Changing Multidisciplinary Care: Integration of Advanced Practice Clinicians in Neurology

Calli L. Cook, NP, DNP

With the disproportionate supply of neurology clinicians unable to meet the demands of patients, a proposed theory by Calli L. Cook, NP, DNP, and Heidi B. Schwarz, MD, may alleviate some of these issues. In a recently published editorial, the duo discussed utilizing and incorporating advanced practice clinicians (APCs) to create more efficient multidisciplinary care and help distribute the mounting responsibilities neurologists have.

To date, there has been reluctancy from both sides to create this change. For APCs, there is little to no exposure to neurology in training, making it less likely they would consider neurology for their career path. On the other hand, neurologists may be concerned about the onboarding process for an APC, as well as the costs associated with losing an APC should they decide to move on.

Despite these concerns, Cook, a nurse practitioner at the Woodruff School of Nursing at Emory University, believes that working towards a resolution can only be beneficial for the patient and their experience. Cook sat down with NeurologyLive to provide context for the editorial, as well as ways this change can be created going forward.

NeurologyLive: What motivated you to lay out this theory for APC integration?

Calli Cook, NP: There were 2 things that motivated me to write this. The first and most important is the patient. I believe the patient deserves the best possible care, and that is delivered through a team-based model. That by far is the number 1 driver of why I do anything. The second driver is that I believe in the role of a neuroscience APP. I believe it’s incredibly valuable and is a conduit for access. It’s a conduit to improve quality and to utilize a team-based model in an area of healthcare that oftentimes has long waits and significant delays for patients. It's a great opportunity for many APPs to look into neurology as a specialty they can call home, and to understand the value of their work and the need for them to practice in this space.

What advantages can APCs bring to the neurology space?

What they bring to the table is different experiences. In a high-functioning effective team, you want people who have different experiences and are exceptional at those different levels of care. When you hire a PA [physician’s assistant], you may be getting someone who has worked as an EMT or in an ambulance and has that experience that another person on the team doesn’t. When you hire an advanced practice nurse, you have those years of nursing experience and those clinical hours that roll into that person who can help with other things.

One of the pros of APPs is that we’re trained as generalists. If you’re taking care of a patient who has multiple sclerosis and they get a UTI, that person is going to feel very comfortable managing that UTI because they have done that before. They’re trained to provide those types of services. It’s not just neurology. From a nursing standpoint, we’re educated in patient safety, quality, and evidence-based practice. We can implement projects that are focused on how to improve the quality of care that the patient receives in the clinic, as well as improve that experience for the patient.

Where do the issues of reluctancy to utilize APCs stem from?

That’s the 1 thing I struggle to answer because I work in an environment with physician champions who support me, have fed into my practice, and how I have evolved as an APP. Sometimes I struggle to understand that. Anytime you say, ‘hey, we’re going to change. We’re going to practice in a team-based model of care. We’re going to do things differently.’ That’s difficult. No one likes change. Embracing that change can be difficult, but once you’re in that model, you see the benefits for your patients and your practice. That’s when you see the winds and value of hiring advanced practice providers.

Can you discuss the importance of building this change through education and starting from the ground up?

It all starts with this term called neurophobia. Unless you’re in neurology, you probably have a little bit of neurophobia. It’s scary. It seems overwhelming. Maybe you weren’t exposed a lot in your schoolwork or your training programs, but neurophobia still exists. The best way to dispel neurophobia is to bring people into the clinic with you. Be a preceptor. Let someone come and work with you whether that’s a PA or an advanced practice nurse. Let them be exposed to what things look like clinically because that’s when you change opinions and perceptions of what we do in neurology clinics.

The other thing is offering to give a lecture. A lot of folks do have neurophobia and may not be comfortable with these topics, so go to your local PA or PRN program and offer a lecture. I’m sure they would be happy to have the expertise that you would offer there. There are multiple ways to get involved, to enhance, or to showcase how wonderful it is to be in neurology and practice in this space.

Who must come to the table to create this change?

That is a very complicated question. But from my perspective, the starting point is really that the clinical administrators need to understand the value that APPs bring, and that they aren't someone who's just going to be answering phones and emails, and that they can provide a billable service, and they are revenue generators. I think that is the very, very first thing. The other thing is for our physician colleagues, who may not be as comfortable with APPs to understand what the training programs are like, and how they differ from a medical training program, and what those differences are, and how to utilize those differences, and create onboarding or training plans to make up for some of those limitations. That's the first thing and then I think, as APPs, we should understand own value and the value we bring to the table, and also really engage with folks who are ready to champion us. I've worked in a private practice, and I've worked in an academic health center, and I've encountered multiple physicians who have been nothing but wonderful to me, and have been champions, as I said, for my practice and my growth. Really finding those people and seeking out a culture that is based on the team, and making sure the patient has the best experience, those are some of the best things you can do to really grow APPs in neurology.

What type of long-term goals are you looking to achieve within this space?

We’re having very positive change and the American Academy of Neurology has been a huge proponent of that positive change by working to get products for APPs that are targeted to them to fill some of those educational gaps. That’s number 1. The second part of what I’d like to see is have more APPs call neurology home. I want more APPs to come to the specialty, be retained within the specialty, and understand the value they bring and feel the joy that I feel practicing in a neurology specialty. That’s my long-term goal; to grow the amount of people who are practicing, who want to take care of patients with neurological concerns and stay. It is not a vacation; it is a career as a neurology APP.

Transcript edited for clarity.