The Medical Staff and CMO: Working with Advanced Practice Providers

In addition to physicians, four other professions make up the medical staff of a hospital. Collectively known as advanced practice providers (APPs), they are physician assistants (newly coined physician associates), nurse practitioners, certified registered nurse anesthetists, and certified nurse midwives.

These four professions, while dissimilar, share a common role in the hospital setting: All APPs manage a patient’s care at some point during the patient’s treatment.

Unfortunately, opportunities for APPs to participate within the hospital typically are very limited or even nonexistent. Although not the case for every hospital or every APP, the majority of APPs are not afforded the full range of opportunities and privileges enjoyed by active, voting physician members of the medical staff. This includes me, a physician assistant with over 10 years of hospital experience as an emergency medicine provider.

I spent the first five years as a physician assistant in a small hospital in an urban setting. It was a great hospital and an excellent experience for a new physician assistant fresh out of school. Yet it was lacking something. At the time, I couldn’t tell you what it was, but I knew I wanted to be more involved with the hospital. I yearned to contribute at a higher level. I wanted to find a way to combine quality patient care with increased hospital involvement.

Something was missing in my need to be the best provider I could be. I craved the chance to lead and to mentor other APPs who also wanted to make a difference with patients, staff, and administration. At the time, that nice little hospital had whispers of APP involvement but never anything more than that.

As my career continued, I changed sites to be closer to home and to focus on my growing family. Luckily, one of the physicians I worked with found her way to my new hospital. She reached out to me about joining the emergency medicine team. It didn’t take much coercion.

The hospital is nestled in a county that is still considered more rural than suburban but is growing by leaps and bounds. As the only hospital in the county, we serve many communities, many generations of families. It is the community I call home.

ROAD TO LEADERSHIP

The first two years were great. It’s a fantastic emergency department. The staff is wonderful. The ancillary staff is amazing. The sense of hometown pride pulses through the hospital, and it shows. One thing remained the same: Non-clinical opportunities for APPs were not open to me. While APPs could attend the quarterly medical staff meetings and the various departmental meetings, that was the extent of the participation.

Then I got the email that changed the course of APPs’ non-clinical involvement forever.

My CMO sent an email to all of the APPs working in the hospital. His message was simple yet incredibly exciting. He was searching for APPs who were interested in being involved in the hospital, interested in helping him, the chief medical officer. He was forming an APP Advisory Committee.

This was the opportunity I was searching for, an opportunity to represent my fellow APPs and to make a difference. Of course, I had no idea what I was signing up for. I had no idea what kind of commitment this newly forming committee would require, but at the time I didn’t care.

Only one other APP expressed interest: a nurse midwife. We met with the CMO and he tasked us with engaging the APPs of the hospital. As we worked toward engaging the APPs, he discussed with the hospital bylaw committee and the Medical Executive Committee the idea of allowing an APP to attend the monthly MEC meetings as a member-at-large.

It was an elected position, so I started campaigning and won the position. As the first advanced practice provider to serve on the MEC at Carroll Hospital, I gave monthly APP updates.

My CMO continued to advocate for APP advancement. Again, he went to the bylaws committee, asking them to consider increasing APP participation among the medical staff. His asks were clear: bylaws voting privileges, the ability to chair hospital committees and being eligible to participate as treasurer of the Medical Executive Committee — one of the three officers in addition to president and vice president. The latter two positions were limited to physicians and continue to be. The only other position still reserved for physicians is that of department chair. I hope that one day, APPs are eligible for all medical staff leadership positions and offices.

I was also the first APP treasurer of the Medical Executive Committee. Over the course of a couple of years, the CMO has been able to engage APPs to participate in all the hospital committees. We are voting members of the hospital staff and pay dues.

My CMO also instituted the annual APP of the Year award. This award is bestowed upon a deserving APP at the annual Doctors Day celebration alongside the Physician of the Year. He also supports APP Week at the hospital — a week honoring the four professions that make up the title of advanced practice provider.

The CMO provided APPs with inclusion. He was able to give them something never offered at the hospital in its 61 years. He gave APPs a voice. He gave them the ability to be a part of the hospital and invoke positive change for the hospital, its providers, and its community.

QUALITY STAFF WITH QUALITY LEADERSHIP

The chief medical officer is a physician leader within the hospital. A person who represents the medical staff with the hospital administration. A leader who ensures development and retention of high-quality medical staff.

What makes a CMO stand out? The answer is not simple. It’s a carefully nuanced blueprint that cannot be exactly duplicated from one hospital to another.

Effective CMOs have a clear vision and plan to create a superior product. They know their constituents, recognize their potential, and give them the opportunity to achieve their greatest potential.

Exemplary CMOs aren’t afraid to make mistakes or ask for help. Their self-awareness bolsters the respect they receive from those around them. They are innovative, aware that the playbook that worked 10 years ago for a CMO most certainly isn’t going to work today.

Great CMOs recognize the needs of their hospitals, their medical staffs, and the communities they serve. CMOs who are aware are ready to innovate, keep an open mind, and lead by example. They recognize that workforce norms are changing, and advanced practice providers deserve a voice within an ever-changing healthcare system.

Excerpted from The Chief Medical Officer's Essential Guidebook by Mark D. Olszyk, MD, MBA, CPE.