to form a council to give them formal input to our board and medical director. Our APPs play a critical role here, and they have a lot of input on how we run the clinic. Our goal is to train practitioners to work at the level of their training and work collaboratively with other providers to deliver the best care, and we know that APPs have a significant role to play there.

When did you recognize the need for a program like Team Medicine?
With the shortage of physicians both locally and nationally, we knew this would be a critical need for us. So a few years ago, we became more focused about attracting and supporting APPs in order to continue to meet primarycare needs in our community. Two and a half years ago we launched Team Medicine, a development program for newly graduated physician assistants and nurse practitioners built on a “residency program” model. Team Medicine allows providers to work directly with a supervising physician.

“Our main goal is to remain a strong, independent presence in the Pacific Northwest, providing lower-cost, higher-quality care and continuing to expand our geographic reach and availability to patients.”

Mark Mantei, CEO
Vancouver Clinic
Vancouver, Washington

How does Team Medicine provide APPs with both mentorship and autonomy?
When new nurse practitioners and physician assistants join the program, they’ll join a small group in either internal medicine or family medicine, with a ratio of around four or five APPs to one physician. In addition to taking part in patient care, they meet regularly for additional education and training. They have consistent access to their supervising physician for questions, but they perform patient-care responsibilities in-clinic. Their employment contracts look very similar to those of our physician staff. They’re building their own practice and panel with the guidance and support of a healthcare organization around them.

How has this effort paid off?
The program is still new—we just graduated our first nurse practitioner this year. Overall, the progression and growth we’ve seen through the program has shown that this model works. As of now, Team Medicine is fully enrolled and in high demand. 
Overwhelmingly, our work to attract and support APPs has been beneficial to the clinic, our providers, and our patients. With Team Medicine, bringing in APPs who can serve primary-care needs has allowed us to help meet the growing need for primary care more effectively.

Bringing more APPs into the ranks has expanded the clinic’s reach without increasing costs. We’re always looking to improve value in healthcare, and if you can look at ways that APPS can contribute to value, they can actually lower costs. This is what we found in some high-demand specialties like obstetrics and gynecology, where we were experiencing high demand in our community. Bringing in midwives to provide care, in particular through our Centering Pregnancy group-prenatal-care program, has expanded access to care, relieved the strain on our OB-GYNs, and created positive outcomes for both providers and patients.

At Vancouver Clinic, we view APPs as part of our care system. Patients are in great hands with our APPs because they’re trained, supported, and encouraged to ask questions of specialty experts. We’ve put a lot of effort into making this a comfortable place for all types of providers to practice, and we’re seeing positive results in the clinic and in the communities we serve.