Friday, June 28, 2019 | Ginger Biesbrock
A month ago, a very important question was posed on the MedAxiom member listserv: “How many hours a week should a full time APP work?” Now, this question comes up about every 6 months and there is definitely tension around the answer to this question. It’s a common issue that I see both administrators and APPs are dealing with. But I actually think that the question is deeper than just the number of hours. I believe that this tension comes from the difference between treating the APP team as a team of professionals versus as a team of shift workers. The difference lies in the expectations that go both ways. Expectations of administrative/physician leadership in the communication and oversight for APPs and expectations of the APPs in their responsibilities to patients and to the program in which they work. I promise I will get to the answer for how many hours should a full time APP work, but I want to start with an outline of what I think are reasonable expectations from both perspectives.
From my perspective, there are several key expectations of the leadership team that are required in order to have a healthy team-based environment where APPs grow, thrive and give back to the program.
Advanced Practice Providers
You are not off the hook as the expectations need to go both ways. Many of you have emerged into the world of professional from a previous role as a shift worker or hourly employee. The rules have changed.
So, back to the question at hand. How many hours are considered reasonable for a full-time APP? We put together a survey and had 61 responses to help answer that question and many others. The majority response was greater than 40 hours (see Figure 1). I typically recommend 45 hours on average with the caveat that if it creeps up to closer to 50 hours on average, then it’s time to think about a realignment of responsibilities or consider adding an additional APP to the team. In addition, the question of employee type was asked, and 97 percent answered that the APP role was an exempt role in their organization. Hence, the importance of understanding the expectation for both leadership and the APP in this professional relationship.
Finally, I have been thinking a lot lately about organizational health. I have worked in both healthy and unhealthy organizations. The health of an organization starts with expectations and any time those are not aligned there will be a struggle. That being said, there are so many challenges in our industry currently that alignment requires trust, communication, hard work and constant surveillance. When I work with organizations that are struggling, rarely do I find that the wrong people are in the roles but rather there is a misalignment of expectations. I appreciate you allowing me to go deep to answer a fairly easy question. As I stated when I started, if this is a hot topic in your organization, there may be a misalignment of expectations and I would start there as you look to come up with an answer that meets the needs of both the organization and its APPs.
Illustration: Lee Sauer
Ginger Biesbrock, PA-C, MPH, MPAS, AACC, is Executive Vice President, Care Transformation. She is a respected executive, provider and teacher with 20+ years of experience in the health care industry with a concentration in clinical care and operations. Before joining MedAxiom Consulting, Ginger was Director of Operations at West Michigan Heart, a 39 Physician practice with 24 mid-level provider. At West Michigan Heart, Ginger oversaw all operations for ambulatory services, tertiary care and rural health practices. Prior to that Ginger was the COO of the Cardiovascular Group at Centra-Health.
Her areas of consulting expertise include APP Utilization, Care Team Optimization and Transitions of Care.
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