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What is an advanced practice provider (APP)?

Advanced practice providers are licensed medical practitioners that are either Physician Assistants or Advanced Practice Registered Nurses, such as nurse practitioners, nurse anesthetists and nurse midwives. All APPs undergo extensive medical education and credentialing to be able to diagnose illness, develop and manage treatment plans, prescribe medications, perform procedures and even publish clinical research. APPs work in every state and all specialties.

APPs adhere to the the same high-quality standards of care as physicians and contribute to making care more accessible and affordable. 

What kind of education, training and certification do APPs complete?

Nurse Practitioners typically start out as registered nurses and often have years of clinical experience in a nursing setting such as a hospital or outpatient clinic prior to enrolling in a nurse practitioner program. They also complete a bachelor's degree in nursing before going on to earn a master of nursing or doctor of nursing degree as a nurse practitioner. These graduate level programs range from 2-4 years and involve 500-1000 clinical hours. They must then meet state licensing requirements and pass a national certification exam in their specialty. In Michigan, NPs renew their license every two years by meeting the continuing education requirements of their credentialing organization.

Physician Assistants must have a bachelor's degree and clinical experience before entering a PA program. Applying to these programs is highly competitive.  Master's level programs range from 2-3 years with roughly 2,000 clinical hours. There are also doctoral programs and optional specialty resident programs. Once they graduate from an accredited PA program and pass the PA National certifying exam, they can apply for a state license. To maintain that license they complete 100 CME (continuing medical education) credits every 2 years and pass the PA national rectifying exam every 10 years.

What is the scope of practice for APPs in Michigan?

In Michigan, APPS are able to perform the same services as physicians with the exception of surgeries, and they can prescribe medications through a collaborating agreement with physicians.

Physician Assistants practice independently but collaborate with a physician. In many cases, they are the primary care provider for a panel of patients and in other cases they may provide specialty care. Working within the boundaries of the supervising physician's scope of practice, they can diagnose, treat and manage illnesses, prescribe medications, perform procedures and conduct clinical research.

APPs are increasingly assuming leadership roles within hospital systems across the county. MyMichigan has been a pioneer in involving APPs in senior leadership. Our dyad leadership model combines the clinical expertise of APPs and physicians with the business acumen of administrators to improve healthcare and the way it is delivered. So not only will you see APPS in clinics and hospitals, you will see them in boardrooms as well. 

What are the advantages of having advanced practice providers?

Having advanced practice providers in your area can increase your access to care by minimizing your travel time or wait time to see a provider, by offering you more one-on-one time for education and communication and by lowering the overall cost of care.

What can patients expect when they see an APP? 

Patients typically do not notice any difference between appointments and encounters with APPs versus physicians. The typical flow of a visit remains the same, with the patient reporting their symptoms or progress to the provider and the provider performing the necessary examination, evaluation and research to come up with a recommended plan of care. The provider may offer education, answer patients' questions, prescribe medications or testing, perform procedures, coordinate referrals to other specialists and follow up with the patient to ensure their goals are met. Patients who have an APP as their primary care provider often develop life-long trusting relationships with their provider.

What do the various credentials mean?

While APPs work across the full spectrum of specialties, here are some of the most common credentialing abbreviations you might see for advanced practice providers at MyMichigan Health:

  • Adult Nurse Practitioners and Adult-Gerontology Nurse Practitioners - These nurse practitioners specialize in caring for adults. Common credentials include ANP-C, ANP-BC, AG-ACNP, AG-PCNP,  AGPCNP-BC and ACNPC-AG. The different abbreviations reflect the various certification boards and whether the provider specializes in primary care or acute care
  • Family Nurse Practitioners - These nurse practitioners provide family-focused primary care for patients of all ages. Common credentials include CFNP, FNP-BC and FNP-C. Again, the main difference is the certifying board. FNP-C is provided by the American Academy of Nurse Practitioners (AANP) and FNP-BC is through the American Nurses Credentialing Center (ANCC)
  • Nurse Anesthetists - Certified registered nurse anesthetists (CRNAs) administer anesthesia to patients, typically during surgical, diagnostic, or obstetric procedures and are certified by the National Board of Certification and Re-certification for Nurse Anesthetists (NBCRNA)
  • Nurse Midwives - A licensed healthcare professional who specializes in women's reproductive health and childbirth. In addition to attending births, they perform annual exams, give counseling, and write prescriptions. Certified Nurse Midwives (CNM) are certified by the American College of Nurse-Midwives (ACNM).
  • Physician Assistants (PA-C) - PA's are generally certified, meaning they do not get certifications in a specific field of medicine. They are able to work in primary care or in any specialty, with their scope of practicing matching that of their collaborating physician. They are certified by the National Commission on Credentialing of Physician Assistants, or NCCPA.
  • Women's Health Care Nurse Practitioners (WHNP-BC) - These nurse practitioners specialize in obstetrics and gynecology but also provide primary care for women, including prevention, health education, prenatal care, contraceptive counseling and managing chronic conditions. They are certified by the National Certification Corporation (NCC).

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