Adding more Advanced Practice Providers isn't enough. Curi Advisory's Margaret Curtin explains how intentional physician-APP care team design improves productivity, reduces operational risk, and drives financial performance.
One of the biggest misconceptions I hear from healthcare leaders is that simply adding more Advanced Practice Providers (APPs) can improve patient access, productivity, and financial performance.
Over the past two decades, healthcare organizations have significantly expanded their use of APPs—nurse practitioners and physician assistants—as a direct response to growing physician shortages and increasing demand for care. Today, APPs represent a substantial portion of the clinical workforce, and their role is only expected to grow.
Yet despite this expansion, many organizations are not realizing the full value of these resources. In fact, some are experiencing the opposite: declining productivity and rising costs.
So what’s going wrong?
In my previous article, I explored the medical professional liability (MPL) risks associated with the growing use of APPs. Here, I'd like to focus on the next step: how thoughtful physician-APP care team design can unlock greater value while strengthening governance and reducing risk.
The other common narrative that has now started to emerge is that APP utilization leads to reduced productivity. However, I don't believe that's the right conclusion either. The issue is not the APP—it’s how care teams are structured.
Too often, I see organizations continue to deploy APPs based on historical staffing norms, physician preference, or fragmented operational decisions instead of intentionally designing care teams around patient needs and organizational goals.
The result?
Inconsistent staffing models
Unclear roles and responsibilities
Inefficient use of clinical resources
Rising labor costs without corresponding gains
When organizations experience declining productivity (measured in wRVUs per clinical FTE) despite increasing APP utilization, the root cause is usually misalignment—not capability.
I’ve seen two primary issues prevent organizations from realizing the full value of their physician-APP care teams:
1. Misaligned productivity and attribution models. In many cases, both physicians and APPs are credited for the same encounter, distorting productivity metrics and masking true performance.
2. Incentive structures that don't reinforce team-based care. Physicians are often incentivized on productivity, while APP costs sit with the system—creating a disconnect between effort, output, and financial accountability.
The result is a model that unintentionally rewards individual performance while discouraging optimal team-based care.
One of the most significant shifts I’m seeing among high-performing healthcare organizations is a move away from individual-centric models toward intentional, team-based design.
This starts with clearly defining roles.
Rather than asking, “Do we have enough APPs?” I encourage organizations to ask:
I’ve found that role clarity is foundational. Without it, variability increases, inefficiencies persist, and organizations struggle to fully realize the value of team-based care.
In my view, one of the most important lessons for healthcare leaders is that value is created through intentional care team design, not simply by increasing headcount.
The difference between inefficient and optimized care models can be significant, as illustrated below:
What changed?
Not staffing costs. Not patient demand. The difference was intentional deployment of clinical resources:
When organizations intentionally define responsibilities across the care team, they often improve both operational performance and provider satisfaction.
Even with better team design, many organizations remain constrained by outdated compensation models.
Today’s typical structure:
I believe compensation models should reinforce the behaviors organizations want to encourage. Not unintentionally discourage collaboration.
Forward-thinking organizations are addressing this by:
For healthcare executives, this conversation goes beyond operations. It’s a strategic opportunity.
From an enterprise risk management (ERM) perspective, I’ve seen poorly designed physician-APP models introduce operational, financial, workforce, and even MPL risk.
Poorly designed care teams can:
Well-designed teams can:
Organizations don’t need to redesign every care team overnight. The first step is understanding where opportunities for improvement exist.
When my Risk Consulting (ERC Risk Solutions) team and I work with healthcare organizations evaluating physician-APP models, we focus on five key areas:
These conversations and evaluations frequently uncover opportunities to improve efficiency, strengthen governance, and better align care deliver with organizational strategy.
APPs are essential to the future of healthcare delivery. We have seen that they offer a critical solution to workforce shortages and access challenges.
But their impact is not automatic.
I believe that organizations will only unlock the full value of APPs when they:
In my experience, organizations that intentionally integrate APPs into well-structured care teams don’t simply improve productivity. They also improve patient access, support safer care, reduce operational strain, and better position themselves for long-term success.
The future of healthcare delivery will increasingly depend on how effectively organizations balance workforce realities with strong clinical governance and risk management oversight.
At Curi Advisory, my ERC Risk Solutions team and I partner with healthcare organizations to evaluate APP integration models through an operational, ERM, and MPL risk lens. Together, we can identify opportunities to strengthen governance, optimize team performance, and build more resilient care delivery models.
Contact my team at risk.consulting@curi.com to learn more and get started today.
The content contained herein was generated by Curi Advisory with the assistance of an AI-based system to augment the effort.SHARE THIS POST